The Technique and Advantages of Contrast-Enhanced Ultrasound in the Diagnosis and Follow-Up of Traumatic Abdomen Solid Organ Injuries

Serafino, Marco Di; Iacobellis, Francesca; Schillirò, Maria Laura; Ronza, Roberto; Verde, Francesco; Grimaldi, Dario; Orabona, Giuseppina Dell’Aversano; Caruso, Martina; Sabatino, Vittorio; Rinaldo, Chiara; Romano, Luigia

doi:10.3390/diagnostics12020435

Cited by 17 publications

(21 citation statements)

References 36 publications

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“…Thus, CECT represents the “gold standard” imaging examination in trauma setting as it improves the detection of subtle organ injuries and allows the detection and the estimation of active bleeding 15,21 . CECT remains the primary imaging method used for whole‐body evaluation in patients with high‐energy blunt trauma 12,14,15,22 . MRI could be useful for early follow‐up (Figure 14).…”

Section: Splenic Pathologies In the Emergency Departmentmentioning

confidence: 99%

“…CEUS can be an alternative to CECT and MRI in the follow-up of traumatic splenic lesions. 12 3.1 | Parenchymal splenic lesions…”

Section: Splenic Pathologies In the Emergency Departmentmentioning

confidence: 99%

“…Contained vascular injuries, such as intrasplenic pseudoaneurysms and arteriovenous fistula, are recognized, albeit rare complications of splenic trauma, which can be identified at CD-US and confirmed at CECT 15 injuries with levels of accuracy similar to those that CECT (Figure 12). 12 The use of US contrast medium increases sensitivity and enables a better depiction of injured parenchyma and a better evaluation of residual vital parenchyma, allowing to differentiate between nonvascularized hypoechoic areas and surrounding hyper-reflective enhanced parenchyma (Figure 13, Table 2). [16][17][18] However, US examination may be limited in most cases for several reasons as patient pain, presence of abdominal dressings or subcutaneous emphysema, foreign bodies, bowel gas, as well as a chaotic emergency room.…”

Section: Splenic Traumamentioning

confidence: 99%

“…In this setting, CEUS is a useful tool to accurately evaluate organ injuries, capsular extensions, and vascular injuries with levels of accuracy similar to those that CECT (Figure 12). 12 The use of US contrast medium increases sensitivity and enables a better depiction of injured parenchyma and a better evaluation of residual vital parenchyma, allowing to differentiate between nonvascularized hypoechoic areas and surrounding hyper‐reflective enhanced parenchyma (Figure 13, Table 2). 16–18 …”

Section: Splenic Pathologies In the Emergency Departmentmentioning

confidence: 99%

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Multimodality ultrasound assessment of the spleen: Normal appearances and emergency abnormalities

Iacobellis

Schillirò

Serafino

et al. 2022

J of Clinical Ultrasound

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This paper summarizes the main splenic emergencies and their ultrasonographic findings to orient appropriate patient management. US requires minimal preparation time and allows to examine the parenchyma and to detect intraperitoneal fluid collections, which may be indirect evidence of solid organ injuries. In this paper, we analyze the role of B‐mode, Doppler and Contrast‐Enhanced Ultrasound in the diagnosis of splenic emergencies, with a particular focus on splenic infarction, infection, traumatic injuries and vascular splenic anomalies.

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Section: Splenic Pathologies In the Emergency Departmentmentioning

confidence: 99%

“…CEUS can be an alternative to CECT and MRI in the follow-up of traumatic splenic lesions. 12 3.1 | Parenchymal splenic lesions…”

Section: Splenic Pathologies In the Emergency Departmentmentioning

confidence: 99%

Section: Splenic Traumamentioning

confidence: 99%

Section: Splenic Pathologies In the Emergency Departmentmentioning

confidence: 99%

See 2 more Smart Citations

Multimodality ultrasound assessment of the spleen: Normal appearances and emergency abnormalities

Iacobellis

Schillirò

Serafino

et al. 2022

J of Clinical Ultrasound

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“…Computed Tomography (CT) represents the “gold standard” imaging technique in the first-line evaluation of polytraumatized patients [ 1 , 2 , 3 ], as it ensures high diagnostic accuracy, rapid execution time, and hospital availability; however, once the diagnosis is made and the patient is stable, a series of possibilities open up regarding the best diagnostic imaging tool to choose for monitoring the diagnosed lesions or detecting complications, depending on the involved anatomical structures, the grade of each injury, and the availability and expertise of each imaging method [ 4 , 5 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT

et al. 2023

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In the transition from the operative to the conservative approach for the polytraumatized patients who undergo blunt trauma, diagnostic imaging has assumed a pivotal role, currently offering various opportunities, particularly in the follow-up of these patients. The choice of the most suitable imaging method in this setting mainly depends on the injury complications we are looking for, the patient conditions (mobilization, cooperation, medications, allergies and age), the biological invasiveness, and the availability of each imaging method. Computed Tomography (CT) represents the “standard” imaging technique in the polytraumatized patient due to the high diagnostic performance when a correct imaging protocol is adopted, despite suffering from invasiveness due to radiation dose and intravenous contrast agent administration. Ultrasound (US) is a readily available technology, cheap, bedside performable and integrable with intravenous contrast agent (Contrast enhanced US—CEUS) to enhance the diagnostic performance, but it may suffer particularly from limited panoramicity and operator dependance. Magnetic Resonance (MR), until now, has been adopted in specific contexts, such as biliopancreatic injuries, but in recent experiences, it showed a great potential in the follow-up of polytraumatized patients; however, its availability may be limited in some context, and there are specific contraindications, such as as claustrophobia and the presence non-MR compatible devices. In this article, the role of each imaging method in the body-imaging follow-up of adult polytraumatized patients will be reviewed, enhancing the value of integrated imaging, as shown in several cases from our experience.

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Contrast‐enhanced point of care ultrasound for the evaluation of stable blunt abdominal trauma by the emergency physician: A prospective diagnostic study

Donner,

Thaler,

Hautz

et al. 2024

JACEP Open

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ObjectivesClinical examination alone cannot reliably rule out significant traumatic abdominal injury. Computed tomography (CT) has become the primary method for evaluating blunt abdominal trauma and clinicians rely heavily on it to rule out abdominal injury. Ultrasound examination may miss significant abdominal injury particularly in stable patients. The use of a contrast agent improves ultrasound sensitivity to visceral abdominal injuries. The objective of this diagnostic study is to compare bedside contrast enhanced ultrasound (CEUS) performed by emergency physicians to CT in hemodynamically stable adults for the assessment of blunt abdominal trauma and evaluate CEUS accuracy outcomes.MethodsHemodynamically stable patients with blunt trauma were prospectively enrolled in the trauma bay. After initial evaluation, we included patients at risk of abdominal injury and for whom an abdominal CT was planned by the trauma leader. Ultrasonography was performed prospectively and at the bedside by the emergency physician followed by abdominal CT used as a reference standard.ResultsThirty‐three patients were enrolled in the study; among them, 52% showed positive traumatic findings in abdominal CT scans, and 42% were diagnosed with solid organ lesions. Compared to CT, a focused abdominal sonography (FOCUS) examination, looking for free fluid or perirenal hematoma, showed limited performance for traumatic findings with a sensitivity of 65% (95% confidence interval [CI]: 38%–86%), a specificity of 75% (95% CI: 48%–93%), a negative likelihood ratio (NLR) of 0.47 (95% CI: 0.23–0.95), and a positive likelihood ratio (PLR) of 2.59 (95% CI: 1.03–6.48). When combining FOCUS with CEUS, the sensitivity of the sonography increased to 94% (95% CI: 71%–100%) with a specificity of 75% (95% CI: 48%–93%). The PLR was 3.76 (95% CI: 1.6–8.87) and the NLR was 0.08 (95% CI: 0.01–0.54). In our population, abdominal sonography with contrast failed to identify a single positive abdominal CT with a grade 1 kidney injury.ConclusionsA FOCUS examination shows limited sensitivity and specificity to detect positive abdominal CT in stable adults with abdominal trauma. With the addition of contrast and careful inspection of solid organs, abdominal sonography with contrast performed by the emergency physician improves the ability to rule out traumatic findings on abdominal CT. CEUS performed by emergency physicians may miss injuries, especially in the absence of free fluid, in cases of low‐grade injuries, simultaneous injuries, or poor‐quality examinations.

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The Technique and Advantages of Contrast-Enhanced Ultrasound in the Diagnosis and Follow-Up of Traumatic Abdomen Solid Organ Injuries

Cited by 17 publications

References 36 publications

Multimodality ultrasound assessment of the spleen: Normal appearances and emergency abnormalities

Multimodality ultrasound assessment of the spleen: Normal appearances and emergency abnormalities

Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT

Contrast‐enhanced point of care ultrasound for the evaluation of stable blunt abdominal trauma by the emergency physician: A prospective diagnostic study

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