Hemoperitoneum as the sole indicator of abdominal visceral injuries: A potential limitation of screening abdominal US for trauma

PURPOSE: To determine, at screening ultrasonography, the prevalence, severi ty, and clinical outcome of clinically important abdominal visceral injurie s, without associated hemoperitoneum, that result from blunt abdominal trau ma. MATERIALS AND METHODS: Computed tomography (CT) was performed at admission in 466 patients with visceral injury. A retrospective review was performed of findings from surgery and contrast material-enhanced spiral and conventi onal CT performed to verify abdominal visceral injuries in 467 (4%) of 11,1 88 patients with blunt trauma. These patients were admitted to a level I tr auma center over 33 months to determine the presence of hemoperitoneum and to identify the grade of injury. Medical records of patients with abdominal visceral injury without hemoperitoneum were reviewed for the management re quired and for results of focused abdominal sonography for trauma (FAST). RESULTS: A total of 575 abdominal visceral injuries were identified at CT a nd/or surgery. Findings of CT at admission (n = 156) and of surgery (n = 1) revealed no evidence of hemoperitoneum in 157 (34%) patients with abdomina l visceral injury; 26 (17%) of whom also had negative FAST studies. Abdomin al visceral injuries diagnosed in patients without hemoperitoneum included 57 (27%) of 210 splenic injuries, 71 (34%) of 206 hepatic injuries, 30 (48% ) of 63 renal injuries, four (11%) of 35 mesenteric injuries, and two (29%) of seven pancreatic injuries. Surgical and/or angiographic intervention wa s required in 26 (17%) patients without hemoperitoneum. CONCLUSION: Reliance on the presence of hemoperitoneum as the sole indicato r of abdominal visceral injury limits the value of FAST as a screening diag nostic modality for patients who sustain blunt abdominal trauma.