Intra-abdominal Solid Organ Injuries: An Enhanced Management Algorithm

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Intra-abdominal Solid Organ Injuries: An Enhanced Management Algorithm Nima Kokabi, MD, Waqas Shuaib, MD, Minzhi Xing, MD, Elie Harmouche, MD, Kenneth Wilson, MD, Jamlik-Omari Johnson, MD, Faisal Khosa, MD Canadian Association of Radiologists Journal Volume 65, Issue 4, Pages 301-309 (November 2014) DOI: 10.1016/j.carj.2013.12.003 Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 1 Splenic injuries. (A) Grade I, 1-cm parenchymal laceration (black arrow). (B) Grade II, 2.5-cm parenchymal tear that does not involve trabecular vessel (white arrow); perisplenic hematoma (star). (C) Grade III, parenchymal laceration >3 cm (white arrow). (D) Grade IV, laceration that involves hilar vessels that causes >25% devascularization; grade III liver injury (white arrow); grade III hepatic injury demonstrated (black arrow) (E) Grade V, almost completely shattered spleen, large hemoperitoneum (star). A shattered spleen was found during surgery. Canadian Association of Radiologists Journal 2014 65, 301-309DOI: (10.1016/j.carj.2013.12.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 2 Splenic injuries. (A, C) Axial and coronal views of a grade III subcapsular hematoma with active extravasation (arrows) and small hemoperitoneum (stars). (B, D) In a different patient, demonstrating grade II splenic injury with active extravasations (arrows). Both injuries were successfully managed with intra-arterial embolization. Canadian Association of Radiologists Journal 2014 65, 301-309DOI: (10.1016/j.carj.2013.12.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 3 Proposed management algorithm for splenic injuries in blunt abdominal trauma. Canadian Association of Radiologists Journal 2014 65, 301-309DOI: (10.1016/j.carj.2013.12.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 4 Liver injuries. (A) Grade I, subscapular hematoma <1 cm and <10% of surface area (white arrow). (B) Grade II, intraparenchymal hematoma <10 cm (black arrow). (C) Grade III, 5-cm parenchymal laceration (white arrow). (D) Grade IV, parenchymal disruption of segments 5 and 8, and approximately 25% of liver parenchyma (white arrow) and small subcapsular hematoma (star). (E) Grade V, parenchymal disruption of >75% of the right hepatic lobe. Canadian Association of Radiologists Journal 2014 65, 301-309DOI: (10.1016/j.carj.2013.12.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 5 Liver injuries. (A, B) Axial and sagittal views of a grade II liver injury with active extravasation (arrows). (C-E) Two axials and 1 coronal view of grade II hepatic extravasations (arrows). Both injuries were successfully managed with intra-arterial embolization. Canadian Association of Radiologists Journal 2014 65, 301-309DOI: (10.1016/j.carj.2013.12.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 6 Proposed management algorithm for liver injuries in blunt abdominal trauma. Canadian Association of Radiologists Journal 2014 65, 301-309DOI: (10.1016/j.carj.2013.12.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 7 Renal injuries. (A) Grade I, <1-cm subcapsular hematoma (white arrow). (B) Grade II, approximately 1-cm cortical laceration (white arrow). (C) Grade III, 4-cm parenchymal laceration without collecting-system injury (white arrow), perirenal hematoma (star). (D) Grade IV, traumatic right renal artery transection and/or injury that caused devitalization of approximately 75% of the right kidney parenchyma (black arrow). (E) Grade V, avulsion of left renal hilum and complete devascularization of the left kidney (white arrow). Canadian Association of Radiologists Journal 2014 65, 301-309DOI: (10.1016/j.carj.2013.12.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 8 Proposed management algorithm for renal injuries in blunt abdominal trauma. Canadian Association of Radiologists Journal 2014 65, 301-309DOI: (10.1016/j.carj.2013.12.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 9 Pancreatic injuries. (A) Grade I, small contusion with no duct injury (arrow). (B) Grade III, distal transection without definite duct injury (arrow). (C) Grade IV, proximal transection and probable involvement of ampulla (arrow). Canadian Association of Radiologists Journal 2014 65, 301-309DOI: (10.1016/j.carj.2013.12.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 10 Pancreatic injuries. (A) Grade II, major size contusion without duct injury (arrow). (B) Grade II, diffuse pancreatic contusion and/or oedema without definite duct injury (arrow). Canadian Association of Radiologists Journal 2014 65, 301-309DOI: (10.1016/j.carj.2013.12.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 11 Proposed management algorithm for pancreatic injuries in blunt abdominal trauma. Canadian Association of Radiologists Journal 2014 65, 301-309DOI: (10.1016/j.carj.2013.12.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions