Optimizing Imaging in the Pediatric Trauma Patient, Part 2: Thoracic and Abdominal Trauma - Trauma EXTRA Supplement (Trauma CME)

Table of Contents

 

About This Issue

When making imaging decisions in children with thoracic and abdominal injuries, clinicians must balance the need to reduce unnecessary radiation exposure in these patients with the need to quickly identify serious and potentially life-threatening injuries. Consideration of the location and mechanism of injury and the physical examination findings are required to make appropriate imaging decisions. This supplement reviews evidence-based recommendations for imaging decisions and interpretations in pediatric patients with thoracic and abdominal injuries and provides examples of imaging modalities and findings. You will learn:

The utility of x-rays and/or ultrasound to quickly identify life-threatening conditions in pediatric chest injuries

How to differentiate hemothorax from simple pleural effusion on x-ray or CT

The importance of using CT when there is suspicion for pulmonary contusion or laceration

The role of imaging in identifying rib fractures

How to interpret CT imaging for indications of diaphragmatic rupture, splenic lacerations, hepatic lacerations, subcapsular hematoma, intrahepatic hematoma, renal laceration, perinephric hematoma, and perirenal hematoma

The utility of the FAST examination in the initial assessment of abdominal trauma

The imaging criteria for grading the severity of spleen, liver, and kidney injuries

The indications for abdominal imaging in the setting of suspicion for nonaccidental trauma

1. About This Issue
2. Abstract
3. Introduction
4. Radiation Reduction
5. Thoracic Trauma
   1. Imaging Modalities in Thoracic Trauma
   2. Pleural Space Injuries
   3. Lung Parenchyma Injuries
   4. Chest Wall Injuries
   5. Cardiac Injuries
   6. Diaphragm Injuries
6. Abdominal Trauma
   1. Imaging Modalities in Abdominal Trauma
   2. Solid-Organ Injuries
      1. Splenic Injuries
      2. Hepatic Injuries
      3. Renal Injuries
   3. Hollow-Viscus Injuries
   4. Abdominal Injuries in Nonaccidental Trauma
7. Summary
8. Tables and Figures
9. References

Abstract

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.

Introduction

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.”

Tables and Figures

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Key References

Following are the most informative references cited in this paper, as determined by the authors.

5. * Minervini F, Scarci M, Kocher GJ, et al. Pediatric chest trauma: a unique challenge. J Vis Surg. 2019;6:1-7. (Review) DOI: 10.21037/jovs.2019.11.05

6. * Golden J, Isani M, Bowling J, et al. Limiting chest computed tomography in the evaluation of pediatric thoracic trauma. J Trauma Acute Care Surg. 2016;81(2):271-277. (Retrospective study; 1035 patients) DOI: 10.1097/TA.0000000000001110

7. * Alemayehu H, Aguayo P. Pediatric blunt thoracic trauma. J Pediatr Intensive Care. 2015;4(1):35-39. (Review) DOI: 10.1055/s-0035-1554987

8. * Tovar JA, Vazquez JJ. Management of chest trauma in children. Paediatr Respir Rev. 2013;14(2):86-91. (Review) DOI: 10.1016/j.prrv.2013.02.011

9. * Moore MA, Wallace EC, Westra SJ. The imaging of paediatric thoracic trauma. Pediatr Radiol. 2009;39(5):485-496. (Review) DOI: 10.1007/s00247-008-1093-5

13. * Miele V, Piccolo CL, Trinci M, et al. Diagnostic imaging of blunt abdominal trauma in pediatric patients. Radiol Med. 2016;121(5):409-430. (Review) DOI: 10.1007/s11547-016-0637-2

14. * Holmes JF, Sokolove PE, Brant WE, et al. Identification of children with intra-abdominal injuries after blunt trauma. Ann Emerg Med. 2002;39(5):500-509. (Prospective observational series; 1095 patients) DOI: 10.1067/mem.2002.122900

16. * Sivit CJ. Imaging children with abdominal trauma. AJR Am J Roentgenol. 2009;192(5):1179-1189. (Review) DOI: 10.2214/AJR.08.2163

18. * Ahmed N, Vernick JJ. Management of liver trauma in adults. J Emerg Trauma Shock. 2011;4(1):114-119. (Review) DOI: 10.4103/0974-2700.76846

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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