title: Traumatic hypovolemic shock revisited: the spectrum of contrast-enhanced abdominal computed tomography findings and clinical implications for its management.
abstract: Hypovolemic shock is often seen in patients with severe blunt trauma who have suffered from blood circulation inadequate to maintain oxygen delivery to multiple organs. The early recognition and prompt management of hypovolemic shock in patients with multiple injuries are mandatory to improving prognosis and patient conditions. The diagnostic accuracy of computed tomography (CT) as a primary diagnostic tool is well established. The abdominal organs show several common and classic appearances on contrast-enhanced CT in patients with trauma. The hypovolemic shock complex is reported in the previous literature as decreased enhancement of the viscera, increased mucosal enhancement and luminal dilation of the small bowel, mural thickening and fluid-filled loops of the small bowel, the halo sign and flattening of the inferior vena cava, reduced aortic diameter, and peripancreatic edema. However, there have been controversial CT reports with contradictory appearances. Physicians understanding these findings could prompt alternative approaches to the early assessment and management of hypovolemic shock. The aim of this article is to illustrate common and well-known abdominal CT features in patients with traumatic hypovolemic shock, to discuss controversial CT signs in the pancreas and adrenal gland, and to describe CT findings' clinical implications when managing hypovolemic shock.
authors.affiliation: Department of Diagnostic Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan, higahiro@med.kawasaki-m.ac.jp.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Higashi
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kanki
authors.forename: Shigeru
authors.initials: S
authors.lastname: Watanabe
authors.forename: Akira
authors.initials: A
authors.lastname: Yamamoto
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Noda
authors.forename: Kazuya
authors.initials: K
authors.lastname: Yasokawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Higaki
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Tamada
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Ito
mesh_terms: D000311:Adrenal Glands / Q000000981:diagnostic imaging; D003287:Contrast Media; D006801:Humans; D009104:Multiple Trauma / Q000150:complications / Q000000981:diagnostic imaging; D010179:Pancreas / Q000000981:diagnostic imaging; D011856:Radiographic Image Enhancement / Q000379:methods*; D011860:Radiography, Abdominal / Q000379:methods*; D012769:Shock / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000150:complications*
chemical_list: D003287:Contrast Media