Localized clotted blood as evidence of visceral trauma on CT: the sentinel clot sign.
We retrospectively reviewed the CT scans of 116 patients with abdominal trauma who had visceral injuries to determine if identification on CT of focal high-density clotted blood (a "sentinel clot") was an accurate sign of injury to an adjacent organ. The sentinel clot sign was sensitive, present in 101 (84%) of 120 visceral injuries with only three false-positive cases. Whereas CT visualized the visceral injury itself in 86% of cases, the sentinel clot was the only clue as to the source of hemorrhage in 14% of the cases. Splenic and bowel/mesenteric injuries were frequently subtle, and the focal clot helped to focus attention on the traumatic lesion. In 9% of splenic trauma cases and 32% of bowel/mesenteric injuries, the sentinel clot was the only positive finding. Localized clot is a frequent and accurate sign of injury to an adjacent organ. By facilitating diagnosis of trauma to a specific organ, it may influence the management decision of surgical vs conservative therapy.
Department of Radiology, University of California, San Francisco General Hospital 94110.
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D
Orwig
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MP
Federle
D000007:Abdominal Injuries / Q000000981:diagnostic imaging; D006406:Hematoma / Q000000981:diagnostic imaging; D006465:Hemoperitoneum / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014781:Viscera / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging