Fatemeh Abdollahi Mofakham MD, Presenter: Nothing to Disclose

Nima Momenin MD, Abstract Co-Author: Nothing to Disclose

Karen Rosenspire MD, Abstract Co-Author: Nothing to Disclose

We determined the sensitivity and specificity of Computed Tomography (CT) in detecting visceral organ injuries in gunshot wounds (GSW) to the abdomen and pelvis. We also evaluated use of reconstructions in the plane of the bullet (trajectography) to improve injury detection. 

The list of 621 patients who had presented to Emergency Department of a trauma center with GSW to the abdomen and pelvis and undergone laparotomy during the last 15 years was obtained from the trauma surgery database. Of those 53 had pre-operative CT abdomen/pelvis and were included in our study. We evaluated concordance of findings in operative report with CT report. Since pneumoperitoneum could not be confirmed by laparotomy, all the cases were reviewed for presence of free intraperitoneal air by a radiologist and second opinion was obtained in case of disagreement with the CT report. Usefulness of trajectography in identifying missed injuries by CT was also determined.

CT has high sensitivity in detecting free air, free fluid, stomach, and kidney injuries (85%, 94%, 86%, and 100% respectively). The sensitivities were lower for liver and spleen injuries (69% and 75%), and small and large bowel injuries (60% and 57%). Penetrating diaphragmatic injury (PDI) was missed in 10 of 12 cases, resulting in a sensitivity of only 17%. Trajectography was shown to be helpful in detecting small solid organ injuries. Review of the available CT images showed that, using trajectography and contiguous injury on sides of the diaphragm is improving sensitivity to 90% in PDI. These signs were previously shown to be highly accurate and sensitive, respectively.  

CT sensitivity for visceral injuries can be improved using trajectography, with special attention to PDI. Bullet trajectography and presence of contiguous injuries on sides of the diaphragm are helpful in detecting PDI. As bowel can move with time, bullet trajectography should be used cautiously to identify the most likely sites of injury that require special attention. However, secondary signs of injury are required to suggest injury.

We show methods to improve injury detection by CT in GSW to the torso, which may lead to improvement in mortality and morbidity.

Abdollahi Mofakham, F, Momenin, N, Rosenspire, K, Use of Computed Tomography in Abdomino-pelvic Gunshot Wounds. Is Bullet Trajectography Important?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005366.html