title: Diagnosis and outcome of blunt caval injuries in the modern trauma center.
abstract: BACKGROUND
  Blunt vena caval injury (BCI) is uncommon with only a few published reports in the literature. Recently, with high resolution computed tomography (CT) scan imaging signs of caval injury are sometimes found in hemodynamically stable patients. The purpose of this study was to assess the current course of patients with BCI.
  
  
  METHODS
  Retrospective review of all patients with BCI treated at a Regional Trauma Center from April 1999 to May 2005. Data collected included demographics, mechanism of injury, associated injuries, diagnostic investigations, surgical findings, and outcomes.
  
  
  RESULTS
  During the 6-year study period, 10 patients presented with BCI (age 42 +/- 19 years; 70% mortality; Injury Severity Score 39 +/- 15). The spectrum of vena cava injury ranged from an intimal flap to extensive destruction. Six of the seven deaths were secondary to exsanguination and one secondary to severe brain injury. Four patients presented with refractory shock and were taken emergently to surgery (all died). Six patients responded to fluid resuscitation and underwent CT imaging (three out of six survived). Although active venous contrast extravasation was not seen in any patient, all six had indirect signs on CT suggestive of BCI. Overall, the diagnosis of BCI was confirmed at surgery in nine patients. The remaining patient had an intimal flap and contained pericaval hematoma confirmed by ultrasound, and was successfully managed nonoperatively.
  
  
  CONCLUSIONS
  The spectrum of BCI ranges from intimal flaps to extensive destruction. CT imaging may not diagnose or may underestimate the severity of BCI. Stable patients with intimal flaps and contained hematoma may be successfully managed nonoperatively.
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Fernando A C Spencer
authors.initials: FA
authors.lastname: Netto
authors.forename: Homer
authors.initials: H
authors.lastname: Tien
authors.forename: Paul
authors.initials: P
authors.lastname: Hamilton
authors.forename: Sandro B
authors.initials: SB
authors.lastname: Rizoli
authors.forename: Peter
authors.initials: P
authors.lastname: Chu
authors.forename: Robert
authors.initials: R
authors.lastname: Maggisano
authors.forename: Frederick
authors.initials: F
authors.lastname: Brenneman
authors.forename: Lorraine N
authors.initials: LN
authors.lastname: Tremblay
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D001011:Aorta / Q000293:injuries; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D014463:Ultrasonography; D014682:Vena Cava, Inferior / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy