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Visceral injury without hemoperitoneum: A limitation of screening abdominal sonography for trauma

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Abstract

Abdominal sonography for the detection of hemoperitoneum has become increasingly popular as a screening test for visceral injury after blunt trauma. The purpose of this study was to determine the frequency, severity, and clinical significance (outcome) of abdominal organ injuries that occur without hemoperitoneum on the initial evaluation of blunt abdominal trauma patients.

During a 12-month period, 3392 blunt trauma patients were admitted to our center. Sonographic studies were performed as an initial screening evaluation to determine the presence of hemoperitoneum in 772 (22.7%) of these patients. Abdominal visceral injuries were verified by computed tomography (CT) or surgery in 196 (5.8%) of all blunt trauma admissions. Sonography, CT, and operative findings were reviewed to determine the presence or absence of hemoperitoneum in patients with abdominal injury. Patients with abdominal visceral injury without hemoperitoneum were further analyzed to identify the type of injury and the management required.

A total of 246 abdominal injuries were identified in 196 patients. Fifty (26%) patients with abdominal visceral injuries diagnosed by admission CT scan had no evidence of hemoperitoneum. Admission sonography performed in 15 (30%) of these 50 patients also showed no evidence of hemoperitoneum. Visceral injuries detected by CT in the patients without hemoperitoneum included 22 of 100 splenic injuries (22%), 18 of 91 hepatic injuries (20%), 12 of 26 renal injuries (46%), and 1 of 9 mesenteric injuries (11%). Surgery was required to manage injuries in 10 of these patients.

Up to 26% of blunt trauma patients with abdominal visceral injuries do not have associated hemoperitoneum identified on admission abdominal CT or sonography. Dependence on hemoperitoneum as the sole criterion of abdominal visceral injury after blunt trauma will result in falsely negative examinations and will miss potentially significant injuries.

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Author notes

  1. Caroline D. Sherbourne M.D.

    Present address: Department of Radiology, University of Texas Southwestern, 5323 Harry Hines Boulevard, Parkland Memorial Hospital, 75235, Dallas, TX

Authors and Affiliations

  1. Department of Diagnostic Radiology, University of Maryland Medical System, Baltimore, Maryland

    Caroline D. Sherbourne M.D., Kathirkamaganathan Shanmuganathan M.D. & Stuart E. Mirvis M.D.

  2. Shock Trauma Center, Baltimore, Maryland

    William C. Chiu M.D. & Aurelio Rodriguez M.D.

Authors
  1. Caroline D. Sherbourne M.D.
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  2. Kathirkamaganathan Shanmuganathan M.D.
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  3. Stuart E. Mirvis M.D.
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  4. William C. Chiu M.D.
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  5. Aurelio Rodriguez M.D.
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Sherbourne, C.D., Shanmuganathan, K., Mirvis, S.E. et al. Visceral injury without hemoperitoneum: A limitation of screening abdominal sonography for trauma. Emergency Radiology 4, 349–354 (1997). https://doi.org/10.1007/BF01451070

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