Imaging is a critical tool for the diagnosis and management of thoracic and abdominal injuries in pediatric patients. The location and mechanism of injury, the physical examination, and other clinical findings should guide emergency clinicians in the selection of the most appropriate imaging modality for the pediatric trauma patient. This supplement reviews the evidence for imaging decisions in the setting of pleural space, lung parenchyma, chest wall, cardiac, diaphragm, solid-organ, and hollow-viscus injuries in pediatric patients. Examples demonstrating imaging modalities, interpretations, and specific findings are provided. Considerations for imaging in suspected nonaccidental abdominal trauma are also discussed.
Evaluation of pediatric thoracic and abdominal injuries requires consideration of the anatomic and biomechanical characteristics of children, as well as assessment of the risks associated with exposure to ionizing radiation. The mechanism of injury and the clinical findings will inform imaging decisions. This supplement provides evidence-based recommendations for the selection of appropriate diagnostic imaging modalities for pediatric patients with pleural space, lung parenchyma, chest wall, cardiac, diaphragm, solid-organ, and hollow-viscus injuries. Recommendations for management of these injuries are not included in the scope of this supplement.
For a detailed review of imaging for pediatric patients with head and neck injuries, see the August 2021 issue of Pediatric Emergency Medicine Practice: Pediatric Trauma Extra titled, “Optimizing Imaging in the Pediatric Trauma Patient, Part 1: Head and Neck Trauma.”
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Following are the most informative references cited in this paper, as determined by the authors.
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Keywords: pediatric trauma, imaging, trauma imaging, thoracic trauma, abdominal trauma, CT, computed tomography, FAST, eFAST, ultrasound, x-ray, ALARA, pleural space injury, tension pneumothorax, hemothorax, pulmonary contusion, lung parenchyma injury, pulmonary laceration, pleural effusion, chest wall injury, rib fractures, cardiac injury, diaphragm injury, diaphragmatic rupture, spleen injury, kidney injury, liver injury, splenic laceration, hepatic laceration, injury grading scale, intrahepatic hematoma, subcapsular hematoma, renal laceration, perinephric hematoma, hollow-viscus injuries, nonaccidental trauma, NAT
Jinel Scott, MD, MBA; Tarundeep Grewal, MD; Selwena Brewster, MD; Ambreen Khan, MD, FAAP
Michelle Arzubi-Hughes, DO; Peter Gutierrez, MD, FAAP
September 30, 2022