Emergency ultrasound in trauma patients
Section snippets
Sonographic examination
The initial focus of sonographic examination was a single view of the hepatorenal fossa (Morison's pouch) [2]. It was soon realized that a more comprehensive examination of the abdomen improved detection of free fluid, however [4]. This included examinations of both upper quadrants, the paracolic gutters, and pelvis. In 1997, McGahan et al [4] documented that sonographic sensitivity for the detection of free fluid could be improved by having a full bladder. Often in traumatized patients a Foley
Free fluid
Free fluid typically appears as a hypoechoic region within the peritoneal cavity or pelvis and is usually linear or triangular in shape (Fig. 1). The shape of the fluid depends on its compression by the surrounding structures. For instance, in Morison's pouch, the fluid between the kidney and liver usually has a linear shape (see Fig. 1). Fluid that surrounds bowel often appears triangular. Fluid often accumulates at the site of injury but then flows throughout the abdomen and into the pelvis.
Solid organ injury
After the initial studies on the use of sonography in detecting organ injuries in the 1970s [1], more recent studies focused on the detection of free fluid [11], [12], [13]. A few recent studies have demonstrated the ability of sonography to detect parenchymal organ abnormalities directly. Rothhin et al [12] reported a sensitivity rate of 41.4% for the direct detection of solid organ injuries by sonography. McGahan et al [4] also reported a sensitivity rate of 41% detection in solid organ
Sonographic appearance of solid organ injuries
Much of the work on sonographic classification and appearance of solid organ injuries has been performed by McGahan et al [23], [24] and Richards et al [25], [26]. When identified, acute solid organ injuries are often echogenic on sonography. A diffuse heterogeneous echogenic pattern is the predominant pattern identified with splenic injuries (Fig. 4). A discrete hyperechoic or diffuse hyperechoic pattern is seen with hepatic injuries (see Fig. 2). Renal injuries are echogenic, with a
Summary
US will be used more frequently in the future for the evaluation of traumatized patients. Previously, the main focus of the sonographic examination was for the detection of free fluid. Unstable patients with free fluid often can be triaged to the operation room without further imaging tests. In patients who are more stable or in whom US results are negative, CT is required. Based on recent studies, sonography has a sensitivity rate of approximately 40% in direct detection of solid organ
References (33)
- et al.
Emergency department ultrasound in the evaluation of blunt abdominal trauma
Am J Emerg Med
(1993) - et al.
Clinical importance of intraperitoneal fluid in patients with blunt intra-abdominal injury
Am J Emerg Med
(2002) - et al.
Ultrasound detection of blunt splenic injury
Injury
(2001) - et al.
Trauma ultrasound examination versus chest radiography in the detection of hemothorax
Ann Emerg Med
(1997) - et al.
Ultrasonic scanning in the diagnosis of splenic haematomas
Acta Chir Scand
(1971) - et al.
Emergency center ultrasonography in the evaluation of hemoperitoneum: a prospective study
J Trauma
(1991) - et al.
Use of ultrasonography in the patient with acute abdominal trauma
J Ultrasound Med
(1997) - et al.
Splenic trauma: evaluation with CT
Radiology
(1987) - et al.
Patterns of fluid accumulation on screening ultrasonography for blunt abdominal trauma: comparison with site of injury
J Ultrasound Med
(2001) - et al.
Quantification of fluid on screening ultrasonography for blunt abdominal trauma: a simple scoring system to predict severity of injury
J Ultrasound Med
(2001)
Ultrasonography for the evaluation of hemoperitoneum during resuscitation: a simple scoring system
J Trauma
Interpreting the trauma ultrasound: observations in 62 positive cases
Emerg Radiol
1,000 consecutive ultrasounds for blunt abdominal trauma
J Trauma
Ultrasound in blunt abdominal and thoracic trauma
J Trauma
Prospective evaluation of surgeons' use of ultrasound in the evaluation of trauma patients
J Trauma
Blunt abdominal trauma in children: evaluation with emergency US
Radiology
Cited by (28)
Pitfalls and pearls in emergency point-of-care sonography
2014, Ultrasound ClinicsCitation Excerpt :Evaluate both paracolic gutters to detect early hemoperitoneum. From the right or left upper quadrant views, slide the transducer caudad to visualize the inferior pole of the kidney.9,10 This action may allow the detection of blood just beginning to spill over from the pelvis into the Morison pouch (see Fig. 2B, C).
The FAST and E-FAST in 2013: Trauma Ultrasonography. Overview, practical techniques, controversies, and new frontiers
2014, Critical Care ClinicsCitation Excerpt :Furthermore, CT may miss clinically significant injuries that may result in little free abdominal bleeding, such as mesenteric, intestinal and pancreatic injuries.40 Ultrasonography cannot reliably grade solid-organ injuries that do not result in significant hemoperitoneum.41–44 CT imaging and/or careful serial abdominal examinations remain indicated to further delineate these injuries in high-risk patients.
Chest Sonography in Children: Current Indications, Techniques, and Imaging Findings
2011, Radiologic Clinics of North AmericaCitation Excerpt :The sliding of the underlying lung can no longer be seen, and the normal reverberation is replaced by a static homogeneous posterior acoustic shadowing (Fig. 13). Some reports indicate that US is superior to plain radiographs in pneumothorax detection and may be useful in monitoring procedural complications and assessing critically ill and trauma patients.15–17,58–63 Similarly, the curtain sign has been described in hydropneumothorax where the normal pleural gliding is lost and mobile air fluid levels are visualized.40
Emergency sonography for the elderly
2011, International Journal of GerontologyCitation Excerpt :Based on recent studies, sonography has a sensitivity rate of approximately 40% for the direct detection of solid organ injuries. In the future, however, with the use of contrast-enhanced agents, sonography may more reliably detect solid organ injuries114. Within the chest, ES has been shown to be helpful in detecting pleural effusions, and it may be useful in detecting pericardial effusions.
Contrast-enhanced ultrasound for blunt hepatic trauma: An animal experiment
2010, American Journal of Emergency MedicineCitation Excerpt :It was advocated as the routine method of choice in stable and cooperative patients with blunt hepatic trauma [4]. However, CT is not convenient to be used at the patients' bedsides and the accident sites because of its cumbersome imaging and high exposure to ionizing radiation [5-9]. Conventional ultrasound (US) is a good modality in the trauma setting for its portable, rapid, noninvasive, and practical nature.