A 18y/old male with abdominal trauma by car accident



Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Mirhadi Razavian


Case Section

Abdominal Imaging


Patient's Information

Gender : Male
Age : 18


Clinical Summary

A 18y/old male with abdominal trauma by car accident


Imaging Findings

CT demonstrates ruptures of segments of 4a ,4b,6 and caudate lobe of liver .also demonstrates hematoma in periphery of gall bladder and into the gall bladder.also demonstrates rupture of cortex of right kidney


Differential Diagnosis



Final Diagnosis

Ruptures of liver , gall bladder and right kidney


Discussion (Related Text)

Abdominal trauma is an injury to the abdomen. It may be blunt or penetrating and may involve damage to the abdominal organs. Signs and symptoms include abdominal pain, tenderness, rigidity, and bruising of the external abdomen. Abdominal trauma presents a risk of severe blood loss and infection. Diagnosis may involve ultrasonography, computed tomography, and peritoneal lavage. Injury to the lower chest may cause splenic or liver injuries.[2] Pneumoperitoneum, air or gas in the abdominal cavity, may be an indication of rupture of a hollow organ. In penetrating injuries, an evisceration (protrusion of internal organs out of a wound) may be present.[7]
Injuries associated with intra-abdominal trauma include rib fractures, vertebral fractures, pelvic fractures, and injuries to the abdominal wall.[8]
Presentation Cause: Hemorrhage. Liver / spleen rupture, Hematuria. Kidney, bladder, ureter injury, Back pain. Injury to retroperitoneum , Peritonitis. Injury hollow viscus , Respiratory. Pneumothorax.
The liver, the most vulnerable abdominal organ to all forms of injury because of its size and location (in the upper right quadrant of the abdomen), is injured in about five percent of all people admitted to a hospital for trauma.[11] Liver injuries present a serious risk for shock because the liver tissue is delicate and has a large blood supply and capacity.[10] In children, the liver is the most commonly injured abdominal organ.[12] The liver may be lacerated or contused, and a hematoma may develop.
Spleen is the most common damaged organ in blunt abdominal trauma. The spleen is the second most commonly injured intra-abdominal organ in children.[12] A laceration of the spleen may be associated with hematoma.
The pancreas may be injured in abdominal trauma, for example by laceration or contusion.[5] Pancreatic injuries, most commonly caused by bicycle accidents (especially by impact with the handlebars) in children and vehicular accidents in adults, usually occur in isolation in children and accompanied by other injuries in adults.
The kidneys may also be injured; they are somewhat but not completely protected by the ribs.[.
The small intestine takes up a large part of the abdomen and is likely to be damaged in penetrating injury.[3] The bowel may be perforated.[5] Gas within the abdominal cavity seen on CT is understood to be a diagnostic sign of bowel perforation; however intra-abdominal air can also be caused by pneumothorax (air in the pleural cavity outside the lungs that has escaped from the respiratory system) or pneumomediastinum (air in the mediastinum, the center of the chest cavity).
One study found that ten percent of polytrauma patients who had no clinical signs of abdominal injury did have evidence of the such injuries using radiological imaging.[1] Diagnostic techniques used include CT scanning, ultrasound,[1] and X-ray.[4] X-ray can help determine the path of a penetrating object and locate any foreign matter left in the wound, bu



1. ^ Jump up to: a b c d e f g h i j k Jansen JO, Yule SR, Loudon MA (April 2008). "Investigation of blunt abdominal trauma". BMJ 336 (7650): 938–42. doi:10.1136/bmj.39534.686192.80. PMC 2335258. PMID 18436949.
2. Jump up ^ Wyatt, Jonathon; Illingworth, RN. Graham, CA. Clancy, MJ. Robertson, CE (2006). Oxford Handbook of Emergency Medicine. Oxford University Press. p. 346. ISBN 978-0-19-920607-0.
3. ^ Jump up to: a b c d e f g h i j k l m Hemmila MR, Wahl WL (2005). "Management of the Injured Patient". In Doherty GM. Current Surgical Diagnosis and Treatment. McGraw-Hill Medical. pp. 227–8. ISBN 0-07-142315-X. Retrieved 2008-06-21.
4. ^ Jump up to: a b c d e f g h i Yeo A (2004). "Abdominal trauma". In Chih HN, Ooi LL. Acute Surgical Management. World Scientific Publishing Company. pp. 327–33. ISBN 981-238-681-5. Retrieved 2008-06-21.
5. ^ Jump up to: a b c d e f g h i j k l m n o p q r s Bixby SD, Callahan MJ, Taylor GA (January 2008). "Imaging in pediatric blunt abdominal trauma". Semin Roentgenol 43 (1): 72–82. doi:10.1053/j.ro.2007.08.009. PMID 18053830.
6. ^ Jump up to: a b c Lichtenstein R, Suggs AH (2006). "Child abuse/assault". In Olshaker JS, Jackson MC, Smock WS. Forensic Emergency Medicine: Mechanisms and Clinical Management (Board Review Series). Hagerstown, MD: Lippincott Williams & Wilkins. pp. 157–9. ISBN 0-7817-9274-6. Retrieved 2008-06-21.


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