Abdominal CT: body wall injuries

Fractures are commonly associated with injury to the abdominal muscles. These injuries can have a wide range of appearances. You might see minor stranding within the subcutaneous fat or muscular enlargement due to haematoma and active bleeding.

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Avulsion injury

Our next case features severe body wall trauma after the patient was hit by a falling tree. On the CT imaging, there is a subcutaneous haematoma in the fat posterior to the spine, as well as extensive muscular injury and a haematoma involving the paraspinal and psoas muscles. Also, notice the asymmetry of the right internal oblique muscle, indicating that it has been injured.

This resulted in an avulsion injury of the lumbar transverse process. An avulsion means that the bone was fractured by pulling it apart at its ligamentous attachments.

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Lumbar hernia

Severe injuries of the body wall can result in tearing of the abdominal wall muscles and attachments. Tearing the lateral abdominal wall musculature can cause a traumatic hernia called a lumbar hernia, which is often surgically repaired.

In the next example, severe abdominal trauma has torn the attachments of the lateral body wall and paraspinal musculature, creating a large defect through which the ascending colon and surrounding fat are starting to herniate. Notice the normal fascial attachments that are intact on the left side, which reminds us of the symmetry that the body wall provides for comparison and evaluation of these types of injuries.

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References

• Top 100 CT scan quiz. LITFL

Radiology Library: Abdominal Trauma. Musculoskeletal injuries

• Hartung MP. Abdominal Trauma: rib fractures
• Hartung MP. Abdominal CT: spinal fractures
• Hartung MP. Abdominal CT: body wall injuries
• Hartung MP. Abdominal CT: pelvic fractures
• Hartung MP. Abdominal CT: bladder injuries

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