Qian Lin1, Faqin Lv1, Yukun Luo1, Qing Song1, Qinghua Xu1, Yihua Su2, Yu Tang3, Jie Tang4. 1. Department of Ultrasound, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China. 2. Department of Function, Tumor Hospital of Datong Coal Mine Group Limited Liability Company, 1 Xinsheng Rd, Datong, 037003, Shanxi, China. 3. Department of Ultrasound, 62th Hospital of Chinese People's Liberation Army, 3 Yushui Rd, Puer, 665000, Yunnan, China. 4. Department of Ultrasound, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China. txiner@vip.sina.com.
Abstract
PURPOSE: Contrast-enhanced ultrasound (CEUS) is a highly specific and sensitive method for assessing hemodynamically stable patients with blunt abdominal trauma. We evaluated the efficacy of CEUS in assessing renal trauma in different states of hemodynamic instability or shock. METHODS: Hemorrhagic renal lesions reflecting grade III-IV trauma were established in the kidneys of 25 mongrel dogs. Mild, moderate, and severe systemic hypotension was induced by controlled exsanguination. The features of renal trauma in CEUS and contrast-enhanced computed tomography (CECT) were assessed and compared before shock and during shock progression. RESULTS: Gross pathology showed that with trauma, the kidneys gradually shrank and became soft, and the active bleeding in the area of the renal trauma gradually reduced and stopped. No significant differences were observed in the trauma detection rates between CEUS and CECT at any stage of shock. During the baseline and mild shock stage, sonograms obtained after intravenous injection of contrast agent showed marked contrast medium extravasation and pooling at the site of active bleeding. With shock progression, the difference in enhancement between trauma areas and the surrounding renal tissue decreased: the trauma areas became indistinct and the abnormal enhancement associated with active bleeding diminished. Further, CEUS enabled visualization of changes in renal perfusion associated with shock progression. Changes in contrast agent arrival time and the time to peaking were observed earliest in the mild shock model. The contrast agent peak intensity reduced, while the washout time increased as shock progressed from moderate to severe. CONCLUSION: In our canine model, CEUS was found to be as accurate as CECT in assessing hemorrhagic renal lesions. Thus, CEUS seems a promising tool for monitoring hemodynamic changes and predicting early shock to enable the conservative treatment of severe renal trauma.
PURPOSE: Contrast-enhanced ultrasound (CEUS) is a highly specific and sensitive method for assessing hemodynamically stable patients with blunt abdominal trauma. We evaluated the efficacy of CEUS in assessing renal trauma in different states of hemodynamic instability or shock. METHODS:Hemorrhagic renal lesions reflecting grade III-IV trauma were established in the kidneys of 25 mongrel dogs. Mild, moderate, and severe systemic hypotension was induced by controlled exsanguination. The features of renal trauma in CEUS and contrast-enhanced computed tomography (CECT) were assessed and compared before shock and during shock progression. RESULTS: Gross pathology showed that with trauma, the kidneys gradually shrank and became soft, and the active bleeding in the area of the renal trauma gradually reduced and stopped. No significant differences were observed in the trauma detection rates between CEUS and CECT at any stage of shock. During the baseline and mild shock stage, sonograms obtained after intravenous injection of contrast agent showed marked contrast medium extravasation and pooling at the site of active bleeding. With shock progression, the difference in enhancement between trauma areas and the surrounding renal tissue decreased: the trauma areas became indistinct and the abnormal enhancement associated with active bleeding diminished. Further, CEUS enabled visualization of changes in renal perfusion associated with shock progression. Changes in contrast agent arrival time and the time to peaking were observed earliest in the mild shock model. The contrast agent peak intensity reduced, while the washout time increased as shock progressed from moderate to severe. CONCLUSION: In our canine model, CEUS was found to be as accurate as CECT in assessing hemorrhagic renal lesions. Thus, CEUS seems a promising tool for monitoring hemodynamic changes and predicting early shock to enable the conservative treatment of severe renal trauma.
Entities:
Keywords:
Active bleeding; Contrast-enhanced ultrasonography; Hemorrhagic shock; Kidney; Trauma
Authors: Anoek L I van Leeuwen; Nicole A M Dekker; Paul Van Slyke; Esther de Groot; Marc G Vervloet; Joris J T H Roelofs; Matijs van Meurs; Charissa E van den Brom Journal: Intensive Care Med Exp Date: 2021-05-17