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Case Reports
. 2016 Oct 19;20(4):325-331.
doi: 10.1007/s40477-016-0220-7. eCollection 2017 Dec.

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

Vasileios Rafailidis  1 , Annamaria Deganello  1 , Maria E Sellars  1 , Erica Makin  2 , Paul S Sidhu  1
Affiliations
Case Reports

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

Vasileios Rafailidis et al. J Ultrasound. .

Abstract
in English, Italian

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.

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.

Keywords: Adrenal; Microbubbles; Pediatric; Trauma; Ultrasound.

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Conflict of interest statement

Conflict of interest

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.

Ethical approval

For this type of study formal consent is not required.

Human and animal studies

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
A 13-year-old boy with renal laceration and adrenal hematoma. Axial CT image a demonstrates a rounded hypodense lesion displacing the right adrenal gland. Coronal reformatted image b demonstrates the relation of the hematoma to the right kidney, liver and adrenal gland. A composite image c correlating US (left), CT (middle) and CEUS (right). The adrenal gland (arrowheads) can be seen hypoechoic with US and normally enhancing with CT and CEUS. The hematoma is identified surrounding the adrenal gland. It is readily identified on CT as hypodense material and is more prominent on CEUS where it is avascular distinct to adjacent normal enhancing tissues. The kidney laceration (arrow) is visible on CT and CEUS but less prominent on US
Fig. 2
Fig. 2
A 15-year-old boy with hepatic laceration, transection of the pancreatic neck and adrenal hematoma. Axial CT a shows the hypodense laceration affecting segments I, IVA and IVB. The corresponding CEUS image b readily demonstrates the non-enhancing laceration. A composite image c correlating US (left), CT (middle) and CEUS (right). The adrenal hematoma (arrowhead) appears anechoic on US, hypodense on CT and non-enhancing hypoechoic on CEUS. The inferiorly displaced adrenal gland can be identified on CT (arrow). A different plane on CEUS demonstrating the normal enhancing displaced adrenal gland (arrowhead)
Fig. 3
Fig. 3
A 2-year-old girl with adrenal hematoma identified after traffic accident. A composite image a correlating US (left), CT (middle) and CEUS (right). The adrenal hematoma (arrowhead) appears isoechoic on US, hypodense on CT and non-enhancing hypoechoic on CEUS. On color Doppler b the lesion was avascular. Following administration of microbubble contrast, the lesion showed no marked immediate a or delayed c enhancement. Note was made of the ‘shine-through’ artifact. Follow-up ultrasound 1 week later d demonstrating the decrease in size of the mass (arrowhead)
See this image and copyright information in PMC

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