Objectives Lower limb deep venous thrombosis (DVT) is a common condition with high morbidity and mortality. The aim of the study was to investigate the temporal evolution of the acute thrombus by magnetic resonance imaging (MRI) and its relationship to venous recanalization in patients with recurrent DVTs. Methods Thirteen patients with newly diagnosed lower limb DVTs underwent MRI with non-contrast MR venography (NC-MRV) and MR direct thrombus imaging (MR-DTI), an inversion-recovery water-selective fast gradient-echo acquisition. Imaging was performed within 7 days of the acute thrombotic event, then at 3 and 6 months. Results By 3 months from the thrombotic event a third of the thrombi had resolved and by 6 months about half of the cases had resolved on the basis of vein recanalisation using NC-MRV. On the initial MR-DTI acute thrombus was clearly depicted by hyperintense signal, while the remaining thrombi were predominantly low signal at 3 and 6 months. Some residual thrombi contained small and fragmented persisting hyperintense areas at 3 months, clearing almost completely by 6 months. Conclusions Our study suggests that synergistic venous assessment with combined NC-MRV and MR-DTI is able to distinguish acute venous thrombosis from the established (old) or evolving DVT detected by ultrasound. Key Points • MRI can distinguish between acute and evolving or chronic lower limb DVT • Two advanced MRI techniques can follow the evolution of lower limb DVT • MRI could be used to avoid an incorrect diagnosis of recurrent DVT • MRI could help avoid the risks and complications of lifelong anticoagulation therapy

Background: South Africa faces a high burden of trauma‐related vascular injury. Prompt diagnosis and management are crucial to limit morbidity and mortality. Literature recommends a thorough vascular examination of at‐risk patients. Ankle brachial index (ABI) and arterial pressure index (API) are considered reliable screening tools for lower extremity vascular injury (LEVI) in the correct clinical scenario. Patients with an abnormal ABI/API warrant diagnostic imaging with computed tomography angiography (CTA). However, recent international literature demonstrates a trend toward potential CTA overuse in the work up for LEVI, when the internationally recommended vascular injury work‐up guidelines are not followed correctly.Aim: To assess the reliability of ABI/API in trauma patients with suspected LEVI as a screening tool to safely avoid unnecessary CTA.Methods: A retrospective cohort study of all lower extremity trauma patients with soft signs of LEVI who presented to Charlotte Maxeke Johannesburg Academic Hospital from February 1, 2018 to January 31, 2020 was undertaken. Sensitivity, specificity, NPV, and PPV were calculated for ABI/API versus CTA and ABI/API/CTA versus surgically significant arterial injury. A p‐value < 0.05 indicated statistical significance (confidence level = 95%).Results: Four hundred and thirty‐three CTAs were performed for suspected traumatic LEVI. Two hundred and eighty‐two were excluded due to missing data (precluding retrospective calculation of ABI/API) and 151 patients were included. To detect surgically significant injury, CTA had a 100% sensitivity, 97.2% specificity, 100% NPV, and 69.2% PPV; ABI and API had a 100% sensitivity, 83.8%–85.9% specificity, 100% NPV, and 28.1%–35.9% PPV, respectively. Neither ABI nor API missed surgically significant arterial injuries.Conclusion: This affirms the reliability of ABI/API as a screening tool to identify patients at risk of LEVI from penetrating trauma. Findings supported international data demonstrating CTA overuse in this subset of patients.

Background: Non-operative management (NOM) has become the standard of care for haemodynamically stable patients with liver trauma, yet robust data from low- and middle-income countries (LMICs) remain scarce, particularly in settings with a high burden of penetrating trauma. Methods: This single-centre retrospective cohort study analysed 251 adult patients with liver injuries managed non-operatively at a major trauma centre in Johannesburg, South Africa, between January 2017 and December 2023. The primary outcome was in-hospital mortality. Secondary outcomes included 30-day survival and associated injury patterns. Results: Overall mortality was 1.20% (3/251; Wilson 95% confidence interval [CI]: 0.41–3.45). All deaths occurred within 30 days. Admission lactate was the only variable significantly associated with mortality in the univariate analysis (odds ratio [OR]: 1.53 per 1 mmol/L increase, 95% CI: 1.11–2.10, p = 0.009). Sensitivity analysis using Firth’s penalised logistic regression yielded consistent results (penalised OR: 1.48, 95% CI: 1.08–2.03, p = 0.015). The American Association for the Surgery of Trauma (AAST) liver injury grade showed no association with mortality. Chest injuries were the most common associated injury (42.6%). Associated injury patterns were consistent across Grades III–V. Conclusion: In appropriately selected haemodynamically stable patients, NOM achieved excellent outcomes despite a substantial polytrauma burden. Physiology, rather than anatomic grade or associated injury pattern, determined survival. These findings support physiology-led selection in resource-constrained environments. Contribution: This study provides key insights into the real-world outcomes of non-operative management (NOM) of liver trauma in a high-volume, resource-constrained South African trauma centre. It demonstrates exceptionally low mortality (1.20%) with physiology-led patient selection despite a high burden of penetrating trauma and polytrauma. The primary contribution is evidence that admission lactate is a strong predictor of mortality, while anatomic injury grade (AAST) is not. These findings reinforce physiology-guided decision-making in LMIC settings and align directly with the journal’s focus on clinical practice and surgical outcomes in Southern Africa.

Background: Liver trauma is prevalent following blunt and penetrating injuries. This study examined liver trauma in a South African urban trauma centre, focusing on the unique prevalence of penetrating injuries and surgical interventions. Methods: A retrospective analysis was conducted of 512 priority-one patients with liver trauma from January 2017 to December 2023 at Charlotte Maxeke Johannesburg Academic Hospital. The data collected included demographics, injury mechanisms, liver injury grades, associated injuries, injury severity scores (ISS and NISS), surgical interventions, and mortality rates. Statistical analyses were performed using Stata (V.18) and R software (version 4.3.2). Results: The median age of the patients was 31 years, with a predominance of male patients (91%) and patients of African ethnicity (95%). Penetrating trauma accounted for 73% of the cases. Most liver injuries were minor (grades I–III). There was a 5% overall mortality rate, with a higher rate observed in patients requiring emergency surgery (10% vs. 1% for non-operative management, p < 0.001). Just over half of the patients required emergency laparotomy, and the majority of these patients sustained penetrating liver trauma. Complications occurred in 6.6% of the patients, predominantly biliary in nature. Conclusions: This study highlights the high incidence of penetrating liver trauma in South Africa, which reflects the context of interpersonal violence. The mortality rate aligns with international standards and demonstrates the need for effective management strategies. These findings emphasise the need for tailored approaches to liver trauma based on injury patterns and demographics, and further research is needed to explore the associated mortality and complications.

Background Liver trauma is prevalent in blunt and penetrating injuries. This study examined liver trauma in a South African urban trauma centre, focusing on the unique prevalence of penetrating injuries and surgical interventions. Methods A retrospective analysis was conducted on 512 priority one patients with liver trauma from January 2017 to December 2023 at Charlotte Maxeke Johannesburg Academic Hospital. The data collected included demographics, injury mechanisms, liver injury grades, associated injuries, Injury Severity Scores (ISS and NISS), surgical interventions, and mortality rates. Statistical analyses were performed using Stata and R software. Results The median age of the patients was 31 years, with a predominance of male patients (91%) and of African ethnicity (95%). Penetrating trauma accounted for 73% of the cases. Most liver injuries were minor (grades I – III). There was an overall 5% mortality rate, with a higher rate observed in patients requiring emergency surgery (10% vs. 1% for non-operative management, p < 0.001). Just over half of the patients required emergency laparotomy, and the majority of these patients sustained penetrating liver trauma. Complications occurred in 6.6% of the patients, predominantly biliary in nature. Conclusions This study highlights the high incidence of penetrating liver trauma in South Africa, which reflects the context of interpersonal violence. The mortality rate aligns with international standards and demonstrates the need for effective management strategies. These findings emphasise the need for tailored approaches to liver trauma based on injury patterns and demographics, and further research is needed to explore mortality and complications.