Computed tomography of abdominal trauma: A step-by-step approach

Patients subjected to trauma to the abdomen and pelvis suffer a wide variety of injuries, many of which can be detected by computed tomography (CT). This article provides a rigorous step-by-step routine useful in the interpretation of these studies, in order to decrease the number of missed traumatic lesions. The routine includes: search for pneumothorax and pneumoperitoneum using lung windows for lower thorax and upper abdominal sections and soft tissue windows for lower abdominal and pelvic sections; search of left paracolic gutter and spleen for blood or laceration; search of right paracolic gutter and liver for blood or laceration; upper abdominal survey evaluating duodenum and pancreas; retroperitoneal survey of kidneys, adrenals, inferior vena cava, and aorta for evidence of bleeding, laceration, hematoma, urinoma, or signs of hypotension; search of gastrointestinal tract and mesentery for extravasation or hematoma; muscle survey including psoas, iliopsoas, rectus abdominus, and buttocks for hematoma; bone survey including ribs, transverse processes, sacrum, sacroiliac joints, and hips for fracture; and lowest section search for thigh hematoma. This pictorial essay illustrates examples of trauma found in each of these steps as well as potential pitfalls in the interpretation of CT of the abdomen and pelvis in the traumatized patient.