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

Abstract

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 avail- abilities. 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 track 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 revealed that the wound track echo was unenhanced in majority. CEUS effectively detected 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.