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Emergency Radiology

, 17:13 | Cite as

Imaging of blunt pancreatic trauma

  • Satinder Rekhi
  • Stephan W. AndersonEmail author
  • James T. Rhea
  • Jorge A. Soto
Pictorial Essay

Abstract

Blunt pancreatic trauma is an exceedingly rare but life-threatening injury with significant mortality. Computed tomography (CT) is commonly employed as the initial imaging modality in blunt trauma patients and affords a timely diagnosis of pancreatic trauma. The CT findings of pancreatic trauma can be broadly categorized as direct signs, such as a pancreatic laceration, which tend to be specific but lack sensitivity and indirect signs, such as peripancreatic fluid, which tend to be sensitive but lack specificity. In patients with equivocal CT findings or ongoing clinical suspicion of pancreatic trauma, magnetic resonance cholangiopancreatography (MRCP) may be employed for further evaluation. The integrity of the main pancreatic duct is of crucial importance, and though injury of the duct may be strongly suggested upon initial CT, MRCP provides clear delineation of the duct and any potential injuries. This article aims to review and illustrate the CT and magnetic resonance imaging findings of blunt pancreatic trauma and delineate the integration of these modalities into the appropriate imaging triage of severely injured blunt trauma patients.

Keywords

Trauma Pancreatic injury Computed tomography Abdominal imaging 

References

  1. 1.
    Cirillo RL Jr, Leonidas GK (2002) Detecting blunt pancreatic injuries. J Gastrointest Surg 6:587–589. doi: 10.1016/S1091-255X(01) 00028-2 CrossRefPubMedGoogle Scholar
  2. 2.
    Gupta A, Stuhlfaut JW, Fleming KW, Lucey BS, Soto JA (2004) Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Radiographics 24:1381–1395. doi: 10.1148/rg.245045002 CrossRefPubMedGoogle Scholar
  3. 3.
    Jurkovich GJ (2000) The duodenum and pancreas. In: Mattox KL, Feliciano DV, Moore EE (eds) Trauma, 4th edn. McGraw-Hill, New York, NY, pp 735–762Google Scholar
  4. 4.
    Anderson SW, Soto JA (2009) Pancreatic duct evaluation: accuracy of portal venous phase 64 MDCT. Abdom Imaging 34:55–63. doi: 10.1007/s00261-008-9396-4 CrossRefPubMedGoogle Scholar
  5. 5.
    Itoh S, Ikeda M, Ota T et al (2003) Assessment of the pancreatic and intrapancreatic bile ducts using 0.5-mm collimation and multiplanar reformatted images in multislice CT. Eur Radiol 13:277–285PubMedGoogle Scholar
  6. 6.
    Venkatesh SK, Chin Wan JM (2008) CT of blunt pancreatic trauma–a pictorial essay. Eur J Radiol 67:311–320. doi: 10.1016/j.ejrad.2007.07.003 CrossRefPubMedGoogle Scholar
  7. 7.
    Bradley EL, Young PR, Chang MC et al (1998) Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multiinstitutional review. Ann Surg 227:861–869. doi: 10.1097/00000658-199806000-00009 CrossRefPubMedGoogle Scholar
  8. 8.
    Al-Ahmadi K, Ahmed N (2008) Outcomes after pancreatic trauma: experience at a single institution. Can J Surg 51:118–124PubMedGoogle Scholar
  9. 9.
    Salles A, Nino-Murcia M, Jeffrey RB Jr (2008) CT of pancreas: minimum intensity projections. Abdom Imaging 33:207–213. doi: 10.1007/s00261-007-9212-6 CrossRefPubMedGoogle Scholar
  10. 10.
    Gong JS, Xu JM (2004) Role of curved planar reformations using multidetector spiral CT in diagnosis of pancreatic and peripancreatic diseases. World J Gastroenterol 10:1943–1947PubMedGoogle Scholar
  11. 11.
    Teh SH, Sheppard BC, Mullins RJ et al (2007) Diagnosis and management of blunt pancreatic ductal injury in the era of high-resolution computed axial tomography. Am J Surg 193:641–643. doi: 10.1016/j.amjsurg.2006.12.024 CrossRefPubMedGoogle Scholar
  12. 12.
    Akhrass R, Kim K, Brandt C (1996) Computed tomography: an unreliable indicator of pancreatic trauma. Am Surg 62:647–651PubMedGoogle Scholar
  13. 13.
    Patel SV, Spencer JA, El-Hasani S, Sheridan MB (1998) Imaging of pancreatic trauma. Br J Radiol 71:985–990PubMedGoogle Scholar
  14. 14.
    Shanmuganathan K (2004) Multi-detector row CT imaging of blunt abdominal trauma. Semin Ultrasound CT MR 25:180–204. doi: 10.1016/j.sult.2004.02.002 CrossRefPubMedGoogle Scholar
  15. 15.
    Ilahi O, Bochicchio GV, Scalea TM (2002) Efficacy of computed tomography in the diagnosis of pancreatic injury in adult blunt trauma patients: a single-institutional study. Am Surg 68:704–707PubMedGoogle Scholar
  16. 16.
    Wong YC, Wang LJ, Lin BC et al (1997) CT grading of blunt pancreatic injuries: prediction of ductal disruption and surgical correlation. J Comput Assist Tomogr 21:246–250. doi: 10.1097/00004728-199703000-00014 CrossRefPubMedGoogle Scholar
  17. 17.
    Heitsch RC, Knutson CO, Fulton RL, Jones CE (1976) Delineation of critical factors in the treatment of pancreatic trauma. Surgery 80:523–529PubMedGoogle Scholar
  18. 18.
    Duchesne JC, Schmeig R, Islam S et al (2008) Selective nonoperative management of low-grade blunt pancreatic injury: are we there yet? J Trauma 65:49–53. doi: 10.1097/TA.0b013e318176c00d CrossRefPubMedGoogle Scholar
  19. 19.
    Brestas PS, Karakyklas D, Gardelis J et al (2006) Sequential CT evaluation of isolated non-penetrating pancreatic trauma. JOP 7:51–55PubMedGoogle Scholar
  20. 20.
    Wong YC, Wang LJ, Fang JF et al (2008) Multidetector-row computed tomography (CT) of blunt pancreatic injuries: can contrast-enhanced multiphasic CT detect pancreatic duct injuries? J Trauma 64:666–672. doi: 10.1097/TA.0b013e31802c5ba0 CrossRefPubMedGoogle Scholar
  21. 21.
    Lane MJ, Mindelzun RE, Sandhu JS et al (1994) CT diagnosis of blunt pancreatic trauma: importance of detecting fluid between the pancreas and the splenic vein. AJR Am J Roentgenol 163:833–835PubMedGoogle Scholar
  22. 22.
    Chapman VM, Rhea JT, Sacknoff R, Novelline RA (2004) CT of nontraumatic abdominal fluid collections after initial fluid resuscitation of patients with major burns. AJR Am J Roentgenol 182:1493–1496PubMedGoogle Scholar
  23. 23.
    Nirula R, Velmahos GC, Demetriades D (1999) Magnetic resonance cholangiopancreatography pancreatic trauma: a new diagnostic modality? J Trauma 47(3):585–587. doi: 10.1097/00005373-199909000-00031 CrossRefPubMedGoogle Scholar
  24. 24.
    Soto JA, Alvarez O, Munera F et al (2001) Traumatic disruption of the pancreatic duct: diagnosis with MR pancreatography. AJR Am J Roentgenol 176:175–178PubMedGoogle Scholar
  25. 25.
    Matos C, Winant C, Deviere J (2001) Magnetic resonance pancreatography. Abdom Imaging 26:243–253. doi: 10.1007/s002610000166 CrossRefPubMedGoogle Scholar
  26. 26.
    Ragozzino A, Manfredi R, Scaglione M et al (2003) The use of MRCP in detection of pancreatic injuries after blunt trauma. Emerg Radiol 10:14–18PubMedGoogle Scholar
  27. 27.
    Gillams AR, Kurzawinski T, Lees WR (2006) Diagnosis of duct disruption and assessment of pancreatic leak with dynamic secretin-stimulated MR cholangiopancreatography. AJR Am J Roentgenol 186:499–506. doi: 10.2214/AJR.04.1775 CrossRefPubMedGoogle Scholar
  28. 28.
    Timberlake GA (1997) Blunt pancreatic trauma: experience at a rural referral center. Am Surg 63:282–286PubMedGoogle Scholar
  29. 29.
    Liu KJ, Atten MJ, Lichtor T et al (2001) Serum amylase and lipase elevation is associated with intracranial events. Am Surg 67:215–219PubMedGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2009

Authors and Affiliations

  • Satinder Rekhi
    • 1
  • Stephan W. Anderson
    • 1
    Email author
  • James T. Rhea
    • 1
  • Jorge A. Soto
    • 1
  1. 1.Department of RadiologyBoston University Medical CenterBostonUSA

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