Abstract
Aims
The aims of the present work were to reevaluate, prospectively, the diagnostic value of already-described computed tomography (CT) landmarks of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) and to study the diagnostic value of some undescribed CT signs for the diagnosis of IAH and ACS.
Materials and methods
Consecutive patients admitted to the intensive care unit (ICU) in shock for whom an abdominal CT was clinically indicated were included. CT examinations were reviewed and scored by two reviewers for the 12 proposed CT features of IAH and ACS. Intravesical pressure (IVP) was measured for each patient. Imaging features and clinical data of patients with IAH (IVP ≥ 12 mmHg) were compared to those of patients with normal intra-abdominal pressure (IVP < 12 mmHg).
Results
Forty-one patients were included. Twenty-one patients (51%) presented IAH with an IVP value ≥ 12 mmHg. Four patients (10%) were considered to have ACS (10%). Only an increased peritoneal-to-abdominal height ratio (PAR) was associated with the presence of IAH (PAR = 0.45 [0.40–0.49] in patients with IVP < 12 mmHg and PAR = 0.52 [0.48–0.53] in patients with IVP ≥ 12 mmHg; p < 0.001). Increased PAR ≥ 0.52 had a specificity of 85% for IAH diagnosis.
Conclusion
The present study suggests that a PAR ≥ 0.52 could help radiologists to identify IAH on abdominal CT scan and could lead to adequate identification and/or treatment, even at early stages of IAH.
Key Points
• CT is an efficient first-intention procedure to evaluate and follow up underlying conditions in critically ill patients at risk of IAH and ACS overcome.
• Raising the possibility of an IAH on a CT examination is relevant information for the clinician.
• The only factors associated with intra-abdominal hypertension were the peritoneal-to-abdominal height ratio (PAR) and the ratio of maximal anteroposterior to transverse abdominal diameter (which define the round belly sign when > 0.8).
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Abbreviations
- ACS:
-
Abdominal compartment syndrome
- CT:
-
Computed tomography
- IAH:
-
Intra-abdominal hypertension
- ICU:
-
Intensive care unit
- IVP:
-
Intravesical pressure
- PAR:
-
Peritoneal-to-abdominal height ratio
- RBS:
-
Round belly sign
- WSACS:
-
World Society of the Abdominal Compartment Syndrome
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The scientific guarantor of this publication is Prof. Eric Delabrousse.
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Bouveresse, S., Piton, G., Badet, N. et al. Abdominal compartment syndrome and intra-abdominal hypertension in critically ill patients: diagnostic value of computed tomography. Eur Radiol 29, 3839–3846 (2019). https://doi.org/10.1007/s00330-018-5994-x
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DOI: https://doi.org/10.1007/s00330-018-5994-x