ivc trauma northern trauma conference 2014. ivc trauma penetrating blunt non
TRANSCRIPT
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IVC TRAUMA•NORTHERN TRAUMA CONFERENCE 2014
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IVC TRAUMA
• Penetrating• Blunt• Non• Non
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IVC Trauma due to penetrating injury
•High mortality (70%)•Higher if other associated vascular injuries•Recognised as a severe marker of injury•Consider other involved structures
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IVC TRAUMA - Imaging
• Range of injuries • Severity of injury• Difficulty of imaging - rate of blood loss and
poor identification• Rare finding. They often die before reaching
CT
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IVC TRAUMA - IMAGING SIGNS
• Index of suspicion. If you don't look for it, you won't find it.
• Active bleeding on CT
• Retro peritoneal haematoma
• Adjacent organ injury or other injuries
• Flat IVC
• Direct/indirect. Two lists
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IVC Injury – Imaging signs•DIRECT•Extravasation•Retroperitoneal haematoma
•INDIRECT•Adjacent injuries•Pericaval oedema•Hypovolaemia
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Hypovolaemia
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Hypovolaemia
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American Association for the Surgery of Trauma Organ Injury Scale for
Vascular Injuries OIS
Grade* Artery Injured Vein Injured
II HepaticSplenicGastric
GastroduodenalInferior mesenteric
Primary named vessels of superior mesenteric
SplenicInferior mesenteric
III RenalIliac
Hypogastric
Superior mesentericRenalIliac
HypogastricVena cava (infrarenal)
IV Superior mesenteric (trunk)Celiac axis
Aorta (infrarenal
Vena cava (infrahepatic)
V Aorta (suprarenal) Vena cava (suprahepatic)Vena cava (retrohepatic)
PortalHepatic (extrahepatic)
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IVC Injury - Penetrating
•24 year old male•0100 Stabbed in back•0230 Arrived in TU ED•0500 CT scan•0730 Laparotomy•1000 Transfer to Cardiothoracic Surgery
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IVC Injury - Penetrating
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IVC Injury - Penetrating
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IVC Injury
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IVC Injury - Blunt
•22 year old male•RTC – two vehicle head on collision. Driver of vehicle•Direct to MTC
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IVC Injury - Blunt
•22 year old male•RTC – two vehicle head on collision. Driver of vehicle•Direct to MTC•Injuries include•Left hepatic contusion•Ruptured left hemidiaphragm
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IVC Injury - Blunt
•22 year old male•RTC – two vehicle head on collision. Driver of vehicle•Direct to MTC•Injuries include•Left hepatic contusion•Ruptured left hemidiaphragm
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IVC injury – blunt trauma
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IVC injury – blunt trauma
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IVC Injury - Blunt
•22 year old male•RTC – two vehicle head on collision. Driver of vehicle•Direct to MTC•Injuries include•Left hepatic contusion•Ruptured left hemidiaphragm•Retroperitoneal haematoma 2ary to IVC laceration
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IVC Injury - Blunt
•Repaired surgically (along with other injuries)•Good recovery
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IVC TRAUMA - SUMMARY
• Marker of v severe injury• Rarely reaches imaging• Awareness of potential allows recognition • Underestimation of depth of penetration in
penetrating injury• Underestimation of haemorrhage in
penetrating injury