ARRS 2022 Abstracts

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E1926. A Whole World of Hurt: Review of AAST Trauma Grading for Abdominal Solid Organs
Authors
  1. Bradley Roth; Department of Radiological Sciences, University of California, Irvine
  2. Thanh-Lan Bui; Department of Radiological Sciences, University of California, Irvine
  3. Elliott Lebby; Department of Radiological Sciences, University of California, Irvine
  4. Louis Fanucci; Department of Radiological Sciences, University of California, Irvine
  5. David Kakish; Department of Radiological Sciences, University of California, Irvine
  6. Roozbeh Houshyar; Department of Radiological Sciences, University of California, Irvine
  7. Rony Kampalath; Department of Radiological Sciences, University of California, Irvine
Background
Trauma is a common cause of morbidity and mortality in the United States. Abdominal solid organ traumas can be life-threatening, especially liver injuries. Management of solid organ injuries has shifted towards nonoperative management for hemodynamically stable patients, with CT being considered the gold standard in assessing and diagnosing solid organ trauma. The American Association for the Surgery of Trauma (AAST) has an organ injury scale for spleen, liver, pancreas, and kidney trauma that was most recently updated in 2018. The AAST injury scoring scale and associated CT imaging findings are useful in evaluating solid organ trauma patients and guiding either nonoperative management for hemodynamically stable patients or interventional radiology/operative management for hemodynamically unstable patients.

Educational Goals / Teaching Points
The educational goals of this presentation are to review and describe the CT imaging findings for blunt and penetrating solid organ trauma using the AAST injury scoring scale. We will identify the major imaging pitfalls and mimics of solid organ trauma. In addition, we will discuss the role of interventional radiology in trauma management based on the AAST injury scoring scale. We will correlate the CT findings with the angiographic findings. The aim of this exhibit is to display the importance of reporting the correct AAST injury scoring scale, as the numerical grade is a metric required by the American College of Surgeons to maintain status as a Level 1 Trauma Center, as well as direct the next step in management for the trauma surgery and interventional radiology teams.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
CT is the imaging modality of choice when using the AAST injury scoring scale. CT imaging findings are dependent on injury severity and associated grade. Blunt trauma of the liver typically involves venous injury more often than arterial injury. Penetrating hepatic trauma is the most frequently occurring type of abdominal penetrating injury, with laceration, hematoma, and active extravasation being the three most encountered parenchymal injuries seen on CT. For splenic injuries from trauma, management varies based on degree of severity, with nonoperative management being potentially appropriate in hemodynamically stable patients. However, this approach has been less successful in penetrating splenic injuries versus blunt splenic trauma. With renal trauma, hematuria is the most commonly presenting clinical sign; however, even in the absence of hematuria, renal injury should be considered in all patients with penetrating abdominal flank or lower thoracic trauma.

Conclusion
The AAST injury scoring scale guides management of traumatic solid organ injuries and predicts prognosis using CT imaging. Therefore, interpreting radiologists must be familiar with the AAST injury scoring scales and associated CT imaging findings.