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Contrast-enhanced ultrasonography (CEUS) in the follow-up of pediatric abdominal injuries: value and timing

Abstract

Aims

Primary aim was to investigate the value and safety of contrast-enhanced ultrasonography (CEUS) during follow-up (FU) of splenic, hepatic and renal post-traumatic injuries in a pediatric population. Secondary aim was to extrapolate appropriate timing of FU-CEUS.

Methods

In a retrospective study, post-traumatic parenchymal injuries diagnosed with CT or CEUS, were subjected to non-operative management and followed with CEUS.

Results

Forty-six patients were enrolled, with isolated or combined injuries, for a total of 30 splenic, 15 hepatic and 12 renal injuries. At admission 42/46 patients underwent CT and 4/46 underwent CEUS. During FU a total of 65 CEUS were performed: 16 within 72 h to check delayed active bleeding or parenchymal rupture; 24 between 5 and 10 days post admission, to pose indication to active mobilization or to discharge; 21 between 20 and 60 days post admission to document complete healing of the lesion or pose indication to discharge in most severe injuries. No complications related to CEUS were encountered.

Conclusions

CEUS is valuable and safe to follow patients with post-traumatic abdominal injuries, even if further data are needed for renal injuries. We propose a tailored approach based on injury grade and clinical course: in the first 3 days only in case of delayed bleeding or rupture suspect; between 5 and 10 days post trauma to ensure a safe active mobilization and/or pose indication to discharge, and over 20–30 days post trauma to pose indication to discharge in most severe injuries or document complete healing and permit return to sport activities.

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Author information

All authors contributed to the study. AP performed all the CEUS examinations. Material preparation, data collection and analysis were performed by DR, MEM and GS. The first draft of the manuscript was written by DR and reviewed by GL and GL. All authors commented on previous versions of the manuscript. Supervision was conducted by PLC. All authors read and approved the final manuscript.

Correspondence to Dacia Di Renzo.

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Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This study involves human participants under 18 years of age; contrast media was “off label” used and informed consent was signed by parents/caregivers of children subjected included in the study.

Ethical approval

The study has been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the Helsinki Declaration of 1975 and its late amendments.

Informed consent

Additional informed consent was obtained from all patients (by parents/caregivers) for which identifying information is not included in this article. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Di Renzo, D., Persico, A., Lisi, G. et al. Contrast-enhanced ultrasonography (CEUS) in the follow-up of pediatric abdominal injuries: value and timing. J Ultrasound (2020) doi:10.1007/s40477-019-00423-z

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Keywords

  • Pediatric abdominal trauma
  • Contrast-enhanced ultrasonography
  • CEUS
  • Follow-up
  • Pediatric