Lars Thorelius1. 1. Imaging Diagnosis Center, Herlev Hospital, Denmark. lars@thorelius.com
Abstract
BACKGROUND: There is no controversy about the use of CT for detection of internal injuries in patients with high-energy multitrauma. However, in most patients isolated blunt abdominal trauma is mild or moderate and the risk of injury to organs other than the liver, spleen or kidneys is minimal. CT scanning exposes patients to radiation, and may often be avoided if significant damage to these three organs can be visualized by contrast-enhanced ultrasonography (CEUS). MATERIALS AND METHODS: In our series SonoVue (Bracco, Milan) and Siemens Acuson Sequoia ultrasound machines were used. Initially patients with injuries detected by CT were examined using CEUS. Subsequently CEUS was used as the first and only modality in patients with mild or moderate blunt abdominal trauma to one flank, provided that they were able to cooperate and were otherwise suitable for US examination. RESULTS: CEUS was able to sensitively detect lacerations and haematomas in the liver, spleen and kidneys in cooperative patients. CEUS also demonstrated very thin lacerations of the parenchyma of these organs. These results were also found in children. CONCLUSION: In our experience CEUS is an accurate and valuable tool for the detection or exclusion of parenchymal damage to the liver, spleen and kidneys. With the proper organization, standardized dynamic documentation and well-trained sonographers, CEUS may replace CT in many patients with mild to moderate blunt abdominal trauma, thus avoiding unnecessary exposure to radiation in this often young and healthy population.
BACKGROUND: There is no controversy about the use of CT for detection of internal injuries in patients with high-energy multitrauma. However, in most patients isolated blunt abdominal trauma is mild or moderate and the risk of injury to organs other than the liver, spleen or kidneys is minimal. CT scanning exposes patients to radiation, and may often be avoided if significant damage to these three organs can be visualized by contrast-enhanced ultrasonography (CEUS). MATERIALS AND METHODS: In our series SonoVue (Bracco, Milan) and Siemens Acuson Sequoia ultrasound machines were used. Initially patients with injuries detected by CT were examined using CEUS. Subsequently CEUS was used as the first and only modality in patients with mild or moderate blunt abdominal trauma to one flank, provided that they were able to cooperate and were otherwise suitable for US examination. RESULTS: CEUS was able to sensitively detect lacerations and haematomas in the liver, spleen and kidneys in cooperative patients. CEUS also demonstrated very thin lacerations of the parenchyma of these organs. These results were also found in children. CONCLUSION: In our experience CEUS is an accurate and valuable tool for the detection or exclusion of parenchymal damage to the liver, spleen and kidneys. With the proper organization, standardized dynamic documentation and well-trained sonographers, CEUS may replace CT in many patients with mild to moderate blunt abdominal trauma, thus avoiding unnecessary exposure to radiation in this often young and healthy population.
Authors: Harriet J Paltiel; Richard A Barth; Costanza Bruno; Aaron E Chen; Annamaria Deganello; Zoltan Harkanyi; M Katherine Henry; Damjana Ključevšek; Susan J Back Journal: Pediatr Radiol Date: 2021-05-12
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Authors: Mauro Podda; Belinda De Simone; Marco Ceresoli; Francesco Virdis; Francesco Favi; Johannes Wiik Larsen; Federico Coccolini; Massimo Sartelli; Nikolaos Pararas; Solomon Gurmu Beka; Luigi Bonavina; Raffaele Bova; Adolfo Pisanu; Fikri Abu-Zidan; Zsolt Balogh; Osvaldo Chiara; Imtiaz Wani; Philip Stahel; Salomone Di Saverio; Thomas Scalea; Kjetil Soreide; Boris Sakakushev; Francesco Amico; Costanza Martino; Andreas Hecker; Nicola de'Angelis; Mircea Chirica; Joseph Galante; Andrew Kirkpatrick; Emmanouil Pikoulis; Yoram Kluger; Denis Bensard; Luca Ansaloni; Gustavo Fraga; Ian Civil; Giovanni Domenico Tebala; Isidoro Di Carlo; Yunfeng Cui; Raul Coimbra; Vanni Agnoletti; Ibrahima Sall; Edward Tan; Edoardo Picetti; Andrey Litvin; Dimitrios Damaskos; Kenji Inaba; Jeffrey Leung; Ronald Maier; Walt Biffl; Ari Leppaniemi; Ernest Moore; Kurinchi Gurusamy; Fausto Catena Journal: World J Emerg Surg Date: 2022-10-12 Impact factor: 8.165