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May 12, 2021 — Pediatric Radiology


Trauma is the leading cause of morbidity and mortality in children, and rapid identification of organ injury is essential for successful treatment. Contrast-enhanced ultrasound (CEUS) is an appealing alternative to contrast-enhanced CT in the evaluation of children with blunt abdominal trauma, mainly with respect to the potential reduction of population-level exposure to ionizing radiation. This is particularly important in children, who are more vulnerable to the hazards of ionizing radiation than adults. CEUS is useful in hemodynamically stable children with isolated blunt low- to moderate-energy abdominal trauma to rule out solid organ injuries. It can also be used to further evaluate uncertain contrast-enhanced CT findings, as well as in the follow-up of conservatively managed traumatic injuries. CEUS can be used to detect abnormalities that are not apparent by conventional US, including infarcts, pseudoaneurysms and active bleeding. In this article we present the current experience from the use of CEUS for the evaluation of pediatric blunt abdominal trauma, emphasizing the examination technique and interpretation of major abnormalities associated with injuries in the liver, spleen, kidneys, adrenal glands, pancreas and testes. We also discuss the limitations of the technique and offer a review of the major literature on this topic in children, including an extrapolation of experience from adults.

Authors: Harriet J. Paltiel1& Richard A. Barth2& Costanza Bruno3& Aaron E. Chen4& Annamaria Deganello5& Zoltan Harkanyi6&M. Katherine Henry7,& Damjana Ključevšek8& Susan J. Back7

1 Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
2 Department of Radiology, Lucile Packard Children’s Hospital at Stanford, Stanford University School of Medicine, Stanford, CA, USA
3 Department of Radiology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
4 Department of Pediatrics, Division of Emergency Medicine, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
5 Department of Radiology, King’s College Hospital, Denmark Hill, London, UK
6 Department of Radiology, Heim Pal National Pediatric Institute, Budapest, Hungary
7 Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
8 Department of Radiology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia

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