Plain radiographs have an extremely limited use in the initial evaluation of patients with blunt abdominal trauma. They are incapable of making the diagnosis of hemoperitoneum. Even patients with hollow visceral injury often have normal radiographs. Occasionally, a chest x-ray will show free air under the diaphragm, and this will prompt laparotomy. However, universal use of plain films of the abdomen is not a cost-effective way of evaluating patients with blunt trauma.
Pelvic films, on the other hand, are standard in the evaluation process. Patients with pelvic fractures must be assumed to have high-energy injury mandating abdominal evaluation. Patients with pelvic fractures can have retroperitoneal blood loss. Thus abdominal evaluation must be rapid to avoid confusing retroperitoneal from intraabdominal blood loss. In addition, patients with thoracolumbar spine fractures have a mechanism that mandates abdominal evaluation. Thus any patient with pain or tenderness in the back must have radiographs to exclude a spine fracture. More sophisticated plain imaging such as intravenous pyelography (IVP) is occasionally useful. In patients who are hemodynamically stable, CT is far superior and has eliminated the use of iVPs. Retrograde urethrography is useful in males with pelvic fractures to exclude urethral injury.
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