Ultrasonographic examination of wound tracts
W. R. Fry, R. S. Smith, J. J. Schneider and C. H. Organ Jr
Department of Surgery, University of California-Davis, East Bay, USA.
OBJECTIVE: To determine if ultrasonography is useful in evaluating
penetrating injuries of the trunk to assess whether violation of the
peritoneum or pleura has occurred. METHODS: The study group was 29 patients
who suffered gunshot (n = 17), stab (n = 10), or shotgun (n = 2) wounds.
The abdomen was at risk in 21 injuries, the thorax in eight. The results of
physical examination and plain x-rays suggested the pleura and or
peritoneum might be intact in all patients. Using a 7-MHz transducer, wound
tract(s) were images, looking for the presence of soft-tissue air and/or
echolucent areas consistent with soft-tissue blood. Injuries were deemed
extraperitoneal or extrapleural if (1) the entire tract was visualized; (2)
it appeared superficial to the deepest fascial structure in that area; and
(3) in shotgun injuries, all visible pellets on x-ray films were identified
by ultrasound in the abdominal wall. RESULTS: Evidence of penetration
occurred in four abdominal wounds and one thoracic wound. These were
confirmed by operation in the abdominal cases and by subsequent chest x-ray
examination in the one thoracic wound. The diagnosis of nonpenetration was
confirmed in all the remainder by serial benign abdominal examination (n =
15), chest x-ray examination (n = 8), and laparoscopy (n = 1). Positive and
negative predictive accuracy were thus 100% in this pilot series.
CONCLUSIONS: Ultrasonographic exploration of penetrating truncal injuries
is feasible and accurate. Ultrasonographic wound exploration may serve as a
noninvasive and safe replacement for diagnostic laparoscopy, conventional
local wound exploration, peritoneal lavage, and 6-hour chest x-rays
(repeated chest x-rays taken 6 hours after initial chest x-ray
examination). If used as part of the initial physical examination,
cost-effectiveness can also be realized.
