Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA 23298-0615, USA.
Radiology. 2010 Sep;256(3):799-805. doi: 10.1148/radiol.10091903.
To retrospectively determine the frequency and importance of a small amount of isolated pelvic free fluid seen at multidetector computed tomography (CT) in male patients who have blunt trauma without an identifiable cause.
Institutional review board approval was obtained, and the requirement for informed consent was waived for this HIPAA-compliant study. One thousand male patients with blunt trauma who underwent abdominopelvic CT at a level 1 trauma center between January 2004 and June 2006 were entered into this study. The CT images of the 1000 patients were reviewed independently by two abdominal radiologists. CT scan assessment included evaluation for presence or absence of pelvic free fluid, any traumatic or nontraumatic cause of the free fluid, pelvic free fluid attenuation and volume measurements, and determination of the location of pelvic free fluid. Interobserver agreement was determined with kappa statistics, and the Student t test was used to assess differences in the mean volume and mean attenuation of the pelvic free fluid in the patients with and those without injury.
Pelvic free fluid was identified in 10.2% (102 of 1000) of patients. A small amount of isolated pelvic free fluid without any identifiable cause was identified in 4.8% (48 of 1000) of patients by reader 1 and in 5.0% (50 of 1000) of patients by reader 2 (kappa value, 0.76) and was located at or below the level of the third sacral vertebral body in all 49 patients with isolated pelvic free fluid. The mean volume and mean attenuation of the small amount of isolated pelvic free fluid were 2.3 mL +/- 1.5 (standard deviation) and 8.1 HU +/- 3.9, respectively. None of the patients in this group had an undiagnosed bowel and/or mesenteric injury.
In male patients with blunt trauma, a small amount of isolated pelvic free fluid with attenuation equal to that of simple fluid and located in the deep region of the pelvis likely is not a sign of bowel and/or mesenteric injury.
回顾性分析在因钝性外伤而就诊、但无明确病因的男性患者中，多层螺旋 CT（multidetector computed tomography，MDCT）检查发现少量单纯性盆腔游离液的频率及其重要性。
本研究经机构审查委员会批准通过，由于符合 HIPAA 标准，故豁免了患者知情同意书的签署。2004 年 1 月至 2006 年 6 月期间，我们对在一家创伤中心就诊的 1000 例因钝性外伤而接受 MDCT 检查的男性患者进行了这项研究。由 2 位腹部放射科医生独立对这 1000 例患者的 CT 图像进行了分析。CT 扫描评估包括：盆腔游离液的存在与否、游离液的创伤性或非创伤性病因、盆腔游离液的衰减值和容量测量以及盆腔游离液的位置。采用 Kappa 统计量评估观察者间的一致性，采用 Student t 检验评估有损伤和无损伤患者的盆腔游离液平均容量和平均衰减值之间的差异。
1000 例患者中，有 10.2%（102 例）存在盆腔游离液。第 1 位观察者发现有 4.8%（48 例）、第 2 位观察者发现有 5.0%（50 例）患者存在少量单纯性孤立性盆腔游离液，且无任何明确病因（Kappa 值，0.76）。49 例孤立性盆腔游离液患者的游离液均位于或低于第 3 个骶椎体水平。少量孤立性盆腔游离液的平均容量和平均衰减值分别为 2.3 mL +/- 1.5（标准差）和 8.1 HU +/- 3.9。这些患者中均未发现未诊断的肠和/或肠系膜损伤。
在因钝性外伤而就诊的男性患者中，存在少量单纯性盆腔游离液且衰减值与单纯液体相等、位置位于骨盆深部区域时，不太可能提示肠和/或肠系膜损伤。
