The role of multislice computed tomography (MSCT) in the direction of traumatic intra abdominal injury : our experience in Hospital Tengku Ampuan Afzan(HTAA), Kuantan, Pahang

Introduction: Blunt abdominal trauma can cause multiple injuries and these injuries are often difficult to be accurately evaluated via clinical assessment. Currently, multislice computed tomography (MSCT) scan is the imaging modality of choice in assessing clinically stable patients with blunt abdominal trauma. This study assessed the role of MSCT in the detection of traumatic intra abdominal injury and correlates the findings with subsequent patient’s management. Methodology This is a retrospective study approved by our institutional review board. All cases of CT scan performed to rule out traumatic intra abdominal injury from January 2008 until December 2009 was traced from the registration book. CT scan images were retrieved and reviewed. Analysis of findings was done and organ injuries were graded according to AAST (American Association of Surgery and Trauma). Case notes and surgical findings were reviewed for correlation with CT findings. Results There were 151 cases included in this study. Positive scan were seen in 130 patients (86.1%). Liver, spleen and renal injuries were seen in 40.8%, 33.8% and 26.2% of cases respectively. Laparotomies were performed in 42 patients from 130 positive scans (32.3%) and in 3 patients who had negative scan. Out of 45 patients who had undergone laparotomies, 10 patients had significant surgically injuries that were missed on CT scan findings. The injuries were bowel perforation (n=4), serosal tear of bowel (n=1), mesenteric injuries (n=2), spleen injury (n=1), liver injury (n=1) and laceration of broad ligaments with oozing of blood from ovarian artery (n=1). Conclusion CT scan is a useful tool in the evaluation of blunt abdominal injuries in haemodynamically stable patients especially in the detection of solid organ injuries and retroperitoneal haematoma. However assessment of bowel and mesenteric injury was not similarly effective in our study

The value of magnetic resonance angiography in evaluation of head and neck pathology: a pictorial essay

Objectives; The aim of this presentation is to highlight the ability of Magnetic Resonance Angiography (MRA) in the clinical applications of head & neck pathology. Methods; Here we present few head and neck lesions with various pathology to illustrate the diagnostic value of MRA along with its influence on therapeutic decisions. Results; MRA has the ability to delineate both the anatomic relationships between head & neck pathology with normal surrounding structures, the tumour vascularity and the tumour feeding vessel. Conclusion; MRA provides sufficient information to aid and influence therapeutic decisions. It is recognized as an alternative to conventional angiography due to its non-invasive approach and less time consuming

Miracle of imaging: the truth is out there!

Introduction In medical practice, we encounter many diseases, which can manifest in different ways. Most of the time, careful history taking and meticulous clinical examination can easily direct the clinician towards an accurate diagnosis. While with others, they may need further supporting evidence either from laboratory investigations or imaging. Likewise, the radiologists face daily challenges of analyzing and interpreting high volume of images in a timely manner. Appropriate diagnosis or differential diagnosis can be derived from cases with good clinical correlation. However, it can be misleading for the radiologists when interpreting images in cases where the history or clinical presentation is unclear although meticulous image assessment for high quality diagnostic and patient care are indeed paramount. Case series We retrospectively reviewed cases where discrepancies existed between the indications for the imaging with findings detected during these investigations. The subsequent management or outcome of the patients is briefly described. Conclusion Thorough history and good clinical assessment can guide radiologists in the analysis and interpretation of the radiological images in most patients. Our illustration of cases will be a good reminder for radiologists to always be meticulous when interpreting images to minimize errors or missed abnormalities as misleading history or clinical presentation is bound to happen

MSCT assessment of blunt abdominal trauma in paediatric and adolescent patients: our experience in Hospital Tengku AMpuan Afzan (HTAA), Kuantan, Pahang

CT scan is the diagnostic technique of choice for the evaluation of abdominal injury due to blunt trauma in hemodynamically stable children. CT scan has high sensitivity specificity and accuracy in the detection of the presence and extent of abdominal injuries. Although operative intervention in these cases were based on clinical criteria rather than imaging findings. CT information frequently increases diagnostic confidence of the surgeons and influence the success of nonoperative management in most children with solid viscus injury

Delay in diagnosis of blunt abdominal injuries in children and adolescents: a pictorial review of CT abdomen in HTAA

Bluntabdominal injuries are often difficult to be accurately assessed clinically especially with concomitant external injury, in patients with head injury and in paediatric patients1. CT scan is the modality of choice for the evaluation of abdominal injury due to blunt trauma in hemodynamically stable children as it is widely available,rapidly performed with accurate depiction of various solid and hollow viscus injuries and associated retroperitoneal or pancreatic injuries2. Delay in diagnosis may not alter the mortality or choice of management but could significantly increase the rate of complications and prolong the length of hospital stay,hence timely and accurate diagnosis of intraabdominal injury is of utmost importance3

Detection of traumatic intra abdominal injuries using MSCT in Hospital Tengku Ampuan Afzan, Kuantan: our preliminary experience

.Blunt abdominal trauma may cause injury to various internal organs. • It is often difficult to accurately evaluate the site and extent of suspected internal injury clinically • Intra-abdominal injury may be masked by more obvious or compelling injuries elsewhere • The management of patients with solid organ injuries has changed dramatically, in most cases treatment has shifted from early surgical treatment to non-operative management • Hence, CT scan plays an important role in patient’s management as it provided a rapid, accurate assessment of abdominal viscera, retroperitoneum and abdominal wal

CT imaging of blunt splenic injury: a pictorial essay

Nonsurgical management has become the standard care for hemodynamically stable patients with splenic injury from blunt abdominal trauma. To attempt nonsurgical management, it is important to identify and characterize not only the splenic injury but also the concurrent injury to solid viscera, bowel and mesentry, or retroperitoneum that may require surgery. The ability of multi-detector row computed tomography (MDCT) to obtain high resolution images has made MDCT the primary imaging modality for the evaluation of these patients. The CT features of splenic injury include lacerations, subcapsular or parenchymal hematomas, active hemorrhage and vascular injuries. A variety of CT grading systems have been proposed to grade splenic injury following trauma. Radiologists should be familiar with the splenic injury grading system to facilitate communication with the managing surgical team and for research purposes. In Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang, from January 2008 to December 2009 there were 42 cases of splenic injuries out of 154 cases of blunt abdominal trauma, which underwent CT assessment. We reviewed all 42 cases of splenic injury and illustrated the spectrum of CT findings based on American Association for the Surgery of Trauma (AAST) classification

Accidental and non-accidental head injury in children. Is there a difference in Tomography (CT) presentation?

Introduction: Differentiation between accidental and non-accidental head injury particularly with intracranial haemorrhages in children is a common medical & legal dilemma. Previous studies & research based on surgical, radiological & autopsy data suggest that different types of brain injuries tend to occur with accidental versus non-accidental trauma. Published data showed that CT brain findings of subdural bleed are more frequently encountered with nonaccidental causes of head injury. Objective: To see if there is any significant difference in the types of intracranial hemorrhages seen on computed tomography (CT) brain between accidental and nonaccidental head injury in children admitted to Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang. Methodology: All CT brain of children (newborn to 18 yrs of age)admitted to HTAA from September 2009 until September 2010 which demonstrated intracranial bleed,traced from the CT scan registration book and from the PACS/RIS systems (Picture Archiving and Communication System / Radiology Information System)were included in this study. Patient’s clinical notes were traced from HTAA’s Record Office. The causes of non-accidental and accidental head injury were determined. All the CT images were interpreted independently by 2 radiologists who were blinded to the indication of the CT examination. Statistical analysis were done using SPSS version 12. Conclusion: Although limited by a small number of patients with non-accidental injury, our data showed that CT brain findings of subdural haemorrhage has a statistically significant association with non-accidental injury. This is similar with other published data in the literature