Intravenous contrast is indicated in all CT examinations performed to detect intraabdominal injuries from blunt trauma, including liver laceration, splenic laceration, renal trauma, bowel hematoma, pancreatic fracture, ureteral injury, and bladder perforation. Intravenous contrast agents differentiate normal organ parenchyma from hematoma within an area of injury. In patients for whom the risk of administering intravenous contrast is thought to be too great, noncontrast CT is probably still of benefit, but small-to-moderate intraabdominal injuries may be missed, especially if there is no associated intraperitoneal fluid from hemorrhage. Because of the importance of intravenous contrast, some institutions proceed with contrast injection (using a low-osmo-lality agent) in all patients undergoing emergent abdominal CT, regardless of past medical history. With such a policy, it is felt that the imaging benefits of contrast enhancement combined with an emergency situation outweigh any possible risk of adverse reaction.
In the setting of penetrating trauma to the back or flank, intravenous contrast material is administered as part of the "triple-contrast" CT, the other two types of contrast being orally and rectally administered. Triple-contrast CT should be reserved for patients who have a wound that penetrates the muscular fascia, are clinically stable, and have no obvious signs of intraperitoneal or other internal injury.11 In such patients, intravascular contrast imaging is required to detect renal and vascular injuries, and rectal administration of contrast material is particularly important for detecting subtle colonic injury.
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