Radiographics : a review publication of the Radiological Society of North America, Inc
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Urethral injury is a common complication of pelvic trauma that, if undiagnosed, may lead to significant long-term morbidity. Segments of the urethra that are near the pubic rami and the puboprostatic ligaments are particularly vulnerable. ⋯ However, even for radiologists who are familiar with standard technique, urethrography after pelvic trauma may be particularly challenging because the patient is immobile or a surgical fixation device or indwelling urethral catheter is present. Various methods may used to overcome these difficulties and ensure that optimal images are obtained so that a correct diagnosis can be made without additional imaging evaluations.
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Pancreatic and duodenal injuries after blunt abdominal trauma are rare; however, delays in diagnosis and treatment can significantly increase morbidity and mortality. Multidetector computed tomography (CT) has a major role in early diagnosis of pancreatic and duodenal injuries. Detecting the often subtle signs of injury with whole-body CT can be difficult because this technique usually does not include a dedicated protocol for scanning the pancreas. ⋯ The latter conditions require immediate surgical intervention. Use of organ injury scales and a surgical classification adapted for multidetector CT enables classification of organ injuries for trauma scoring, treatment planning, and outcome control. In addition, multidetector CT reliably demonstrates potential complications of duodenal and pancreatic injuries, such as posttraumatic pancreatitis, pseudocysts, fistulas, exudates, and abscesses.
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Blunt cerebrovascular injuries (BCVIs) can cause ischemic stroke and are associated with high mortality rates. However, treatment of BCVI can prevent or limit stroke. Although digital subtraction angiography is the diagnostic standard for detecting BCVI, recent studies indicate that multidetector computed tomographic (CT) angiography may be an accurate, rapid, noninvasive diagnostic alternative. ⋯ Several other injuries and injury patterns can be used to identify patients with a high likelihood of concurrent BCVI, and these patterns can be used as indications to screen for BCVI. By facilitating early diagnosis and treatment of BCVI, such screening has been shown to improve the clinical outcomes of affected patients. Familiarity with the various imaging manifestations of injury at multidetector CT angiography, as well as with the diagnostic limitations of this modality and the various clinical factors that affect its use, is necessary if it is to be used effectively to diagnose and influence the management of BCVIs.
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High-frequency ultrasonography (US) with a linear-array transducer is the modality of choice for the initial evaluation of patients with acute scrotal pain after trauma. Testicular trauma is the third most common cause of acute scrotal pain. ⋯ In addition, 10% of testicular tumors are found incidentally at US performed for the evaluation of trauma. If a conservative approach is adopted for the management of an intratesticular abnormality after trauma, follow-up US should be performed until the images show a complete resolution of the abnormality, so that a tumor will not be missed.