Diagnostic imaging of blunt abdominal trauma in pediatric patients

Abstract

Trauma is a leading cause of morbidity and mortality in childhood, and blunt trauma accounts for 80-90 % of abdominal injuries. The mechanism of trauma is quite similar to that of the adults, but there are important physiologic differences between children and adults in this field, such as the smaller blood vessels and the high vasoconstrictive response, leading to the spreading of a non-operative management. The early imaging of children undergoing a low-energy trauma can be performed by CEUS, a valuable diagnostic tool to demonstrate solid organ injuries with almost the same sensitivity of CT scans; nevertheless, as for as urinary tract injuries, MDCT remains still the technique of choice, because of its high sensitivity and accuracy, helping to discriminate between an intra-peritoneal form a retroperitoneal urinary leakage, requiring two different managements. The liver is the most common organ injured in blunt abdominal trauma followed by the spleen. Renal, pancreatic, and bowel injuries are quite rare. In this review we present various imaging findings of blunt abdominal trauma in children.

Organ -preserving trends in the treatment of blunt splenic trauma in children

“…This algorithm allows treating patients in less aggressive way and reducing operative costs in conservatively treated and reducing postoperative pain in those who require LS. The fail of conservative treatment was found in 1 patient in the first period and total number of conservatively treated patients was 86, so the fail rate was 1.15 % which is the corresponds to level of centers using CT routinely [7,11]. Conclusions.…”

Enhancing the role of paediatric ultrasound with microbubbles: a review of intravenous applications

“…29,30 Blunt abdominal trauma accounts for 80% of cases, with liver and spleen being the most frequently injured organs. 30 Initial diagnostic work-up depends on severity of trauma.…”

“…33,34 CT is characterized by excellent diagnostic accuracy for the detection of abdominal traumatic injuries but should be limited by ionizing radiation in children. 29,31,35 CT imaging may not be appropriate for low-or moderate-energy isolated trauma where the diagnostic yield is insignificant. 35,36 CEUS could be an alternative modality as a complementary technique to greyscale ultrasonography and has been shown to improve the detection of solid organ injuries in adults.…”

“…35,36 CEUS could be an alternative modality as a complementary technique to greyscale ultrasonography and has been shown to improve the detection of solid organ injuries in adults. 29 CEUS is perfectly suited for the follow-up of patients with paediatric trauma, without the need for ionizing radiation, sedation and nephrotoxic contrast agents and no compromise in terms of diagnostic accuracy. 31 A recently published retrospective analysis of 73 haemodynamically stable children sustaining minor abdominal trauma compared CEUS with baseline ultrasonography and CT. 37 In this study, ultrasonography detected only 26/67 (38.8%) parenchymal traumatic lesions involving the liver, spleen and kidneys, whereas CEUS was concordant with CT in every patient ( Figure 1).…”

Upper Limbs Trauma in Pediatrics

“…It has been estimated that ligamentous structures are two to five times stronger than open physes. [1][2][3] Nearing closure the physis becomes more prone to injuries, with the risk of arresting growth.…”