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Contrast-enhanced ultrasound (CEUS) in pediatric blunt abdominal trauma

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Abstract

Baseline ultrasound is the first-choice technique in traumatic hemodynamically stable children, and is essential in the early assessment of unstable patients to detect hemoperitoneum or other potentially fatal conditions. Despite the technological advancements in new ultrasound equipment and the experience of the operators, it is not always possible to rule out the presence of parenchymal traumatic lesions by means of baseline ultrasound nor to suspect them, especially in the absence of hemoperitoneum. For this reason, in the last decades, basic ultrasound has been associated with contrast-enhanced ultrasound (CEUS) to evaluate the stable little patient in cases such as low-energy blunt abdominal trauma. Because it relies on second-generation contrast agents, the CEUS technique allows for better detection of parenchymal injuries. CEUS has been demonstrated to be almost as sensitive as contrast-enhanced CT in the detection of traumatic injuries in patients affected by low-energy isolated abdominal trauma, with levels of sensitivity and specificity up to 95%. A very important point in favor of CEUS is its capacity to help distinguish the healthy patient, who can be discharged, from the one needing prolonged monitoring, operative management or hospitalization. Finally, we also have the ability to follow-up on low-grade traumatic lesions using CEUS, always keeping in mind patients’ clinical conditions and their hemodynamics.

Sommario

Il trauma rappresenta una importante causa di morbidità e mortalità infantile ed il trauma chiuso dell’addome è responsabile di circa l’ 80-90% delle lesioni addominali. Il meccanismo traumatico è abbastanza simile a quello che si verifica nell’adulto, con significative differenze fisiologiche tra le due classi di età responsabili di un sempre maggior utilizzo del management non operativo in età infantile. In caso di trauma a bassa energia l’imaging può essere effettuato con la CEUS, una tecnica diagnostica in grado di evidenziare le lesioni traumatiche addominali con un’ accuratezza diagnostica molto vicina a quella della TC con mdc. Tuttavia, per alcune lesioni traumatiche, come quelle che interessano le vie urinarie, la TC con mdc resta la metodica di scelta, in ragione della sua elevata sensibilità ed accuratezza, in grado di distinguere tra un leakage retro-peritoneale o intraperitoneale, guidando quindi anche il management terapeutico. Il fegato è l’organo più comunemente interessato dalle lesioni traumatiche addominali, seguito dalla milza. Le lesioni renali e pancreatiche sono piuttosto rare. In questa review gli autori si propongono di presentare i reperti di imaging più comuni in corso di trauma chiuso dell’addome infantile con CEUS e relativo confronto con la TC.

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Authors and Affiliations

  1. Department of Emergency Radiology, S. Camillo Hospital, Rome, Italy

    Margherita Trinci, Riccardo Ferrari, Michele Galluzzo & Stefania Ianniello

  2. Department of Radiology, Ospedale del Mare, Naples, Italy

    Claudia Lucia Piccolo

  3. Department of Radiology, Careggi University Hospital, L.go G.A. Brambilla, 3, 50134, Florence, Italy

    Vittorio Miele

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  1. Margherita Trinci
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  2. Claudia Lucia Piccolo
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Trinci, M., Piccolo, C.L., Ferrari, R. et al. Contrast-enhanced ultrasound (CEUS) in pediatric blunt abdominal trauma. J Ultrasound 22, 27–40 (2019). https://doi.org/10.1007/s40477-018-0346-x

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