Skip to main content

Advertisement

SpringerLink
Log in

Role of Interventional Radiology in Solid Organ Trauma

  • Vascular Interventional Radiology (O Zurkiya, Section Editor)
  • Published:
Current Trauma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review describes the current role of diagnostic and interventional radiology in the management of solid organ trauma, particularly the role of non-operative endovascular interventions such as angioembolization (AE). We will also provide a brief highlight of interventions available for thoracic trauma.

Recent Findings

There has been a paradigm shift over the past 2 decades in the management of solid organ injuries from surgical management to non-operative management, especially in cases of minor injuries. Many factors, including the advances in multidetector contrast enhanced CT (MD-CECT) imaging, demands of cost-effective healthcare, and innovation of minimally invasive interventions with lower complication rates than surgical laparotomy have all contributed to this shift. Interventional radiology now plays a crucial role in the management of solid organ trauma, focusing on less invasive endovascular therapies. In addition, the grading and triaging of patients with stable solid organ traumatic injuries has become more reliant on MD-CECT findings.

Summary

This review article highlights the common imaging findings, grading systems, and most current management guidelines for solid organ trauma with a brief highlight of thoracic trauma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) http://www.cdc.gov/injury/wisqars. Published 2007. Accessed January 10, 2017.

  2. Raza M, Abbas Y, Devi V, Prasad KV, Rizk KN, Nair PP. Non operative management of abdominal trauma: a 10 years review. World J Emerg Surg. 2013;8:14.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Fang JF, Wong YC, Lin BC, Hsu YP, Chen MF. Usefulness of multidetector computed tomography for the initial assessment of blunt abdominal trauma patients. World J Surg. 2006;30(2):176–82.

    Article  PubMed  Google Scholar 

  4. Cox EF. Blunt abdominal trauma. A 5-year analysis of 870 patients requiring celiotomy. Ann Surg. 1984;199(4):467–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Marmery H, Shanmuganathan K, Alexander MT, Mirvis SE. Optimization of selection for nonoperative management of blunt splenic injury: comparison of MDCT grading systems. AJR Am J Roentgenol. 2007;189:1421–7.

    Article  PubMed  Google Scholar 

  6. •• Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, Guillamondegui OD, et al. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73:S294–300. The above reference outlines and highlights the most current guidelines for management of blunt splenic trauma

    Article  PubMed  Google Scholar 

  7. •• Stassen NA, Bhullar I, Cheng JD, Crandall M, Friese R, Guillamondegui O, et al. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73:S288–93. The above reference outlines and highlights the most current guidelines for management of blunt hepatic injury

    Article  PubMed  Google Scholar 

  8. ACR appropriateness criteria: https://acsearch.acr.org/docs/69409/Narrative/

  9. Korner M, Krotz MM, Degenhart C, Pfeifer K-J, Reiser MF, Lisenmaier U. Current role of emergency US in patients with major trauma. Radiographics. 2008;28:255–44.

    Article  Google Scholar 

  10. Branney SW, Wolfe RE, Moore EE, et al. Quantitative sensitivity of ultrasound in detecting free intraperitoneal fluid. J Trauma. 1995;39:375–80.

    Article  CAS  PubMed  Google Scholar 

  11. • Soto JA, Anderson SW. Multidetector CT of blunt abdominal trauma. Radiology. 2012;265:678–93. The above reference describes important MD-CT findings seen in blunt abdominal organ trauma

    Article  PubMed  Google Scholar 

  12. Anderson SW, Varghese JC, Lucey BC, et al. Bluntsplenictrauma: delayed- phase CT for differentiation of active hemorrhage from contained vascular injury inpatients. Radiology. 2007;243(1):88–95.

    Article  PubMed  Google Scholar 

  13. Peng MY, Parisky YR, Cornwell EE, Radin R, Bragin S. CT cystography versus conventional cystography in evaluation of bladder injury. AJR Am J Roentgenol. 1999;173(5):1269–72.

    Article  CAS  PubMed  Google Scholar 

  14. Chan DP, Abujudeh HH, Cushing GL, Novelline RA. CT cystography with multiplanar reformation for suspected bladder rupture: experience in 234 cases. AJR Am J Roentgenol. 2006;187(5):1296–302.

    Article  PubMed  Google Scholar 

  15. Orwig D, Federle MP. Localized clotted blood as evidence of visceral trauma on CT: the sentinel clot sign. AJR Am J Roentgenol. 1989;153(4):747–9.

    Article  CAS  PubMed  Google Scholar 

  16. Federle MP, Jeffrey RB. Hemoperitoneum studied by computed tomography. Radiology. 1983;148(1):187–92.

    Article  CAS  PubMed  Google Scholar 

  17. Levine CD, Patel UJ, Silverman PM, Wachsberg RH. Low attenuation of acute traumatic hemoperitoneum on CT scans. AJR Am J Roentgenol. 1996;166(5):1089–93.

    Article  CAS  PubMed  Google Scholar 

  18. Hassan R, Abd Aziz A, Md Ralib AR, Saat A. Computed tomography of blunt spleen injury: a pictorial review. Malays J Med Sci. 2011;18:60–7.

    PubMed  PubMed Central  Google Scholar 

  19. King H, Shumacker HB. Splenic studies. I. Susceptibility to infection after splenectomy performed in infancy. Ann Surg. 1952;136(2):239–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Renzulli P, Gross T, Schnüriger B, et al. Management of blunt injuries to the spleen. Br J Surg. 2010;97(11):1696–703.

    Article  CAS  PubMed  Google Scholar 

  21. • Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995;38(3):323–4. The above reference includes the most current AAST organ injury scaling for traumatic splenic and liver injuries

    Article  CAS  PubMed  Google Scholar 

  22. Kokabi N, Waqas S, Xing M, Harmouche E, Wilson K, Johnson JO, et al. Intra-abdominal solid organ injuries: an enhanced management algorithm. Can Assoc Radiol J. 2014;65:301–9.

    Article  PubMed  Google Scholar 

  23. Frandon J, Rodière M, Arvieux C, Michoud M, Vendrell A. BrouxC, et al. blunt splenic injury: outcomes of proximal versus distal and combined splenic artery embolization. Diagn Interv Imaging. 2014;95(9):825–31.

    Article  CAS  PubMed  Google Scholar 

  24. Haan JM, Bochicchio GV, Kramer N, Scalea TM. Nonoperativemanagement of blunt splenic injury: a 5-year experience. JTrauma. 2005;58(3):492–8.

    Google Scholar 

  25. Gaarder C, Dormagen JB, Eken T, Skaga NO, Klow NE, Pillgram-Larsen J, et al. Nonoperative management of splenic injuries: improved results with angioembolization. J Trauma. 2006;61(1):192–8.

    Article  PubMed  Google Scholar 

  26. Bessoud B, Denys A, Calmes JM, etal. Nonoperative management of traumatic splenic injuries: is there a role for proximal splenic artery embolization? AmJ Roentgenol 2006;186:779–785.

  27. Raikhlin A, Baerlocher MO, Asch MR, et al. Imaging and transcatheter arterial embolization for traumatic spleen icinjuries: review of the literature. Can J Surg. 2008;51:464–72.

    PubMed  PubMed Central  Google Scholar 

  28. Wu SC, Chen RJ, Yang AD, etal. Complications associated with embolization in the treatment of blunt splenic injury. World J Surg 2008; 32:476–482.

  29. • Imbrogno BF, Ray CE. Splenic artery embolization in blunt trauma. Semin Interv Radiol. 2012;29(2):147–9. The above reference describes the most current indications and technique for splenic artery embolization in blunt trauma

    Article  Google Scholar 

  30. Schnüriger B, Inaba K, Konstantinidis A, Lustenberger T, Chan LS, Demetriades D. Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis. J Trauma. 2011;70:242–60.

    Google Scholar 

  31. Steichen FM. Hepatic trauma in adults. Surg Clin North Am. 1975;55:387–407.

    Article  CAS  PubMed  Google Scholar 

  32. Yoon W, Jeong YY, Kim JK, et al. CT in blunt liver trauma. Radiographics. 2005;25:87–104.

    Article  PubMed  Google Scholar 

  33. Patten RM, Spear RP, Vincent LM, Hesla RB, Jurkovich GJ. Traumatic laceration of the liver limited to the bare area: CT findings in 25 patients. AJR Am J Roentgenol. 1993;160(5):1019–22.

    Article  CAS  PubMed  Google Scholar 

  34. Fleming KW, Lucey BC, Soto JA, Oates ME. Posttraumatic bile leaks: role of diagnostic imaging and impact on patient outcome. Emerg Radiol. 2006;12(3):103–7.

    Article  PubMed  Google Scholar 

  35. Salazar GMM, Walker TG. Evaluation and management of acute vascular trauma. Tech Vasc Interv Radiol. 2009;12:102–16.

    Article  PubMed  Google Scholar 

  36. Schwartz RA, Teitelbaum GP, Katz MD, Pentecost MJ. Effectiveness of transcatheter embolization in the control of hepatic vascular injuries. J Vasc Interv Radiol. 1993;4(3):359–65.

    Article  CAS  PubMed  Google Scholar 

  37. Kandarpa K, Machan L, editors. Handbook of interventional radiologic procedures. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011.

    Google Scholar 

  38. Alonso RC, Nacenta SB, Martinez PD, et al. Kidney in danger: CT findings of blunt and penetrating renal trauma. Radiographics. 2009;29(7):2033–53.

    Article  PubMed  Google Scholar 

  39. Ramchandani P, Buckler PM. Imaging of genitourinary trauma. AJR Am J Roentgenol. 2009;192(6):1514–23.

    Article  PubMed  Google Scholar 

  40. Santucci RA, McAninch JW, Safir M, Mario LA, Service S, Segal MR. Validation of the American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma. 2001;50(2):195–200.

    Article  CAS  PubMed  Google Scholar 

  41. • Moore EE, Shackford SR, Pachter HL, et al. Organ injury scaling: spleen, liver, kidney. J Trauma. 1989;29(12):1664–6. The above reference outlines and describes the most current AAST organ injury scaling for traumatic renal injuries

    Article  CAS  PubMed  Google Scholar 

  42. Harris AC, Zwirewich CV, Lyburn ID, Marchinkow LO. CT findings in blunt renal trauma. Radiographics. 2001;21:S201–14.

    Article  PubMed  Google Scholar 

  43. Sauk S, Zuckerman DA. Renal artery embolization. Semin Interv Radiol. 2011;28:396–406.

    Article  Google Scholar 

  44. • Mani N, Kim L. Role of interventional radiology in urologic tract trauma. Semin Interv Radiol. 2011;28:415–23. The above reference outlines the most current indications and technique for IR management of traumatic kidney injuries

    Article  Google Scholar 

  45. Cirillo RL, Koniaris LG. Detecting blunt pancreatic injuries. J Gastrointest Surg. 2002;6:587–98.

    Article  PubMed  Google Scholar 

  46. Kao LS, Bulger EM, Parks DL, Byrd GF, Jurkovich GJ. Predictors of morbidity after traumatic pancreatic injury. J Trauma. 2003;55:898–905.

    Article  PubMed  Google Scholar 

  47. Venkatesh SK, Wan JM. CT of blunt pancreatic trauma: a pictorial essay. Eur J Radiol. 2008;67:311–20.

    Article  PubMed  Google Scholar 

  48. Gupta A, Stuhlfaut JW, Fleming KW, Lucey BC, Soto JA. Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Radiographics. 2004;24:1381–95.

    Article  PubMed  Google Scholar 

  49. Madiba TE, Mokoena TR. Favourable prognosis after surgical drainage of gunshot, stab, or blunt trauma of the pancreas. Br J Surg. 1995;82:1236–9.

    Article  CAS  PubMed  Google Scholar 

  50. Linsenmaier U, Wirth S, Reiser M, Körner M. Diagnosis and classification of pancreatic and duodenal injuries in emergency radiology. Radiographics. 2008;28:1591–601.

    Article  PubMed  Google Scholar 

  51. Moore EE, Cogbill TH, Malangoni MA, Jurkovich GJ, et al. Organ injury scaling, II: pancreas, duodenum, small bowel, colon, and rectum. J Trauma. 1990;30(11):1427–9.

    Article  CAS  PubMed  Google Scholar 

  52. Heitsch RC, Knutson CO, Fulton RL, Jones CE. Delineation of critical factors in the treatment of pancreatic trauma. Surgery. 1976;80(4):523–9.

    CAS  PubMed  Google Scholar 

  53. Jones RC. Management of pancreatic trauma. Ann Surg. 1978;187:555–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Fisher M, Brasel K. Evolving management of pancreatic injury. Curr Opin Crit Care. 2011;17:613–7.

    Article  PubMed  Google Scholar 

  55. Canty TG, Weinman D. Treatment of pancreatic duct disruption in children by an endoscopically placed stent. J Pediatr Surg. 2001;36:345–8.

    Article  PubMed  Google Scholar 

  56. Bradley EL, Young PR, Chang MC, Allen JE, Baker CC, Meredith W, et al. Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multiinstitutional review. Ann Surg. 1998;227:861–9.

    Article  PubMed  PubMed Central  Google Scholar 

  57. The American College of Surgeons Committee on Trauma Leadership. In: Clark DE, Fantus RJ, editors. National Trauma Data Bank (NTDB) annual report. Chicago: Ill: American College of Surgeons; 2007. p. 1–64.

    Google Scholar 

  58. Report on injuries in America: all unintentional injuries, 2005. Available at: http://www.nsc.org/library/report_table_1.htm. Accessed December 9, 2007.

  59. Livingston DH, Haurer CJ. Trauma to the chest wall and lung. In: Moore EE, Feliciano DV, Mattox KL, editors. Trauma. 5th ed. Philadelphia, Pa: McGraw-Hill; 2004. p. 507–37.

    Google Scholar 

  60. Kaewlai R, Avery LL, Asrani A, Novelline RA. Multidetector CT of blunt thoracic trauma. Radiographics. 2008;28:1555–70.

    Article  PubMed  Google Scholar 

  61. Exadaktylos AK, Sclabas G, Schmid SW, Schaller B, Zimmermann H. Do we really need routine computed tomographic scanning in the primary evaluation of blunt chest trauma in patients with “normal” chest radiograph? J Trauma. 2001;51:1173–6.

    CAS  PubMed  Google Scholar 

  62. Hagiwara A, Yanagawa Y, Kaneko N, Takasu A, et al. Indications for transcatheter arterial embolization in persistent hemothorax caused by blunt trauma. J Trauma. 2008;65:589–94.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Interventional Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Frank Kowalkowski Jr., Gurpreet Sandhu & Indravadan J. Patel

Authors
  1. Frank Kowalkowski Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gurpreet Sandhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Indravadan J. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frank Kowalkowski Jr..

Ethics declarations

Conflict of Interest

Frank Kowalkowski Jr., Gurpreet Sandhu, and Indravadan Patel declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Vascular Interventional Radiology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kowalkowski, F., Sandhu, G. & Patel, I.J. Role of Interventional Radiology in Solid Organ Trauma. Curr Trauma Rep 3, 212–222 (2017). https://doi.org/10.1007/s40719-017-0091-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40719-017-0091-1

Keywords

Search

Navigation