CT Abdomen and Pelvis After Pelvic Fracture: Timing and Indications

Immediate CT Imaging (Initial Presentation)

The American College of Radiology recommends performing thoraco-abdomino-pelvic CT scan with IV contrast immediately as the primary imaging modality when the patient can tolerate transport to the scanner 1, 2, 3
CT with contrast in the portal venous phase provides optimal characterization of solid organ injury and active bleeding 4, 5
This imaging allows complete inventory of all injuries including hepatic, splenic, renal, and pelvic vascular injuries 1, 2
The predictive positive and negative values of CT with contrast compared to angiography are 93.9%, 77.8%, 88.6%, and 87.5% respectively 1

The Journal of the American College of Radiology recommends using IV contrast in portal venous phase as the standard protocol 4, 5
Arterial phase imaging may be added to assess for active arterial bleeding and pseudoaneurysm formation 4, 5
Noncontrast CT should be avoided when possible due to lower sensitivity for detecting visceral organ and vascular injuries 4, 5

Bladder and urethral injuries occur in 3.5-19% of pelvic fractures and are best evaluated with CT cystography if clinical symptoms are present 1, 2

The American College of Radiology advises against delaying initial CT imaging to arbitrary time points in stable patients—perform it immediately 1, 2, 3
Noncontrast CT should not be performed as it significantly reduces sensitivity for vascular and visceral injuries 4, 5

The decision algorithm recommends assessing hemodynamic stability immediately, and if stable, proceeding directly to CT abdomen/pelvis with IV contrast 1, 2, 3
If unstable, perform chest X-ray and E-FAST, then stabilize, and proceed to CT with contrast and angiography/embolization as needed 1, 2, 3, 6