title: CT Appearance of Traumatic Inferior Vena Cava Injury.
abstract: OBJECTIVE
  CT plays a crucial role in the evaluation of stable patients with blunt and penetrating trauma in the emergency department. Among the more severe injuries that may occur in penetrating and blunt trauma are those to the inferior vena cava (IVC). The purpose of this study was to evaluate and differentiate the CT findings associated with penetrating versus blunt trauma to the IVC to aid the radiologist in diagnosing IVC injuries.
  
  
  METHODS
  Cases of blunt and penetrating IVC injury were retrospectively identified using search queries. Criteria for inclusion were preoperative contrast-enhanced CT and surgically confirmed caval injury or direct findings of caval injury on CT with patient death before surgical confirmation could be obtained.
  
  
  RESULTS
  Twelve cases of traumatic IVC injury were identified over a 9-year period: six blunt and six penetrating. The most common finding was a retroperitoneal hematoma, seen in 75% of cases. Eighty-three percent of blunt injuries were associated with hepatic lacerations and contrast material extravasation. Thirty-three percent of penetrating IVC injuries were associated with extravasation. Contour abnormalities were seen in 50% of blunt and 17% of penetrating injuries to the IVC. All three cases of IVC injury resulting in mortality occurred in the retrohepatic segment.
  
  
  CONCLUSIONS
  Injury to the IVC is frequently fatal in patients with penetrating or blunt trauma. The CT appearance of IVC injury is dichotomous between the two causes, with blunt IVC injury more likely to show extravasation, contour abnormality, and associated hepatic laceration. Injury of the retrohepatic IVC portends a poor outcome. With the continued use of CT for evaluation of trauma patients, the radiologist should be familiar with IVC injury and its different CT appearances.
authors.affiliation: 1 Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO 63110.
authors.forename: Richard
authors.initials: R
authors.lastname: Tsai
authors.affiliation: 1 Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO 63110.
authors.forename: Constantine
authors.initials: C
authors.lastname: Raptis
authors.affiliation: 2 Department of Surgery, Washington University in St. Louis, St. Louis, MO.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Schuerer
authors.affiliation: 1 Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO 63110.
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Mellnick
keywords: CT; blunt trauma; inferior vena cava; penetrating trauma