Ultrasonography for interval assessment in the nonoperative management of hepatic trauma.
Abdominal ultrasonography (US) is gaining widespread acceptance as a valuable diagnostic tool in the initial evaluation of trauma victims. We investigated the utility of US as a follow-up radiologic study in nonoperative hepatic trauma. Patients with liver injury designated for nonoperative management were prospectively studied over a 2-year period at our primary adult resource center for trauma. Computed tomography (CT) and radiologist-performed US were obtained at admission and at 1 week. The ability of US to detect lesions, fluid, and complications was evaluated by comparing with the corresponding CT. Twenty-five hepatic trauma patients in the study were successfully managed nonoperatively and had both initial and follow-up US and CT scans: 1 (4%) grade I, 5 (20%) grade II, 7 (28%) grade III, 7 (28%) grade IV, and 5 (20%) grade V. Four complications developed [biloma (3) and biliary fistula (1)] in 3 patients with grade IV injury and 1 with a grade II injury. Interval US appropriately detected a complication or confirmed the absence of complication in all (13/13, 100%) patients with low-grade (I-III) injury and only missed a small biloma in one patient with a grade IV injury. Interval US and CT agreement was 92 per cent for change in hemoperitoneum or parenchymal lesion. Ultrasonography is a convenient imaging modality in the evaluation of hepatic trauma. US is sufficient to detect or exclude complications in low-grade injuries. In high-grade injuries, US may be an adjunct to CT for definitive interval assessment.
Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 South Greene Street, Baltimore, Maryland 21201-1595, USA.
William C
WC
Chiu
Jade J
JJ
Wong-You-Cheong
Aurelio
A
Rodriguez
K
K
Shanmuganathan
Stuart E
SE
Mirvis
Thomas M
TM
Scalea
D000007:Abdominal Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D013505:Digestive System Surgical Procedures; D006465:Hemoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008099:Liver / Q000293:injuries*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography