The diagnostic superiority of computerized tomography

One hundred three patients with blunt abdominal trauma were studied using computerized tomography (CT). By protocol CT was performed in hemodynamically stable adults either: 1) before tap and lavage (T&L)—32 patients; 2) after ‘negative’ (less than 20,000 RBC/mm³) or ‘borderline’ (20,000—50,000 RBC/mm³) lavage—28 patients; or 3) to evaluate hematuria—43 patients. CT was performed after administration of oral and intravenous contrast. A comparison of T&L and CT was made in 60 patients. 16 of 42 patients with negative lavage had 22 injuries identified by CT. One of these patients with bilateral renal artery transection, mesenteric and pararenal hematomas died of a closed head injury. Six of 14 patients with borderline lavage results had nine injuries found on CT, including two with actively bleeding spleens confirmed at operation or angiography. One patient with a large retroperitoneal hematoma underwent successful control of hemorrhage by embolization. Only one injury, a paranephric hematoma found at operation was not identified preoperatively by CT. Seventeen of 85 patients with hematuria had GU abnormalities identified by CT. Findings included seven intrarenal hematomas or contusions, three fractures, three major renovascular injuries, four para-and six perinephric hematomas, and three collection system injuries with extravasation. The majority of these injuries were found in patients with more than 50 RBC/HPF; however, six of 47 patients with less than 20 RBC/HPF had abnormalities including a retroperitoneal bladder perforation and a renal mass (hypernephroma). Two bladder perforations and one urethral injury were identified by CT cystogram. Abdominal CT is more sensitive and specific than T&L or IVP. CT is the diagnostic modality of choice in the hemodynamically stable patient with nonpenetrating trauma for the evaluation of intra-abdominal injury or hematuria.