Epelman et al. [29] evaluated the preoperative abdominal CT scans of three children with proven ACS to identify signs of elevated IAP. Findings common to these patients included narrowing of the inferior vena cava, direct renal compression or displacement, bowel wall thickening with enhancement, and a rounded appearance of the abdomen. Other investigators described elevation of the diaphragm (Fig. 17.4) in association with IAH [30]. Al-Bahrani et al. [31] evaluated the abdominal CT examination performed in 24 critically ill patients and affirmed that the presence of the round belly sign and the bowel wall thickening with enhancement on CT images of critically ill surgical patients should alert clinicians to the possibility of the presence of IAH and ACS.

It is important to recognize that the CT examination should be viewed as an adjunct toward the recognition of IAH, but not as a substitute to the measurement of the intravesical pressure in at-risk patients. Individual CT signs such as elevated hemidiaphragm, flattened inferior vena cava and renal veins, and increased bowel wall enhancement are neither sensitive nor likely specific for abdominal compartment syndrome. However, when a combination of these findings is present in the appropriate clinical setting or if the signs are seen to worsen on sequential imaging studies, the radiologist should raise the possibility of abdominal compartment syndrome [27, 32]. Identifying patients with IAH and/or ACS at earlier stages could potentially improve the outcome of these patients by early radiological drainage of large fluid collections and/or surgical intervention with abdominal decompression (laparotomy).