The Follow-Up of Patients with Abdominal Injuries

  • Grazia Loretta Buquicchio
  • Gavina Cuneo
  • Stefano Giannecchini
  • Riccardo Palliola
  • Margherita Trinci
  • Vittorio Miele


Nowadays, the growing tendency to treat patients with organ injury with nonoperative management, as well as attention to problems concerning limiting X-ray exposure for the patients, have led to the search for alternative methods for the follow-up of sick patients. Transportation of the critically bedridden patient to another department with nonnegligible risk of displacement of medical devices is another important concern in the management of polytrauma patients.

Contrast-enhanced ultrasound (CEUS) is a technique that fully satisfies the foregoing concerns because it can be performed at the bedside, and there is no X-ray exposure for either patient or medical equipment. CEUS exceeds the limitations of nonenhanced ultrasonography in detecting parenchymal organ injury and can detect some of the positive prognostic factors such as parenchymal bleeding, changing the management of the patient.


Trauma Trauma imaging Organ injury Ultrasound (US) Contrast-enhanced ultrasound (CEUS) Magnetic resonance imaging (MRI) Computed tomography (CT) Blunt abdominal trauma (BAT) Follow-up Radioprotection 


  1. 1.
    Parks RW, Chrysos E, Diamone T. Management of liver trauma. Br J Surg. 1999;86:1121–35.CrossRefGoogle Scholar
  2. 2.
    Uranus S, Pfeifer J. Nonoperative treatment of blunt splenic injury. World J Surg. 2001;25:1405–7.CrossRefGoogle Scholar
  3. 3.
    Valentino M, Ansaloni L, Catena F, et al. Contrast-enhanced ultrasonography in blunt abdominal trauma: considerations after 5 years of experience. Radiol Med. 2009;114:1080–93.CrossRefGoogle Scholar
  4. 4.
    Miele V, Buffa V, Stasolla A, et al. Contrast enhanced ultrasound with second generation contrast agent in traumatic liver lesions. Radiol Med. 2004;108:82–91.PubMedGoogle Scholar
  5. 5.
    Regine G, Atzori M, Miele V, et al. Second-generation sonographic contrast agents in the evaluation of renal trauma. Radiol Med. 2007;112:581–7.CrossRefGoogle Scholar
  6. 6.
    Pinto F, Miele V, Scaglione M, Pinto A. The use of contrast-enhanced ultrasound in blunt abdominal trauma: advantages and limitations. Acta Radiol. 2014;55:776–84. doi: 10.1177/0284185113505517.CrossRefPubMedGoogle Scholar
  7. 7.
    Pinto F, Valentino M, Romanini L, Basilico R, Miele V. The role of CEUS in the assessment of haemodynamically stable patients with blunt abdominal trauma. Radiol Med. 2015;120:3–11. doi: 10.1007/s11547-014-0455-3.CrossRefPubMedGoogle Scholar
  8. 8.
    Albrecth T, Blombley M, Bolondi L. Guidelines for the use of contrast agents in ultrasound. Ultraschall Med. 2004;25:249–56.CrossRefGoogle Scholar
  9. 9.
    Miele V, Piccolo CL, Sessa B, Trinci M, Galluzzo M. Comparison between MRI and CEUS in the follow-up of patients with blunt abdominal trauma managed conservatively. Radiol Med. 2016;121:27–37.CrossRefGoogle Scholar
  10. 10.
    Gruessner R, Mentges B, Duber CH. Sonography versus peritoneal lavage in blunt abdominal trauma. J Trauma. 1989;29:242–4.CrossRefGoogle Scholar
  11. 11.
    McKenney M, Lentz K, Nunez D. Can ultrasound replace diagnostic peritoneal lavage in the assessment of blunt trauma? J Trauma. 1994;37:439–41.CrossRefGoogle Scholar
  12. 12.
    Körner M, Krotz MM, Degenhart C, et al. Current role of emergency US in patients with major trauma. Radiographics. 2008;28:225–44.CrossRefGoogle Scholar
  13. 13.
    Poletti P-A, Wintermark M, Schnyder P. Traumatic injuries: role of imaging in the management of polytrauma victim (conservative expectation). Eur Radiol. 2002;12:969–78.CrossRefGoogle Scholar
  14. 14.
    Sessa B, Trinci M, Ianniello S, et al. Blunt abdominal trauma: role of contrast-enhanced ultrasound (CEUS) in the detection and staging of abdominal traumatic lesions compared to US and CE-MDCT. Radiol Med. 2015;120:180–9.CrossRefGoogle Scholar
  15. 15.
    Valentino M, Serra PP, et al. Blunt abdominal trauma: diagnostic performance of contrast enhanced US in children. Initial experience. Radiology. 2008;246:903–9.CrossRefGoogle Scholar
  16. 16.
    Brown MA, Casola G, Sirlin CB, et al. Blunt abdominal trauma: screening US in 2,693 patients. Radiology. 2001;218:352–8.CrossRefGoogle Scholar
  17. 17.
    Miele V, Piccolo CL, Trinci M, et al. Diagnostic imaging of blunt abdominal trauma in pediatric patients. Radiol Med. 2016;121:409–30. doi: 10.1007/s11547-016-0637-2. Epub 2016 Apr 13CrossRefPubMedGoogle Scholar
  18. 18.
    Sidhu PS, Cantisani V, Deganello A, et al. Role of contrast-enhanced ultrasound (CEUS) in paediatric practice: an EFSUMB position statement. Ultraschall Med. 2017;38:33–43. PMID: 27414980. doi: 10.1055/s-0042-110394.CrossRefPubMedGoogle Scholar
  19. 19.
    Miele V, Di Giampietro I, Ianniello S, et al. Diagnostic imaging in pediatric polytrauma management. Radiol Med. 2015;120:33–49. doi: 10.1007/s11547-014-0469-x. Epub 2014 Nov 7CrossRefPubMedGoogle Scholar
  20. 20.
    Minarik L, Slim M, Rachlin S. Diagnostic imaging in the follow-up of nonoperative management of splenic trauma in children. Pediatr Surg Int. 2002;18(5-6):429–31.CrossRefGoogle Scholar
  21. 21.
    Menichini G, Sessa B, Trinci M, et al. Accuracy of contrast-enhanced ultrasound (CEUS) in the identification and characterization of traumatic solid organ lesions in children: a retrospective comparison with baseline US and CE-MDCT. Radiol Med. 2015;120:989–1001.CrossRefGoogle Scholar
  22. 22.
    Freshman SP, Wisner DH, Battistella FD. Secondary survey following blunt trauma: a new role for abdominal CT scan. J Trauma. 1993;34(3):337–40.CrossRefGoogle Scholar
  23. 23.
    Cuff RF, Cogbill TH, Lambert PJ. Nonoperative management of blunt liver trauma: the value of follow-up abdominal computed tomography scans. Am Surg. 2000;66:332–6.PubMedGoogle Scholar
  24. 24.
    Manetta R, Pistoia ML, Bultrini C, et al. Ultrasound enhanced with sulphur-hexafluoride-filled microbubbles agent (SonoVue) in the follow-up of mild liver and spleen trauma. Radiol Med. 2009;114:771–9.CrossRefGoogle Scholar
  25. 25.
    Catalano O, Lobianco R, Sandomenico F, et al. Real-time, contrast-enhanced sonographic imaging in emergency radiology. Radiol Med. 2004;108:454–69.PubMedGoogle Scholar
  26. 26.
    Poletti PA, Kinkel K, Vermeulen B, et al. Blunt abdominal trauma: should US be used to detect both free fluid and organ injuries? Radiology. 2003;227:95–103.CrossRefGoogle Scholar
  27. 27.
    Wilson SR, Burns PN. Microbubble-enhanced US in body imaging: what role? Radiology. 2010;257(1):24–39.CrossRefGoogle Scholar
  28. 28.
    Oldenburg A, Hohmann J, Skrok J. Imaging of paediatric splenic injury with contrast-enhanced ultrasonography. Pediatr Radiol. 2004;34(4):351–4.CrossRefGoogle Scholar
  29. 29.
    Federle MP, Courcoulas AP, Powell M, et al. Blunt splenic injury in adults: clinical and CT criteria for management, with emphasis on active extravasation. Radiology. 1998;206:137–42.CrossRefGoogle Scholar
  30. 30.
    Gavant ML, Schurr M, Flick PA, et al. Predicting clinical outcome of nonsurgical management of blunt splenic injury: using CT to reveal abnormalities of splenic vasculature. AJR Am J Roentgenol. 1997;168:207–12.CrossRefGoogle Scholar
  31. 31.
    Kawashima A, Sandler CM, Corl FM, et al. Imaging of renal trauma: a comprehensive review. Radiographics. 2001;21:557–74.CrossRefGoogle Scholar
  32. 32.
    Sirlin CB, Brown MA, Deutsch R, et al. Screening US for blunt abdominal trauma: objective predictors of false-negative findings and missed injuries. Radiology. 2003;229:766–74.CrossRefGoogle Scholar
  33. 33.
    Miele V, Piccolo CL, Galluzzo M, et al. Contrast enhanced ultrasound (CEUS) in blunt abdominal trauma. Br J Radiol. 2016;89(1061):20150823. doi: 10.1259/bjr.20150823 Epub 2016 Jan 8.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Grazia Loretta Buquicchio
    • 1
  • Gavina Cuneo
    • 1
  • Stefano Giannecchini
    • 1
  • Riccardo Palliola
    • 1
  • Margherita Trinci
    • 1
  • Vittorio Miele
    • 2
  1. 1.Department of Emergency RadiologyS. Camillo HospitalRomeItaly
  2. 2.Department of RadiologyCareggi University HospitalFlorenceItaly

Personalised recommendations