In stable patients with suspected intra-abdominal injury after resuscitation, which imaging modality is preferred?

• A. CT scan of the abdomen and pelvis
• B. Ultrasound focused assessment with sonography in trauma (FAST)
• C. MRI of the abdomen without contrast
• D. Abdominal X-ray series

Answer: (A)

In a hemodynamically stable patient after resuscitation, CT scan of the abdomen and pelvis with IV contrast is preferred because it provides a rapid, comprehensive and highly accurate assessment of intra-abdominal injuries. It can detect solid organ lacerations, hollow-viscera injuries, mesenteric tears, and retroperitoneal or vascular injuries, and it helps stage and grade injuries to guide whether nonoperative management is appropriate or if surgery is needed.

FAST is excellent for quickly assessing free fluid in unstable patients, but its sensitivity for detecting intra-abdominal injuries in stable patients is limited and it doesn’t give detailed injury characterization. MRI offers detailed imaging but is impractical in the acute trauma setting due to longer scan times and availability constraints. An abdominal X-ray series has poor sensitivity for most intra-abdominal injuries and is not reliable for acute evaluation in stable trauma.