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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.
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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
DIRECT Extravasation Retroperitoneal haematoma INDIRECT Adjacent injuries Pericaval oedema Hypovolaemia IVC Injury – Imaging signs
American Association for the Surgery of Trauma Organ Injury Scale for Vascular Injuries
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 - 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 • 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