Contrast-enhanced US evaluation in patients with blunt abdominal trauma()

Abstract

Introduction: To evaluate the use of contrast-enhanced ultrasonography (CEUS) in patients with blunt abdominal trauma.

Materials and methods: A total of 133 hemodynamically stable patients were evaluated using ultrasonography (US), CEUS and multislice Computer Tomography (CT) da eliminare.

Results: In 133 patients, CT identified 84 lesions: 48 cases of splenic injury, 21 of liver injury, 13 of kidney or adrenal gland injury and 2 of pancreatic injury. US identified free fluid or parenchymal abnormalities in 59/84 patients positive at CT and free fluid in 20/49 patients negative at CT. CEUS revealed 81/84 traumatic injuries identified at CT and ruled out traumatic injuries in 48/49 negative at CT. Sensitivity, specificity, positive and negative predictive values for US were 70.2%, 59.2%, 74.7% and 53.7%, respectively; for CEUS the values were 96.4%, 98%, 98.8% and 94.1%, respectively.

Conclusions: The study showed that CEUS is more accurate than US and nearly as accurate as CT, and CEUS can therefore be proposed for the initial evaluation of patients with blunt abdominal trauma.

Keywords: Abdominal trauma; Contrast agent; Ultrasonography.

Figures

Fig. 1

Blunt abdominal trauma. A) US: hypoechoic lesion of the right hepatic lobe with irregular contours consistent with traumatic injury (calipers). B) CEUS shows extended liver rupture (arrows) and the presence of a second adjacent contusion (asterisk). C) Contrast-enhanced CT confirms rupture (white arrow) and contusion (black arrow).

Fig. 2

Left flank trauma. A) US of the left kidney: no evidence of traumatic injuries. B) CEUS shows complete rupture at the middle third of the left kidney, the profile is interrupted by a thin perirenal hematoma (arrow). C) Contrast-enhanced CT confirms rupture (arrow) and a thin perirenal hematoma.

Fig. 3

Right flank trauma. A) Subcostal oblique scan: US evidences a small fluid collection in the hepatorenal space (arrow). B) CEUS evidences a shaded hypoechoic area at the upper pole of the right kidney (arrow) which appears well-delineated. On revision of the case, this hypoechoic area was interpreted as adrenal gland contusion. C) Contrast-enhanced CT shows inhomogeneous enlargement of the adrenal gland (arrow). This patient was monitored for 48 h while the contusion cleared up.

Fig. 4

Trauma due to road accident. A) US of the left flank: diffused alteration of the splenic echo pattern but no evidence of free fluid. B) CEUS showed a large rupture of the lower half of the spleen with extravasation of contrast agent within the hematoma (arrow). C) CT scan confirmed splenic rupture and bleeding (arrow).