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