Contrast-enhanced ultrasound (CEUS) in blunt abdominal trauma

Abstract

Baseline ultrasound is essential in the early assessment of patients with a huge haemoperitoneum undergoing an immediate abdominal surgery; nevertheless, even with a highly experienced operator, it is not sufficient to exclude parenchymal injuries. More recently, a new ultrasound technique using second generation contrast agents, named contrast-enhanced ultrasound (CEUS) has been developed. This technique allows all the vascular phase to be performed in real time, increasing ultrasound capability to detect parenchymal injuries, enhancing some qualitative findings, such as lesion extension, margins and its relationship with capsule and vessels. CEUS has been demonstrated to be almost as sensitive as contrast-enhanced CT in the detection of traumatic injuries in patients with low-energy isolated abdominal trauma, with levels of sensitivity and specificity up to 95%. Several studies demonstrated its ability to detect lesions occurring in the liver, spleen, pancreas and kidneys and also to recognize active bleeding as hyperechoic bands appearing as round or oval spots of variable size. Its role seems to be really relevant in paediatric patients, thus avoiding a routine exposure to ionizing radiation. Nevertheless, CEUS is strongly operator dependent, and it has some limitations, such as the cost of contrast media, lack of panoramicity, the difficulty to explore some deep regions and the poor ability to detect injuries to the urinary tract. On the other hand, it is timesaving, and it has several advantages, such as its portability, the safety of contrast agent, the lack to ionizing radiation exposure and therefore its repeatability, which allows follow-up of those traumas managed conservatively, especially in cases of fertile females and paediatric patients.

Upper Limbs Trauma in Pediatrics

“…This helps achieve the correct diagnosis and recognize some complications occurring in the acute setting, and it also prevents possible disabilities due to a delayed diagnosis in the chronic setting. [59][60][61] These pathologic entities usually occur with the same predictable patterns, mainly because of the presence of open physes and apophyseal ossification centers in children, and in some cases they have a typical radiographic appearance. When in doubt a comparative study or a MRI should be performed to avoid adjunctive radiation exposure, especially in the chronic setting.…”

Contrast-enhanced ultrasound performance in predicting blunt splenic injuries requiring only observation and monitoring

“…injuries, particularly in hemodynamically stable patients with isolated blunt low or moderate-energy abdominal trauma [8][9][10][11]. Some previous studies showed that CEUS can detect active bleeding [12,13] and that performing one or two CEUS during follow-up is useful [14,15].…”

Use of contrast-enhanced ultrasound for the diagnosis of idiopathic renal hematuria in a dog

“…The use of CEUS to detect intraand extra-parenchymal active bleeding, which is seen as http: //www.openveterinaryjournal.com P. Di Donato et al Open Veterinary Journal, (2019), Vol. 9(4): 309-312 extravasation/pooling of microbubbles or hyperechoic bands, has been described in medicine (Miele et al, 2016). This technique, when compared to cystoscopy or even cystotomy, is a safe and non-invasive alternative that does not require general anesthesia, endoscopic equipment, or extensive training.…”