IVC TRAUMA•NORTHERN TRAUMA CONFERENCE 2014
IVC TRAUMA
• Penetrating• Blunt• Non• Non
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
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
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
IVC Injury – Imaging signs•DIRECT•Extravasation•Retroperitoneal haematoma
•INDIRECT•Adjacent injuries•Pericaval oedema•Hypovolaemia
Hypovolaemia
Hypovolaemia
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)
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
IVC Injury - Penetrating
IVC Injury - Penetrating
IVC Injury
IVC Injury - Blunt
•22 year old male•RTC – two vehicle head on collision. Driver of vehicle•Direct to MTC
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
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
IVC injury – blunt trauma
IVC injury – blunt trauma
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
IVC Injury - Blunt
•Repaired surgically (along with other injuries)•Good recovery
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