IVC TRAUMA NORTHERN TRAUMA CONFERENCE 2014

IVC TRAUMA Penetrating Blunt 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 with collapsed IVC/right heart (despite aggressive resuscitation)

Hypovolaemia Hypovolaemia with collapsed IVC/right heart (despite aggressive resuscitation)

American Association for the Surgery of Trauma Organ Injury Scale for Vascular Injuries OIS Grade* Artery Injured Vein Injured II Hepatic Splenic Gastric Gastroduodenal Inferior mesenteric Primary named vessels of superior mesenteric Splenic Inferior mesenteric III Renal Iliac Hypogastric Superior mesenteric Renal Iliac Hypogastric Vena cava (infrarenal) IV Superior mesenteric (trunk) Celiac axis Aorta (infrarenal Vena cava (infrahepatic) V Aorta (suprarenal) Vena cava (suprahepatic) Vena cava (retrohepatic) Portal Hepatic (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