(Radiology Review) Children affected by blunt abdominal trauma with active extravasation of intravenous (IV) contrast (blush) demonstrated on abdominal CT are at greater risk than those not demonstrating a blush, according to doctors at the Children’s Medical Center of Dallas. The group discussed their experiences with children that had CT following blunt abdominal trauma in the Journal of Pediatric Surgery.
Only patients with liver laceration that had CT documentation were included. A study cohort of 105 children was established and data regarding age, causes of injury, injury severity, and clinical outcome was reviewed. They eliminated children with mild injury (grades I-II), which left a group of 75 patients with severe liver injury (grades III-VI). CT was performed using a Tomoscan (Philips Medical Systems, Andover, MA) CT using a slice thickness ranging 5-7 mm. Only IV contrast was administered; no oral contrast was given because of preoperative considerations.
Results determined that 29% of children demonstrated extravasation of IV contrast (blush). Although 17 patients underwent surgery only two cases were operations relating to the liver injury.
"At this time we would not recommend transcatheter arterial embolization in the stable patient with a severe liver laceration and a blush unless there is an ongoing transfusion requirement or unless there is obvious intraperitoneal pooling of IV contrast on CT scan," they suggested.
"Children with a blush seen on abdominal CT after blunt liver injury have higher transfusion requirements and greater risk of mortality than those without blush," they concluded. They also suggested that individual mortality was more dependent upon the severity of other injuries than liver damage.
Significance of blush on computed tomography scan in children with liver injuryEubanks, K. III et. al.
Children’s Medical Center of Dallas, Dallas, TX
J Pediatr Surg 2003 March; 38:363-366
By Radiology Review
July 29, 2003
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