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. 2010 Mar;13(1):22-7.
doi: 10.1016/j.jus.2010.06.002. Epub 2010 Jul 8.

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

M Valentino  1 , C De Luca, S Sartoni Galloni, M Branchini, C Modolon, P Pavlica, L Barozzi
Affiliations

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

M Valentino et al. J Ultrasound. 2010 Mar.

Abstract
in English, Italian

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.

Sommario INTRODUZIONE: Descrivere l’impiego dell’ecografia con mezzo di contrasto (CEUS) nella valutazione dei pazienti con trauma chiuso dell’addome. MATERIALI E METODI: 133 pazienti con trauma addominale chiuso emodinamicamente stabile sono stati esaminati con ecografia (US), CEUS e Tomografia Computerizzata multistrato (TC) da eliminare. RISULTATI: I 133 pazienti avevano alla TC 84 lesioni, di cui 48 spleniche, 21 epatiche, 13 renali o dei surreni e 2 del pancreas. L’US ha identificato versamento libero o alterazioni parenchimali in 59/84 pazienti positivi alla TC e versamento libero in 20/49 pazienti negativi alla TC. La CEUS ha riconosciuto 81/84 lesioni traumatiche identificate dalla TC e ha escluso lesioni traumatiche in 48/49 pazienti negativi alla TC. Sensibilità, specificità, valore predittivo positivo e negativo per l’US sono stati rispettivamente 70.2%, 59.2%, 74.7% e 53.7%; per la CEUS sono stati 96.4%, 98%, 98.8% e 94.1%. CONCLUSIONI: Lo studio ha dimostrato che la CEUS ha una accuratezza diagnostica maggiore dell’US e quasi sovrapponibile alla TC e può quindi essere proposta nella valutazione iniziale del paziente traumatizzato.

Keywords: Abdominal trauma; Contrast agent; Ultrasonography.

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Figures

Fig. 1
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
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
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
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).
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