General Abdomen/Pelvis

• Spaces and ligaments

  • Right subphrenic space communicates with anterior and posterior subhepatic spaces and with pelvic peritoneal cavity via the right paracolic gutter

    • Morrison's pouch => posterior subhepaptic space

  • Left subphrenic space communicates with left subhepatic space, but not with right subhepatic space because of the falciform ligament

  • Lesser omentum is composed of gastrohepatic and hepatoduodenal ligaments

    • Separates the gastrohepatic recess of the left subphrenic space from lesser sac

  • Greater omentum

  • Retroperitoneal space is divided into:

    • Anterior pararenal space => pancreas, duodenal loop, ascending and descending portions of the colon

    • Perirenal space

    • Posterior perirenal space => contains fat

  • Pelvic compartments

    • Peritoneal => Pouch of Douglas (Cul de Sac) or rectovesical pouch

    • Retroperitoneal => Extraperitoneal space of the pelvis, which includes retropubic space of Retzius

    • Perineum => ischiorectal fossa

• Ascites Fluid

  • Serous ascites => -10 to +10 HU

  • Exudative ascites => +15 HU

  • Acute blood => + 45 HU

• Pseudomyxoma peritonei => gelatinous ascites from spread of mucin producing cells (scalloping of the liver)

  • Rupture of appendiceal mucocele

  • Intraperitoneal spread of mucinouls adenocarcinoma

    • Ovarian

    • Colol/rectum

  • Mucinous tumors

    • Pancreas

    • Ovary

    • Appendix

    • Urachus

• Peritoneal carcinomatosis

  • Omental caking

• Peritoneal metastases

• Peritoneal mesothelioma

• Retractile mesenteritis

  • Infiltrating soft tissue mass with calcifications and tethering of bowel loops

• Desmoid tumors

  • Gardner syndrome

• Low density cystic mesenteric masses

  • Treated lymphoma

  • Necrotic metastases

  • Mycobacterium

  • Whipple disease

  • Cavitary mesenteric lymph node syndrome

    • Complication of celiac disease

• Calcifications

  • Vascular calcifications

  • Calcified lymph nodes

  • Gallstones or calcified gallbladder

  • Urinary calculi

  • Granulomas

  • Appendicoliths and enteroliths

  • Calcified adrenals

  • Pancreatic calcifications

  • Calcified cysts

  • Tumor calcifications

  • Soft tissue calcifications => hypercalcemia, old hematomas, injection granulomas, cysticercosis

• Retroperitoneal fibrosis

  • Idiopathic in 2/3 of the cases

  • Methysergine (anti-migraine medication)

  • Metastatic foci which elicit fibrotic reaction

  • Inflammatory aneurysms

  • TB, syphillis, actinomycosis, fungi

• Omental caking

  • Primary => mesothelioma

  • Peritoneal carcinomatosis

    • Ovary

    • Colon

    • Stomach

    • Pancreas

    • Uterus

    • Bladder

• Omental torsion

  • Usually in the right abdomen

• Epiploic appendigitis

  • Fatty mass with hyperattenuating rim

  • Usually adjacent to sigmoid

Liver

• Fatty infiltration is best evaluated on non-contrast images. Spleen enhances 1-2 min before liver and may be transiently brighter than normal liver. Normal liver is same or higher density than the spleen on CT, and slightly hypoechoic to spleen and isoechoic or slightly hyperechoic to kidney on US. Liver is higher in SI compared to spleen on T1WI , and lower or same compared to spleen on T2WI.

• Diffuse disease

  • Diffuse fatty infiltration

  • Focal fatty infiltration

  • Multifocal fatty infiltration

  • Focal sparing

    • Cirrhosis

      • Fatty infiltration and hepatomegaly (early)

      • Non-uniform attenuation and irregular fibrosis (late)

      • Irregular contour

      • Regenerating nodules

      • Decreased liver volume (chronic cirrhosis)

      • Accentuation of fissures

      • Ascites and portal hypertension

    • Portal hypertension

    • Portal vein thrombosis

    • Passive congestion

    • Iron deposition

    • Budd Chiari

  • Hemochromatosis

    • Liver, pancreas, heart

  • Hemosiderosis

    • Liver, spleen, bone marrow

  • Glycogen storage disease

    • Predisposes to multiple adenomas

• Focal disease

  • Infection

    • Pyogenic abscess

    • Amebic cyst

      • Solitary cyst

    • Echinococcal cyst

      • Solitary mass with internal cysts

    • Candidiasis

      • Bull-eye lesions on sonography.

  • Cavernous hemangioma (most common focal hepatic mass)

    • Well-defined isodense to blood-filled spaces

    • Peripheral nodule-like enhancement, centripetal fill-in

    • Contrast enhancement for 20-30 min

    • Large lesion with areas of fibrosis, occasional calcifications

    • Red blood cell scintigraphy is usually diagnostic

  • Focal nodular hyperplasia

    • Hypodense, homogenous, homogenous enhancement, central scar (hyperintense on T2)

    • Central scar enhances late

    • Tc99mSC → normal (40%), increased (10%), cold defect (50%)

    • Multiple in 7% of cases

  • Hepatic adenoma

    • Hypodense heterogenous mass, hemorrhagic, heterogenous enhancement

    • Absence of uptake of Tc-99m SC

    • Multiple in 30% of cases

    • Can hemorrhage

    • Intracellular fat on in-phase/out-phase imaging

  • Biliary cystadenoma

    • Large septated cystic mass

  • Angiomyolipoma

  • Metastasis

  • Hepatoma (Hepatocellular carcinoma)

    • Types: Solitary (50%), Diffuse infiltrative (30%), Multinodular (20%)

    • Low density, enhances in arterial phase, areas of necrosis, calcifications in 25%

  • Fibrolamellar carcinoma => subtype of HCC

    • Well-defined hypodense mass, central low density scar (hypointense on T2), marked enhancement

    • DiffDx: Focal Nodular hyperplasia (central scar is hyperintense on T2)

  • Lymphoma

    • Multiple well defined hypodense nodules

  • Hepatoblastoma

  • Cystic masses

    • Simple hepatic cyst

    • Pyogenic abcess

    • Amebic abcess

    • Echinoccoccus cyst

    • Cystic/Necrotic liver tumors

  • Biliary hamartomas of the liver (Von Meyenburg complexes)

• Trauma

Biliary Tree

• Cholangiocarcinoma

• Primary sclerosing cholangitis

  • DiffDx: PBC, cholangiocarcinoma

  • Discontinous biliary dilatation

  • Associated with IBD, pancreatitis, retroperitoneal and mediastinal finrosis

  • Complications: cirrhosis and cholangiocarcinoma

• AIDS cholangiopathy

  • Indistinguishable from PSC

• Oriental cholangiohepatitis

  • Strictures, dilatations, stones, straight rigid intrahepatic ducts

• Primary biliary cirrhosis

  • Small bile ducts are involved

  • Crowding and deformity of bile ducts

• Bacterial cholangitis

• Caroli’s disease => saccular ectasia of intrahepatic ducts

  • Associated with medullary sponge kidney and ARPKD

• Choledochal cyst

  • Classification of congenital cysts

    • Focal saccular or fusiform dilatation of CBD

    • True diverticuli of CBD

    • Cholledochoceles at the intraduodenal portion of CBD

    • Multiple intrahepatic and extrahepatic cysts

    • Caroli's disease

      • Segmental saccular dilatations in the non-obstructed intrahepatic ductal system

      • Stasis with resultant predisposition to infection and stone formation

      • Increased risk of cholangiocarcinoma

      • Renal tubular exctasia and renal cystic disease are seen in 80% of cases

      • May need luminal contrast studies to differentiate from polycystic disease

• Biliary obstruction

  • Stones

  • Sphincter of Oddi spasm

  • Cholangiocarcinoma

  • Ampullary carcinoma

  • Pancreatic carcinoma

  • Biliary papillomatosis

Gallbladder

• Gallbladder

  • Anatomy

    • Phrygian cap => fold or septation near the gallbladder fundus.

    • Ectopic gallbladder

      • Herniation into the lesser sac is possible

    • Duplications

  • Gallstones

    • Cholesterol 80%

    • Sufficiently calcified to be seen on plain films 15%

  • Acute cholecystitis

  • Porcelain gallbladder

    • Gallbladder carcinoma develops in 20%-30% of patients with porcelain gallbladder.

  • Gallbladder carcinoma

  • Mirizzi's syndrome => biliary obstruction from stone in cystic duct eroding into the CBD and causing inflammation which obstructs CBD

  • Thick GBW

    • Cholecystitis (acute or chronic)

    • Hepatitis

    • Portal venous HTN and CHF

    • AIDS

    • Hypoalbunemia

    • GB carcinoma

    • Adenomyomatosis

      • Hyperplastic changes in the mucosa and muscularis with resultant outpouchings of the mucosa into or through muscularis to form Rokitansky-Aschoff sinuses

    • Cholesterolosis

      • Cholesterol polyps

      • Strawberry gallbladder is diffuse

  • Most common metastatic lesion is melanoma

  • Gallstone ileus

    • Fistula

    • Gallbladder to duodenum (obstruction at the ileocecal valve)

    • Gallbladder to hepatic flexure (no obtruction)

    • Gallbladder to stomach (pyloric obstruction is possible)

  • Gallbladder varices

  • Emphysematous cholecystitis

    • Dirty shadowing

Spleen

• Anomalies

  • Accessory spleen

  • Wandering spleen

  • Splenic regeneration

• Splenomegaly

  • Size greater than 12 cm

  • Extension below costal margin

• Diffuse disease

  • Gamna-Gandy Bodies (siderotic nodules) => small splenic hemorrhages caused by portal HTN

  • Lymphoma

  • Sarcoidosis

    • Multiple tiny hypoattenuating splenic lesions

• Cystic lesions

  • Post-traumatic (false cysts)

  • Congenital epidermoid cysts (true cysts)

  • Echinococcal cysts

  • Pancreatic pseudocysts via dissection

  • Abcesses

    • Bacterial

    • Microabcesses – usually in immunocompromised

      • Fungi (Candida, Aspergillus, Cryptococcus)

      • TB

      • PCP

      • CMV

• Solid lesions

  • Hemangioma

  • Inflammatory pseudotumor

  • Hamartoma

  • Infarction

  • Lymphoma

  • Metastases

    • Most commonly melanoma, breast, ovary, lung

  • Angiosarcomas

• Hematoma

• Dense atrophic spleen

  • Autosplenectomy from sickle cell disease

  • Thorium dioxide exposure

Pancreas

• Congenital

  • Pancreas divisum

    • Normally dorsal duct (tail and body) and ventral duct (head) fuse to form Wirsung duct which drains into major papilla. Remaining portion of dorsal duct (Santorini) drains into more proximal minor papilla

    • In pancreas divisum, dorsal and ventral ducts never fuse resulting in dorsal duct (Santorini) draining most of pancreas via minor papilla

    • On axial CT in pancreas divisum, dorsal duct appears ventral, but drains most of the pancreas

  • Annular pancreas

    • Pancreatic duct encircles endoscope or duodenum on ERCP

    • Duodenal narrowing

    • Pancreatic tissue encircles duodenum on CT

• Pancreatitis

  • Acute pancreatitis complications:

    • Phlegmon

    • Fluid collections

    • Pseudocyst (clearly identifiable fibrous capsule)

    • Necrosis

    • Abcess

    • Hemorrhage

    • Pseudoaneurysm

    • Thrombosis

    • Ascites

  • Chronic pancreatitis complications

    • Dilation of pancreatic duct, dilations of biliary duct

    • Atrophy

    • Calcifications

    • Fluid collections

    • Focal enlargement

    • Fascial thickening and stranding

• Neoplasms

  • Pancreatic ductal adenocarcinoma

    • Hypovascular

    • Encases vessels

    • Rarely calcifies

    • Ductal dilatation is usually present

  • Lymphoma

  • Islet cell tumors

    • Hypervascular

    • Does not encase vessels

    • Calcifies

  • Solid and papillary epithelial tumor

    • Usually found in young women of African descent

  • Acinar cell carcinoma

    • Usually found in older men

    • Large size

  • Metastases

    • Renal cell and melanoma are most common

    • Local spread from kidney, stomach, or colon (may be hypervascular)

    • Hematogenous spread from breast, lung, melanoma

    • Lymphoma, leukemia

  • Local spread from adjacent organs

  • Cystic lesions

    • Cystic tumors

      • Serous cystadenoma (young female)

        • Usually more than 6 small cysts (< 2cm)

      • Intraductal pancreatic mucinous neoplasms

        • Ducts are usually dilated by mucin

        • Filling defects maybe visible

      • Mucinous cystic neoplasm

        • Most commonly found in pancreatic tail

        • Usually less than 6 large cysts (>2cm)

      • Microcystic adenomas

    • Pseudocyst

    • Abscess

    • True pancreatic cyst

    • vHL

• Trauma

• Fatty pancreas

  • CF

Kidneys

• Tumors

  • RCC

  • Oncocytoma

  • Transitional cell carcinoma

  • Angiomyolipoma (tuberous sclerosis)

  • Renal lymphoma

  • Metastases

• Cystic disease

  • Simple cyst (-10 HU to +15 HU)

  • Complicated cyst

  • Indeterminate

  • Renal abcess

  • RCC

  • Multilocular cystic neproma

• Mutliple renal cysts

  • Multiple simple cysts

  • ADPD

  • Multicystic dysplastic kidney

  • von Hippel-Lindau disease

  • TS

  • Long term haemodialysis

• Stones

• Infection

  • Acute bacterial infection

    • Acute pyelonephritis

    • Lobar nephronia

    • Abscess

    • Emphysematous pyelonephritis

    • Pyonephrosis

  • Chronic infection

    • TB

    • Xantogranulomatous pyelonephritis

• Trauma

GI Tract

• Esophagus

  • Esophagitis - inflammation/ulceration

    • Reflux

      • Barret's

    • Infectious

      • Candida => small mucosal nodules, which occur in longitudical columns - plaquelike

        • DiffDx: reflux and glycogenic acanthosis

      • Herpes => multiple discrete ulcers, normal mucosa in between ulcers

      • CMV/HIV => large flat plaques

      • TB

    • Drug induced

    • Crohn esophagitis

  • Motility

    • Cricopharyngeal achalasia

    • Esophageal achalasia => disease of myenteric plexus

      • Peristalsis is decreased or absent

      • LES fails to relax

      • Chaga's disease => destruction of Ganglion cells by Trypanosoma cruzi

    • Diffuse esophageal spasm

    • Neuromuscular disorders

      • CVA most common

    • Scleroderma => smooth muscle replaced by fibrous tissue

  • Rings

    • A-ring

      • Muscular ring at the superior aspect of the esophageal vestibule

    • B-ring

      • Mucosal ring at the inferior aspect of the esophageal vestibule

      • If less than 13 mm => Schatzki ring

      • Z-line is the squamcolumnar junction line and may not correspond to the B-ring.

  • Strictures

    • Bening

      • Achalasia

      • Blistering skin disorders

      • Long strictures (RRC)

        • Reflux

        • Radiation

        • Caustic

    • Malignant

      • Annular carcinoma

      • Pseudoachalasia (submucosal carcinoma involving gastroesophageal junction)

      • Lymphoma

  • Enlarged esophageal folds

    • Esophagitis

    • Varices

      • Uphill from portal hypertension => predominantly inferior location

      • Downhill from SVC obstruction => predominantly superior location

    • Lymphoma

    • Varicoid carcinoma

  • Masses/nodules

    • Non-neoplastic (EV FMD)

      • Ectopic gastric mucosa

      • Varices

      • Foreign body

      • Mucosal edema from reflux

      • Duplication cyst

      • Glycogenic acanthosis => focal deposits of glycogen

      • Pemphigoid and epidermolysis bullosa => subepidermal bullae or blebs

      • Cowden's syndrome => diffuse mucosal nodularity from hamartomas

      • Leukoplakia => hyperplasia of squamous epithelium

    • Neoplastic

      • Benign (GIFA)

        • GIST

          • In esophagus, the leiomyomas or more common

        • Inflammatory esophagogastric tumor

        • Fibroepithelial or fibrovascular polyp

          • May regurgitate into the pharynx

        • Adenoma

      • Malignant (CG MLS)

        • Carcinomas

          • 90% are squamous cell carcinomas

          • Superficial spreading carcinoma

        • GIST

        • Metastases

        • Lymphomas

        • Spindle cell

        • Kaposi's sarcoma

        • Granular cell tumors

  • Outpouchings

    • Killian-Jamieson => Lateral pharyngeal outpouchings => common in wind players

    • Zenker's diverticulum => Killian dehiscence between circular and oblique fibers of the posterior aspect of cricopharyngeus

    • Midesophageal diverticula

      • Pulsion => from disordered peristalsis

      • Traction => from fibrous inflammatory reactions of adjacent lymph nodes

    • Epinephric diverticula

      • Usually of pulsion type in patients with motility disorders

    • Sacculations from healing of ulcerations

    • Foregut duplication cysts or acquired retention cysts

    • Intramural pseudodiverticula

      • Flask shaped

      • Associated with esophageal strictures/malignancies

  • Webs

    • Plummer-Vinson syndrome => esophageal webs, dysphagia, iron-deficiency anemia

  • Hernias

    • Sliding hiatal hernia

    • Paraesophageal hiatal hernia

    • Mixed hiatal hernia

  • Rupture

    • Boerhaave's syndrome => rupture

    • Mallory-Weiss tear => mucosa only

• Stomach

  • Thickened folds (GP MZ MCL)

    • Can be normal

      • Fundus => 1 cm

      • Antrum => 5 mm

    • Gastritis (H.pylori)

    • Peptic ulcer disease

    • Menetrier disease

    • Zollinger-Ellison syndrome

    • Metastases

    • Carcinoma

    • Lymphoma

    • Varices

  • Ulcerations

    • Ulceration found in the fundus may be malignant because benign ulcers are uncommon in this location

    • Both benign and malignant ulcers are most common in the antrum

    • Carman meniscus sign

      • Compressed lesser curvature demonstrates convex barium trapped by heaped up mucosa

      • Kirkland complex => heaped up mucosa

  • Focal filling defects thickening (GAL BMP LP)

    • GIST (60-70% of GISTs occur in the stomach)

      • Arises either from common precursor cell to Cajal cells (intestinal pacemaker cell) and smooth muscle cells or from Cajal cells

    • Adenocarcinoma

      • Four types

        • Polypoid

        • Ulcerative

        • Scirrhous => linitis plastica

        • Superficial spreading => nodular thickening or superficial mucosal ulceration

    • Lymphoma

    • Bezoar

    • Metastases

    • Pancreatic rest

    • Lipoma

    • Polyps

      • Bowler hat sign

      • Mexican hat sign

        • Three types

          • Hyperplastic polyps

          • Adenomatous polyps

          • Hamartomatous polyps

    • Kaposi's sarcoma

    • Varices

      • Stomach and esophageal varices result from portal heypretension

      • Stomach onlyl varices result from splenic vein thrombosis

    • Extrinsic compression

  • Gastric narrowing (CG PMS)

    • Caustic stricture

    • Granulomatous disease (Crohn, sarcoid, TB, syphilis, eosinophilic gastroenteritis)

    • Peptic scarring

    • Metastases (linitis plastica)

      • Usually from breast carcinoma

    • Scirous adenocarcinoma

    • Lymphoma

• Duodenum

  • Filling defects

    • Tumors

      • Adenocarcinoma

      • Metstases

      • Lymphoma

      • Duodenal adenoma

      • Leiomyoma/Leiomyosarcoma

      • Lipoma

    • Lymphoid hyperplasia

    • Brunner's gland hyperplasia/adenoma

    • Heterotopic gastric mucosa

    • Ectopic pancreas

    • Extrinsic mass

  • Thickened folds

    • Can be normal

    • Duodenitis

    • Pancreatitis/cholecystitis

    • Crohn's disease

    • Parasites

      • Giardia lamblia

    • Lymphoma

    • Intramural hemorhhage

      • Thick folds resemble stack of coins

  • Ulcers

    • H. pylori infection

    • Zollinger-Ellison syndrome

    • Flexural pseudotumors

      • Filling defect at the flexure at the apex of the bulb

  • Diverticula

    • Can be intraluminal

  • Narrowing

    • Annular pancreas

    • Neoplasms

    • Postbulbar ulcer

    • Extrinsic

• Small Bowel

  • Obstruction

    • Strangualtion obstruction

    • Closed loop obstruction

    • Intussusception

  • Filling defects

    • Carcinoid => sunburst pattern of radiating mesenteric fibrosis

    • Adenocarcinoma

    • Lymphoma

      • Most cases are Non-Hodgkins

      • Burkitt's lymphoma

      • AIDS related lymphoma

    • Nodular lymphoid hyperplasia

    • Metastasis

    • Kaposi's sarcoma

    • Leiomyoma and leiomyosarcoma

    • Adenoma

    • Lipoma

    • Hemangioma

    • Polyposis syndromes

    • Acariasis

  • Diffuse small bowel disease

    • Uniform thickening => infiltration by fluid

    • Irregular thickening => infiltration by cells or non-fliud material

    • Dilatation

    • Thickened folds

      • Regular => edema or hemorrhage

      • Irregular

  • Focal small bowel disease

    • Proximal dilatation

      • Sprue

      • Scleroderma

  • Erosions and ulcerations

    • Crohn's disease

    • Yersenia enterocolitis

    • Behcet's disease

    • TB

  • Diverticula

    • Meckel's diverticula

    • Pseudodiverticula => outpouchings of antimesenteric border that result from disease of the small bowel

  • Circumferential small bowel wall thickening (HIL)

    • Hematoma

    • Ischemia (if diffuse)

    • Lymphoma

• Mesentery

  • Mesenteric masses

    • Lymphoma

    • Mesenteric desmoid

    • Mesenteric cysts

    • GI duplication cysts

    • Mesenteric teratomas

• Colon

  • Obstruction

    • Sigmoid volvulus

    • Cecal volvulus

    • Fecal impaction

  • Adenocarcinoma

  • Polyps

    • Four types

      • Hyperplastic

      • Adenomatous

      • Hamartomatous

      • Inflammatory

    • Familial Adenomatous Polyposis Syndromes

      • Gardner's

      • Turcot's

    • Hamartomatous Polyposis Syndromes

      • Peutz-Jeghers

      • Cowden's

      • Cronkite-Canada

  • Lymphoid hyperplasia

  • Lymphoma

  • Leiomyoma and Leiomyosarcoma

  • Lipoma

  • Extrinsic masses

    • Endometriosis

    • Metastastases

  • Colitis

  • Diverticulitis

    • Fat stranding

    • Comma sign => comma shaped thickening of root of sigmoid mesocolon (1)

    • Centipede sign => engorged parallel mesenteric vessels supplying the affected segment of bowel (1)

    • Abcesses that are less than 3 cm typically resolve with conservative management (1)

  • Cecal coning (CAAAT)

    • Crohn's disease

    • Amebiasis

    • Appendicitis

    • Actinomycosis

    • TB

  • Colonic wall thickening (PIIL)

    • Pseudomembranous colitis

    • Ischemic colitis

    • Infectious colitis

    • Lymphoma

  • Sacculations

    • Scleroderma

  • Multiple intusseseptions

    • Melanoma metastasis

  • Rectal thickening

    • Lymphoma

• Inflammatory bowel disease

  • UC

    • Cause of toxic megacolon in 75% of cases

    • Fat in bowel wall

  • Crohn's

    • Comb sign => parallel vascular engorgement of the vessels supplying the affected segment (1)

    • Creeping fat around terminal ileum

    • Crohn disease is associated with oxalate renal stones, gallstones, fusion of SI joints.

• Appendix

  • Appendicitis

    • Primary findings (1)

      • 6-10 mm => equivocal or suggestive

      • >10 mm => nearly diagnostic

      • Wall thickening > 3mm

      • Hyperenhancment

      • Wall stratification

    • Secondary findings (1)

      • Appendicolith

      • Regional fat stranding

      • Thickened lateral conal fascia

      • Cecal or ileal wall thickening

      • Reactive regional lymph nodes

    • Phegmon vs. abcess

      • Phlegmon > 20 HU

      • Abcess < 20 HU (If more than 3 cm, generally requires drainage)

  • Apendiceal tumors

    • Carcinoid

    • Adenomas

    • Adenocarcinomas

Trauma

• Liver Injury

  • Grade 1 - Subcapsular hematoma less than 1 cm in maximal thickness, capsular avulsion, superficial parenchymal laceration less than 1 cm deep, and isolated periportal blood tracking

  • Grade 2 - Parenchymal laceration 1-3 cm deep and parenchymal/subcapsular hematomas 1-3 cm thick

  • Grade 3 - Parenchymal laceration more than 3 cm deep and parenchymal or subcapsular hematoma more than 3 cm in diameter

  • Grade 4 - Parenchymal/subcapsular hematoma more than 10 cm in diameter, lobar destruction, or devascularization

  • Grade 5 - Global destruction or devascularization of the liver

  • Grade 6 - Hepatic avulsion

• Bowel Injury

  • CT signs

    • Free intraperitoneal fluid without evidence of solid organ injury

    • Free air

    • Bowel wall edema

  • Associated with Chance fracture's in seat belt injury

• Renal Injury

  • Renovascular injury

  • Contusion

  • Subcapsular hematoma

  • Renal laceration/fracture

References

• Kottler et al, Applied Radiology 2005, 34 (4), 20.