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Emergency Radiology

, Volume 20, Issue 4, pp 259–266 | Cite as

Blunt pancreatic trauma: evaluation with MDCT technology

  • Robert W. Gordon
  • Stephan W. AndersonEmail author
  • Al Ozonoff
  • Satinder Rekhi
  • Jorge A. Soto
Original Article

Abstract

The purpose of this paper is to determine the relative frequency of multi-detector CT (MDCT) findings of pancreatic injury in blunt trauma and to determine their diagnostic accuracy in predicting main pancreatic duct injury. Fifty-three patients (31 male, 22 female; mean 44.1 years) with blunt trauma and admission MDCT findings suspicious for pancreatic injury or who underwent MDCT and had a discharge diagnosis of pancreatic trauma were included in this study. Two radiologists reviewed all images and recorded findings suspicious for pancreatic injury, which were subsequently compared to surgical findings to generate diagnostic accuracy. MDCT imaging findings suggestive of pancreatic injury included low attenuation peripancreatic fluid (n = 51), hyperattenuating peripancreatic fluid (n = 13), pancreatic contusion (n = 7), active hemorrhage (n = 2), and pancreatic laceration (n = 16). Diagnostic accuracy of the various imaging findings varied for diagnosing main duct injury; there were highly sensitive, nonspecific imaging findings such as the presence of low attenuation peripancreatic fluid (sensitivity, 100 %; specificity 4.9 %) as well as insensitive, specific findings such as visualizing a pancreatic laceration involving >50 % of the parenchymal width (sensitivity, 50 %; specificity, 95.1 %). In the setting of blunt abdominal trauma, MDCT imaging findings can be grouped into two categories for determining integrity of the main pancreatic duct: indirect, highly sensitive but nonspecific findings and direct, specific but insensitive findings. Awareness of the clinical implications of the various MDCT imaging findings of pancreatic trauma is useful in interpreting their significance.

Keywords

Blunt pancreatic trauma Multi-detector CT Diagnostic accuracy in predicting main pancreatic duct injury 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Cirillo RL Jr, Leonidas GK (2002) Detecting blunt pancreatic injuries. J Gastrointest Surg 6:587–589PubMedCrossRefGoogle 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 24:1381–1395PubMedCrossRefGoogle 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.
    Wong YC, Wang LJ, Lin BC, Chen CJ, Lim KE, Chen RJ (1997) CT grading of blunt pancreatic injuries: prediction of ductal disruption and surgical correlation. J Comput Assist Tomogr 21:246–250PubMedCrossRefGoogle Scholar
  5. 5.
    Fischer JH, Carpenter KD, O’Keefe GE (1996) CT diagnosis of an isolated blunt pancreatic injury. AJR Am J Roentgenol 167:1152PubMedCrossRefGoogle Scholar
  6. 6.
    Ilahi O, Bochicchio GV, Scalea TM (2002) Efficacy of computed tomography in the diagnosis of pancreatic injuries in adult blunt trauma patients: a single-institutional study. Am Surg 68:704–708PubMedGoogle Scholar
  7. 7.
    Akhrass R, Yaffe MB, Brandt CP et al (1997) Pancreatic trauma: a ten-year multi-institutional experience. Am Surg 63:598–604PubMedGoogle Scholar
  8. 8.
    Madiba TE, Mokoena TR (1995) Favorable prognosis after surgical drainage of gunshot, stab or blunt trauma of the pancreas. Br J Surg 82:1236–1239PubMedCrossRefGoogle Scholar
  9. 9.
    Lin BC, Chen RJ, Fang JF et al (2004) Management of blunt major pancreatic injury. J Trauma 56:774–778PubMedCrossRefGoogle Scholar
  10. 10.
    Wolf A, Bernhardt J, Patrzyk M et al (2005) The value of endoscopic diagnosis and the treatment of pancreas injuries following blunt abdominal trauma. Surg Endosc 19:665–669PubMedCrossRefGoogle Scholar
  11. 11.
    Tyburski JG, Dente CJ, Wilson RF et al (2001) Infectious complications following duodenal and/or pancreatic trauma. Am Surg 67:227–231PubMedGoogle Scholar
  12. 12.
    Bradley EL 3rd, Young PR Jr, Chang MC et al (1998) Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multi-institutional review. Ann Surg 227:861–869PubMedCrossRefGoogle Scholar
  13. 13.
    Wisner DH, Wold RL, Frey CF (1990) Diagnosis and treatment of pancreatic injuries. Arch Surg 125:1109–1113PubMedCrossRefGoogle Scholar
  14. 14.
    Lucas CE (1977) Diagnosis and treatment of pancreatic and duodenal injury. Surg Clin North Am 57:49–65PubMedGoogle Scholar
  15. 15.
    Wilson RH, Moorehead RJ (1991) Current management of trauma to the pancreas. Br J Surg 78:1196–1202PubMedCrossRefGoogle Scholar
  16. 16.
    Jurkovich GJ, Carrico CJ (1990) Pancreatic trauma. Surg Clin North Am 70:575–593PubMedGoogle Scholar
  17. 17.
    Northrup WF III, Simmons RL (1972) Pancreatic trauma: a review. Surgery 71:27–43PubMedGoogle Scholar
  18. 18.
    Bach RD, Frey CF (1971) Diagnosis and treatment of pancreatic trauma. Am J Surg 121:20–29PubMedCrossRefGoogle Scholar
  19. 19.
    Donovan AJ, Turrill F, Berne CJ (1972) Injuries of the pancreas from blunt trauma. Surg Clin North Am 52:649–665PubMedGoogle Scholar
  20. 20.
    Jeffrey RB Jr, Federle MP, Crass RA (1983) Computed tomography of pancreatic trauma. Radiology 147:491–494PubMedGoogle Scholar
  21. 21.
    Haapiaienen RA, Kiluto T, Lempinen M (1988) Pancreatic trauma: acute and late manifestations. Br J Surg 75:165–167CrossRefGoogle Scholar
  22. 22.
    Cook DE, Walsh JW, Vick CW, Brewer WH (1986) Upper abdominal trauma: pitfalls in CT diagnosis. Radiology 159:65–69PubMedGoogle Scholar
  23. 23.
    Lane MJ, Mindelzun RE, Sandhu JS, McCormick VD, Jeffrey RB (1994) CT diagnosis of blunt pancreatic trauma: Importance of detecting fluid between the pancreas and the splenic vein. AJR 163:833–835PubMedCrossRefGoogle Scholar
  24. 24.
    Peitzman AB, Makaroun MS, Slasky BS, Ritter P (1986) Prospective study of computed tomography in initial management of blunt trauma. Trauma 26:585–592CrossRefGoogle Scholar
  25. 25.
    Keogan MT, Baker ME (1995) Computed tomography and magnetic resonance imaging in the assessment of pancreatic disease. Gastrointest Endosc Clin N Am 5:31–59PubMedGoogle Scholar
  26. 26.
    Mirvis SE, Shanmuganathan K (1994) Trauma radiology: Part I. Computerized tomographic imaging of abdominal trauma. J Intensive Care Med 9:151–163PubMedGoogle Scholar
  27. 27.
    Sivit CJ, Eichelberger MR, Taylor GA, Bulas DI, Gotschall CS, Kushner DC (1992) Blunt pancreatic trauma in children: CT diagnosis. AJR 158:1097–1100PubMedCrossRefGoogle Scholar
  28. 28.
    Udekwu DO, Gurkin B, Oller DW (1996) The use of computed tomography in blunt abdominal injuries. Am Surg 62:56–59PubMedGoogle Scholar
  29. 29.
    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 193:641–643PubMedCrossRefGoogle Scholar
  30. 30.
    Wong YC, Wang LJ, Fang JF, Lin BC, Ng CJ, Chen RJ (2008) Multidetector-row computed tomography (CT) of blunt pancreatic injuries: can contrast-enhanced multiphasic CT detect pancreatic duct injuries? J Trauma 64(3):666–672PubMedCrossRefGoogle Scholar
  31. 31.
    Akhrass R, Kim K, Brandt C (1996) Computed tomography: an unreliable indicator of pancreatic trauma. Am Surg 62:647–651PubMedGoogle Scholar
  32. 32.
    Wilson RH, Moorehead RJ (1991) Current management of trauma to the pancreas. Br J Surg 78:1196–1202PubMedCrossRefGoogle Scholar
  33. 33.
    West OC, Jarolinek AM (2000) Abdomen: Traumatic emergencies. In: Harris JH Jr, Harris WH (eds) The radiology of emergency medicine, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 708–710Google Scholar
  34. 34.
    Anderson SW, Soto JA (2009) Pancreatic duct evaluation: accuracy of portal venous phase 64 MDCT. Abdom Imaging 34:55–63PubMedCrossRefGoogle Scholar
  35. 35.
    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
  36. 36.
    Ventatesh SK, Chin WJM (2008) CT of blunt pancreatic trauma—a pictorial essay. Eur J Radiology 67:311–320CrossRefGoogle Scholar
  37. 37.
    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 182:1493–1496PubMedCrossRefGoogle Scholar
  38. 38.
    Jones RC (1985) Management of pancreatic trauma. Am J Surg 150:698–704PubMedCrossRefGoogle Scholar
  39. 39.
    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 186:499–506PubMedCrossRefGoogle Scholar
  40. 40.
    Arkovitz MS, Johnson N, Garcia VF (1997) Pancreatic trauma in children: mechanism of injury. J Trauma 42:49–53PubMedCrossRefGoogle Scholar
  41. 41.
    Brandon JC, Izenberg SD, Fields PA, Evankovich C, Wilson G, Teplick SK (2000) Pancreatic clefts caused by penetrating vessels: a potential diagnostic pitfall for pancreatic fracture on CT. Emerg Radiol 7:283–286CrossRefGoogle Scholar
  42. 42.
    Katz DS, Hines J, Math KR, Nard PM, Mindelzun RE, Lane MJ (1999) Using CT to reveal fat-containing abnormalities of the pancreas. AJR 172:393–396PubMedCrossRefGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2013

Authors and Affiliations

  • Robert W. Gordon
    • 1
  • Stephan W. Anderson
    • 2
    Email author
  • Al Ozonoff
    • 3
  • Satinder Rekhi
    • 4
  • Jorge A. Soto
    • 2
  1. 1.Department of RadiologyBrigham and Women’s HospitalBostonUSA
  2. 2.Department of RadiologyBoston University Medical CenterBostonUSA
  3. 3.Biostatistics Core, Children’s Hospital BostonClinical Research ProgramBostonUSA
  4. 4.Department of RadiologyGeorge Washington UniversityWashingtonUSA

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