CT Diagnosis of Abdominal Compartment Syndrome

Abstract Abdominal compartment syndrome (ACS) is defined as elevated intra-abdominal pressure resulting in dysfunction of at least one thoracoabdominal organ. Diagnosing ACS is particularly challenging in critically ill patients. This study aimed to identify specific CT imaging findings predictive of ACS by comparing cohorts with a clinical diagnosis of ACS and critically ill patients without this diagnosis. A retrospective case–control study identified patients with a clinical diagnosis of ACS. A matched control cohort consisted of critically ill patients without a diagnosis of ACS. Three radiologists, blinded to the patients' diagnosis and clinical course, reviewed CT scans for 19 different signs. Univariate analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis were performed. Thirty-one patients with ACS and 36 without ACS were enrolled. On univariate analysis, abdominal anteroposterior-to-transverse dimension ratio (AR; p = 0.0002), peritoneal to abdominal height ratio (PAR) (p = 0.007), contour changes of solid organs (CCSO) (p = 0.005), and retroperitoneal collections (p = 0.02) were significant. On logistic regression analysis, only PAR was significant (p = 0.01). The presence of at least one of PAR >0.52 or AR >0.75 had sensitivity of 81% and specificity of 81% for predicting ACS. The presence of both of these signs had a specificity of 100% for ACS. Radiologists should consider ACS in critically ill patients when CT shows increased AR or PAR. CCSO and large retroperitoneal collections are secondary signs. Recognition of these imaging findings may aid in the timely and accurate diagnosis of ACS in clinical practice.