Journal of Veterinary Clinics (한국임상수의학회지)

The Korean Society of Veterinary Clinics (한국임상수의학회)
권호 표지
DOI QR코드

DOI QR Code

Computed Tomographic Features of Blunt Abdominal Trauma in a Dog

개에서 컴퓨터단층촬영을 이용한 복부 장기 열상 진단 1례

  • Park, Hyun-young (College of Veterinary Medicine, Chungnam National University) ;
  • Seo, Ji-won (College of Veterinary Medicine, Chungnam National University) ;
  • Lee, Young-won (College of Veterinary Medicine, Chungnam National University) ;
  • Choi, Ho-jung (College of Veterinary Medicine, Chungnam National University)
  • Accepted : 2016.02.20
  • Published : 2016.02.29
Download PDF
⟨ Previous Next ⟩

Abstract

A 10 months old, male Poongsan dog was referred with a history of right forelimb lameness due to hit by a car a few hours before presentation. On the physical examination, the dog showed pale mucous membrane, respiration distress, and skin abrasions. The main laboratory finding was leukocytosis, while hematocrit was normal. Abdominal radiography revealed the loss of abdominal serosal detail, which was diagnosed as peritoneal hemorrhage on ultrasonography (US) and aspiration. On computed tomography (CT), hepatic and splenic injuries were seen characterized by the discontinuity of the capsule with irregular margin and lower density lesions than parenchyma. No contrast enhancing area were shown in the laceration lesion. The accessory spleen was incidentally found by US and CT. In this case, acute intra-abdominal hemorrhage from splenic and hepatic laceration was diagnosed using CT.

10개월령 몸무게 20 kg의 수컷 풍산개가 내원 몇 시간 전 발생한 교통사고로 인한 우측 전지 파행을 주증으로 의뢰되었다. 신체검사상 점막은 창백한 색이었고, 피부에 다수의 열상과 호흡곤란 증세를 보였다. 혈액검사에서 적혈구 용적률은 정상이었으며, 백혈구 수치가 증가하였다. 복부 방사선 검사에서 전반적인 복막 선예도 소실이 확인되었고, 이는 초음파 검사를 통해 복수로 진단되었다. CT 검사상 간과 비장의 손상 부위에서 불규칙한 변연을 동반한 피막의 불연속성과 조영 증강이 나타나지 않는 정상 실질보다 낮은 밀도가 특징적인 병변이 확인되어, 간과 비장의 열상과 혈복을 진단하였다. 또한 초음파와 CT 검사에서 우연히 부비장이 진단되었다. 본 증례는 CT 검사를 이용하여 급성 복강내 출혈의 원인으로 간과 비장의 열상을 확인하였다.

Keywords

References

  1. Eichler K, Marzi I, Wyen H, Zangos S, Mack MG, Vogl TJ. Multidetector computed tomography (MDCT): simple CT protocol for trauma patient. Clin Imaging 2015; 39: 110-115. https://doi.org/10.1016/j.clinimag.2014.09.011
  2. Federle MP, Goldberg HI, Kaiser JA, Moss AA, Jeffrey Jr RB, Mall JC. Evaluation of abdominal trauma by computed tomography. Radiology 1981; 138: 637-644. https://doi.org/10.1148/radiology.138.3.6450962
  3. 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: 60-67.
  4. Herold L V, Devey JJ, Kirby R, Rudloff E. Clinical evaluation and management of hemoperitoneumin dogs. J Vet Emerg Crit Care 2008; 18: 40-53. https://doi.org/10.1111/j.1476-4431.2007.00265.x
  5. Hoff WS, Holevar M, Nagy KK, Patterson L, Young JS, Arrillaga A. Practice management guidelines for the evaluation of blunt abdominal trauma: EAST Practice Management Guidelines Work Group. J Trauma 2002; 53: 602-615. https://doi.org/10.1097/00005373-200209000-00038
  6. Kokabi N, Harmouche E, Xing M, Shuaib W, Mittal PK, Wilson K, Khosa F. Specific radiological findings of traumatic gastrointestinal tract injuries in patients with blunt chest and abdominal trauma. Can Assoc Radiol J 2015; 66: 158-163. https://doi.org/10.1016/j.carj.2014.11.003
  7. Kokabi N, Shuaib W, Xing M, Harmouche E, Wilson K, Johnson JO, Khosa F. Intra-abdominal solid organ injuries: An enhanced management algorithm. Can Assoc Radiol J 2014; 65: 301-309. https://doi.org/10.1016/j.carj.2013.12.003
  8. Lisciandro GR, Lagutchik MS, Mann KA, Fosgate GT, Tiller EG, Cabano NR, Howard PK. Evaluation of an abdominal fluid scoring system determined using abdominal focused assessment with sonography for trauma in 101 dogs with motor vehicle trauma. J Vet Emerg Crit Care 2009; 19: 426-437. https://doi.org/10.1111/j.1476-4431.2009.00459.x
  9. Peitzman AB, Makaroun MS, Slasky BS, Ritter P. Prospective study of computed tomography in initial management of blunt abdominal trauma. J Trauma 1986; 26: 585-592. https://doi.org/10.1097/00005373-198607000-00001
  10. Prosser KJ, Webb JA, Hanselman BA. Ectopic spleen presenting with anemia and an abdominal mass in a dog. Can Vet J 2013; 54: 1071-1074.
  11. Ramirez GA, Altimira J, Garcia-Gonzalez B, Vilafranca M. Intrapancreatic ectopic splenic tissue in dogs and cats. J Comp Path 2013; 148: 361-364. https://doi.org/10.1016/j.jcpa.2012.08.006
  12. Rossi F, Rabba S, Vignoli M, Haers H, Terragni R, Saunders JH. B-mode and contrast-enhanced sonographic assessment of accessory spleen in the dog. Vet Radiol Ultrasound 2010; 51: 173-177.
  13. Tang J, Li W, Lv F, Zhang H, Zhang L, Wang Y, Yang L. Comparison of gray-scale contrast-enhanced ultrasonography with contrast-enhanced computed tomography in different grading of blunt hepatic and splenic trauma: An animal experiment. Ultrasound Med Biol 2009; 35: 566-575. https://doi.org/10.1016/j.ultrasmedbio.2008.09.028
  14. Taylor GA, Kaufman RA, Sivit, CJ. Active hemorrhage in children after thoracoabdominal trauma: Clinical and CT features. Am J Roentgenol 1994; 162: 401-404. https://doi.org/10.2214/ajr.162.2.8310935
  15. Wadham BM, Adams PB, Johnson MA. Incidence and locations of accessory spleens. N Engl J Med 1981; 304: 1111.
  16. Whitehead A, Moront M, Wu L, Prasad R. Predictors of solid organ injury following blunt abdominal trauma: A single institution process improvement initiative. J Surgery 2015; 3.
  17. Yoon W, Jeong YY, Kim JK. CT in blunt liver trauma. Radiographics 2005; 25: 87-104. https://doi.org/10.1148/rg.251045079