PancreaticTrauma--LiuHongli分析.pptVIP

Fig.3A. Pancreatic fracture isolated injury The fracture line can easily be seen traversing the entire width of the gland (arrow). No peripancreatic abnormalities are detected. Fig.3B. Pancreatic fracture as lesser injury CT image from a 33-year-old patient who sustained a stab wound to the left flank. There is extravasation of iodinated contrast from the aorta. Additionally, there is a fracture across the pancreatic body (arrow). A B the findings that pancreatic edema and peripancreatic collections may obscure visualization of the actual pancreatic injury. Although the actual parenchymal defect in the injured pancreas may not be detected, CT findings that simulate acute pancreatitis (peripancreatic increased density, thickening of anterior renal fascia, peripancreatic fluid collections, mesocolic collections, intra- and retroperitoneal fluid) should raise the suspicion of pancreatic injury. (Fig.4) If there is high clinical suspicion of pancreatic injury, particularly in the presence of a delayed elevation in the serum amylase, a repeated CT study may actually reveal the injury that was occult on the initial evaluation. (Fig.5) Diffuse pancreatic hematoma Fig.4A. Single image from a non-IV enhanced CT scan reveals diffuse pancreatic enlargement (P). The high attenuation rim surrounding the pancreas represents blood accumulating (arrowheads). Fig.4B. There is a blood-fluid level in the pancreatic head (arrow). Peripancreatic fluid is present in the right anterior pararenal space. Additional injuries included renal contusions (arrowheads) . A B Evolution of pancreatic injury Fig.5A. CT image in 29-year-old patient who was in an automobile accident reveals a small lucency in the body of the pancreas (arrow). Hemoperitoneum and a liver laceration are seen. Fig.5B. CT study 3 days later. The hematoma has increased in size resulting in increasing separation of the pancreatic fragments (arrow). The hemoperitoneum has increased. Fig.5C. Study perfor