Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy.
Radiol Med. 2023 Dec;128(12):1447-1459. doi: 10.1007/s11547-023-01724-4. Epub 2023 Sep 25.
The intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) are life-threatening conditions with a significant rate of mortality; therefore, early detection is paramount in their optimal management. IAH is diagnosed when the intra-abdominal pressure (IAP) is more than 12 mmHg. It can occur when the intra-abdominal volume increases (ileus, ascites, trauma, pancreatitis, etc.) and/or the abdominal wall compliance decreases. IAH can cause decreased venous flow, low cardiac output, renal impairment, and decreased respiratory compliance. Consequently, these complications can lead to multiple organ failure and induce the abdominal compartment syndrome (ACS) when IAP rises above 20 mmHg. The diagnosis is usually made with intravesical pressure measurement. However, this measurement was not always possible to obtain; therefore, alternative diagnostic techniques should be considered. In this setting, computed tomography (CT) may play a crucial role, allowing the detection and characterization of pathological conditions that may lead to IAH. This review is focused on the pathogenesis, clinical features, and radiological findings of ACS, because their presence allows radiologists to raise the suspicion of IAH/ACS in critically ill patients, guiding the most appropriate treatment.
腹腔内高压（IAH）和腹腔间隔室综合征（ACS）是危及生命的病症，死亡率很高；因此，早期发现对于最佳治疗至关重要。IAH 是当腹腔内压力（IAP）超过 12mmHg 时诊断的。当腹腔内容积增加（肠梗阻、腹水、创伤、胰腺炎等）和/或腹壁顺应性降低时，可能会发生 IAH。IAH 可导致静脉血流减少、心输出量降低、肾功能损害和呼吸顺应性降低。因此，这些并发症可能导致多器官衰竭，并在 IAP 升高至 20mmHg 以上时引发腹腔间隔室综合征（ACS）。诊断通常通过测量膀胱内压来进行。然而，并非总是能够获得这种测量值；因此，应考虑替代诊断技术。在这种情况下，计算机断层扫描（CT）可能发挥关键作用，允许检测和特征化可能导致 IAH 的病理状况。本综述重点介绍 ACS 的发病机制、临床特征和影像学发现，因为它们的存在可以让放射科医生在危重病患者中怀疑存在 IAH/ACS，从而指导最合适的治疗。
