title: Clinical implications of immediate or later periportal edema in MS-CT trauma scans: surrogate parameter of intravenous fluid status and venous congestion.
abstract: Periportal edema (PPE) of the liver in multislice computed tomography (MS-CT) scans that develops immediately (primary PPE [pPPE]) or later (secondary PPE [sPPE]) is not uncommon in severe trauma patients. Although PPE may serve as a marker for blunt abdominal trauma (22-31 % of cases), distinct causes and clinical implications of PPE are unclear. We analyzed the incidence of pPPE and sPPE in 68 MS-CT scans in severe trauma patients (2007-2009). Exclusion criteria were severely burned patients and patients with preexistent liver diseases predisposing to PPE. We divided PPE+ patients into two subpopulations-either initial/primary PPE (pPPE+) or later/secondary PPE (sPPE+). Further patient data were collected and statistically analyzed. PPE+ was found in 27.9 % (n = 19). Females predominated (p = 0.01), and PPE+ patients presented with a significantly better pH at admission (p = 0.008). The total amount of volume resuscitation (1,983 ± 1,155 ml; p = 0.02) and crystalloids (1,117 ± 796 ml; p = 0.006) administered before MS-CT scans was significantly higher in PPE+, whereas the amount of administered colloids (797 ± 640 ml) showed no significant difference in both groups. PPE+ was not associated with further patient data, i.e., trauma mechanism, injury severity, prognosis-relevant factors, adverse clinical events, or mortality. pPPE+ in MS-CT may serve as a surrogate parameter for intravenous volume load and/or venous congestion, and sPPE+ may also indicate venous congestion and right heart failure after severe trauma. In severe trauma patients with pPPE+/sPPE+ in MS-CT scans, causes of PPE relating to intravenous fluid overload and/or venous congestion should be excluded or treated.
authors.affiliation: Center for Musculoskeletal Surgery, AG Polytrauma, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kleber
authors.forename: C T
authors.initials: CT
authors.lastname: Buschmann
mesh_terms: D000328:Adult; D002056:Burns / Q000150:complications; D003102:Colloids / Q000008:administration & dosage; D004487:Edema / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D011169:Portal Vein / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014882:Water-Electrolyte Balance; D014947:Wounds and Injuries / Q000150:complications*
chemical_list: D003102:Colloids