Contrast-enhanced ultrasound (CEUS) in evaluation and follow-up of pediatric blunt abdominal trauma.

Congress:

ECR 2020

Poster Number:

C-06211

Type:

Educational Exhibit

Keywords:

Not applicable, Trauma, Radiation safety, Diagnostic procedure, Complications, Ultrasound, CT, Paediatric, Abdomen

Authors:

M. Costilla Frías, V. P. Beltrán Salazar, C. Martin Martinez, I. Artacho Rodríguez, I. Romero Novo, N. brun lozano, E. Casanovas Navarro, A. Framis Utset; Sabadell/ES

DOI:

10.26044/ecr2020/C-06211

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-06211

Fig. 2: Renal enhancement phases. a and b) Arterial phases with cortical enhancement. b...

Fig. 3: Hepatic enhancement phases. a-b) Arterial phase with minimal hepatic...

Fig. 4: Spleen enhancement phases. a) Early arterial phase characterized by an...

Fig. 7: 11 year-old boy who fell on the playground. a) CT showed a large hepatic...

Fig. 14: 12-year-old boy who sustained abdominal trauma while skiing. a) CT shows a...

Fig. 20: a) CT in an 11-year-old boy shows an AAST grade IV injury in the right kidney,...

Learning objectives

To review the utility of contrast-enhanced ultrasound in the follow-up of traumatic solid organ lesions in children.

Background

Blunt abdominal trauma represents one of the principal causes of morbi-mortality in children. Some particular anatomic features (e.g., a thinner abdominal wall, less intraabdominal fat, and a lower position and distance of the organs to the abdominal wall) make severe injuries from a low energy impact more likely in children. The most widely used abdominal ultrasound technique in polytrauma patients, Focused Assessment with Sonography for Trauma (FAST), has high sensitivity for detecting free abdominal fluid, but low sensitivity for detecting solid-organ injuries [1]. By contrast,...

Findings and procedure details

Overview In 2016 some recommendations for the use of CEUS in paediatric polytaruma were published, including [7]: a)Haemodynamically stable patients who sustained low/moderate blunt abdominal trauma. Systematic examination requires the administration of intravenous contrast in two independent boluses, starting on the side of clinical concern. b) Normal or indeterminate CT findings and suspicious laboratory tests. c)In the follow-up of conservatively managed traumatic injuries to ensure resolution of the lesions or detect associated complications. Ultrasound evaluation should target the damaged organ, so only one contrast bolus...

Conclusion

CEUS has proven useful and highly sensitive in the follow-up of traumatic solid-organ lesions. It has several advantages over multiphasic CT: it is child-friendly because it does not require sedation and does not use ionizing radiation, so it allows repeated imaging. Based on our experience, CT should be the preferred initial imaging technique for acute trauma, and CEUS should be the technique of choice for follow-up.

Personal information and conflict of interest

M. Costilla Frías; Sabadell/ES - nothing to disclose V. P. Beltrán Salazar; Sabadell/ES - nothing to disclose C. Martín Martínez; Sabadell/ES - nothing to disclose I. Artacho Rodríguez; Sabadell/ES - nothing to disclose I. Romero Novo; Sabadell/ES - nothing to disclose N. Brun Lozano; Sabadell/ES - nothing to disclose E. Casanovas Navarro; Sabadell/ES - nothing to disclose A. Framis Utset; Sabadell/ES - nothing to disclose

References

[1] Poletti P et al. Blunt abdominal trauma: should US be used to detect both free fluid and organ injuries? Radiology 2003; 227:95–103. [2] Pinto F et al. The role of the radiologist in the management of polytrauma patients. Eur J Radiol 2006; 59: 315–16. [3] Claudon M et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver – update 2012. Ultraschall Med 2013; 34: 11–29. [4] Piscaglia F et al. The EFSUMB guidelines and recommendations on the clinical...