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Pediatric adrenal trauma: evaluation and follow-up with contrast-enhanced ultrasound (CEUS)

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Abstract

Adrenal trauma is rarely encountered in the pediatric population, often as a component of multi-organ injury and often presenting with hematoma formation. Contrast-enhanced computed tomography (CECT) is the established imaging modality both for initial evaluation and follow-up of patients with blunt abdominal trauma. In children, radiation exposure should be minimized and alternative imaging strategies are needed. Contrast-enhanced ultrasound (CEUS) has recently been successfully used for evaluation of patients with hepatic, renal and splenic injury. We present three cases of children with post-traumatic adrenal hematomas, which were initially diagnosed with CECT and subsequently followed up with CEUS, suggesting that CEUS may be considered for follow-up of adrenal injuries in children. CEUS improves the diagnostic capabilities by increasing tissue contrast and spatial resolution, readily differentiating viable from necrotic tissue in comparison to conventional ultrasound without the risk of iodine contrast agents and ionizing radiation of repeated CECT examinations.

Sommario

Il trauma dei surreni accade raramente nella popolazione pediatrica, spesso è parte di un poli-trauma e spesso si presenta normalmente sotto forma di ematoma. La tomografia computerizzata con contrasto (TAC) è stabilita come modalità di diagnostica per immagini per la valutazione iniziale e il follow-up di pazienti con trauma addominale chiuso. Nei bambini e’ necessario ridurre al minimo l’esposizione alle radiazioni ionizzanti, pertanto sono necessarie strategie d’immagine alternative. L’ecografia con mezzo di contrasto (CEUS) e’ stata usata recentemente con successo nella valutazione di pazienti con lesioni traumatiche epatiche, renali e spleniche. Presentiamo tre casi di bambini con ematomi surrenali post-traumatici, inizialmente diagnosticati con tomografia computerizzata con contrasto (TAC) e successivamente esaminati al follow-up con ecografia con contrasto (CEUS), e suggeriamo che la CEUS può essere considerata per il follow-up delle lesioni traumatiche dei surreni nei bambini. La CEUS migliora le capacità diagnostiche aumentando contrasto tissutale e la risoluzione spaziale, differenziando prontamente il tessuto vitale da quello necrotico rispetto all’ecografia convenzionale, senza il rischio inerente ai mezzi di contrasto iodati e alle radiazioni ionizzanti legate a ripetuti esami con TAC con contrasto.

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Authors and Affiliations

  1. Department of Radiology, King’s College Hospital, King’s College London, London, UK

    Vasileios Rafailidis, Annamaria Deganello, Maria E. Sellars & Paul S. Sidhu

  2. Paediatric Surgery, King’s College Hospital, King’s College London, London, UK

    Erica Makin

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  1. Vasileios Rafailidis
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  2. Annamaria Deganello
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  3. Maria E. Sellars
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  4. Erica Makin
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  5. Paul S. Sidhu
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Correspondence to Vasileios Rafailidis.

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Author AD has received lecture fees from Bracoo company. Author MES has received lecture fees from Bracco company. Author PSS has received lecture fees from Siemens, Hitachi, GE, Bracco companies.

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Rafailidis, V., Deganello, A., Sellars, M.E. et al. Pediatric adrenal trauma: evaluation and follow-up with contrast-enhanced ultrasound (CEUS). J Ultrasound 20, 325–331 (2017). https://doi.org/10.1007/s40477-016-0220-7

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  • DOI: https://doi.org/10.1007/s40477-016-0220-7

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