Ultraschall Med 2016; 37 - PS2_09
DOI: 10.1055/s-0036-1587832

CEUS in gunshot wound of the liver – first experience in military mission

C Richter 1, K Schwabe 2, M Grunert 3, B Friemert 4
  • 1Bundeswehrkrankenhaus Ulm, Klinik für Innere Medizin – Gefäßzentrum der Bundeswehr, Ulm, Germany
  • 2Bundeswehrkrankenhaus Ulm, Klinik für Allgemein-, Visceral- und Thoraxchirurgie, Ulm, Germany
  • 3Bundeswehrkrankenhaus Ulm, Klinik für diagnostische und interventionelle Radiologie und Neuroradiologie, Ulm, Germany
  • 4Bundeswehrkrankenhaus Ulm, Klinik für Unfallchirurgie und Orthopädie, Ulm, Germany

Purpose: Computed tomography (CT) is the gold standard technique in gunshot injuries imaging. In military missions and in case of mass casualties availability of CT scanning and capacity of airborne transporting may be limited. FAST (Focused Assessment with Sonography in Trauma) remains the primary imaging examination in abdominal trauma. Contrast-enhanced ultrasound (CEUS) could close the diagnostic gap between CT scanning and FAST and back-up shortage of diagnostic availabilities.

Material and methods: We report a case of gunshot wound of the liver during military mission in Afghanistan. FAST and CT scanning were done as first diagnostic imaging. CEUS was performed additionally in the emergency room by CX 50 Philips ultrasoundsystem and SonoVue contrast agent. CEUS was repeated after each following operation and also done intraoperative to estimate the damage of the liver and hematoma.

Results: The wound tract extension of traumatic gunshot wound could not be estimated on first CEUS examination due to aerodermectasia and gas echo extended along the wound track.

Subsequent CEUS after first operations were done revealed that the wound track echo was unenhanced in majority. CEUS effectively detect the wound tract, hematoma, and the liver area injured by the gunshot and could accurately reveal necrotic tissue in the injured area and differentiate it from normal tissue.

Conclusions: Application of CEUS may provide important imaging for gunshot wound debridement in its follow up and avoid repeated CT scannings. Thus may spare time and transport capacity in millitary missions. CEUS is an interesting diagnostic tool in blunt and gunshot trauma of the abdomen.