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Interesting finding on “Pan Scan”…

January 24, 2014

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The trauma “Pan Scan” has been a controversial topic for a while now.  “Pan Scan” has multiple meanings but is usually some combination of head, c-spine, chest and abdomen CT imaging to identify serious traumatic related injuries.  Downsides include cost, radiation, and contrast.  Upsides include early identification of serious trauma including solid organ injuries.  Here is an interesting case that presents an original argument for the “Pan Scan:”

Pills in skin folds 2 Pills in skin folds

This person came in with altered mental status and trauma (single car MVC).  CT identified a large number of hidden pills later identified as an opioid pain medication.  They were hidden in an abdominal fold just above the pubis!

(Disclaimer:  Please don’t misinterpret this as an argument to identify pills with a pan scan.  It would have been much more cost effective to find them on physical exam)

Image Contributor:  Julie Phan, MD

Author:  Russell Jones, MD

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Kidney fracture with active extravasation…

March 31, 2013

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This patient came in shortly after a high speed motor-vehicle collision.  Here is the patient’s CT abdomen with IV contrast:

Kidney fx 3Kidney Fx 2Kidney fx 1

This is an interesting CT as it demonstrates “active extravasation” of IV contrast.  The patient has a large left kidney fracture.  You can see a hematoma surrounding the area where you would expect the kidney.  In that hematoma there is a mix of low attenuation material and high attenuation material.  Both of these represent blood; the high attenuation is contrast material that leaking into the hematoma (some of the high attenuation includes perfusing kidney fragments but most of it is extravasating contrast).  The low attenuation is blood that collected before IV contrast administration.

Practically speaking, this means that there is active bleeding into this hematoma.  This is BAD and represents a large amount of bleeding that needs to be stopped.  The patient was actually relatively stable and was taken to interventional radiology where the offending lesion was embolized.

Author:  Russell Jones, MD

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