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Imaging Children with Abdominal Trauma

¹ Department of Radiology, Division of Pediatric Radiology, Rainbow Babies and Children's Hospital, 11100 Euclid Ave., Cleveland, OH 44106-5056.

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —8-year-old boy with hepatic laceration. Coronal reformation of contrast-enhanced CT scan through upper abdomen shows complex hepatic laceration.

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —12-year-old boy with subcapsular hematoma of liver. Contrast-enhanced CT scan through upper abdomen shows laceration extending to periphery of liver with associated subcapsular hematoma.

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —12-year-old boy with subcapsular hematoma of liver. CT scan obtained 2 cm below A shows inferior extension of subcapsular hematoma. Note compression of underlying hepatic parenchyma.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —5-year-old boy with vascular injury in posterior segment of right hepatic lobe. Contrast-enhanced CT scan through upper abdomen shows absence of contrast enhancement in posterior segment of right hepatic lobe.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —11-year-old girl with hepatic laceration through bare area. Contrast-enhanced CT scan through upper abdomen shows laceration extending into bare area of liver.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —8-year-old girl with periportal low-attenuation zones. Contrast-enhanced CT scan through liver shows circumferential periportal low-attenuation zones surrounding main portal vein. Note there is right-sided periadrenal hematoma. Also note small amount of free peritoneal air anterior to liver.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —14-year-old boy with shattered spleen. Contrast-enhanced CT scans through upper abdomen (A) and 2 cm lower (B) show shattered spleen.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —14-year-old boy with shattered spleen. Contrast-enhanced CT scans through upper abdomen (A) and 2 cm lower (B) show shattered spleen.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7 —12-year-old boy with splenic laceration and associated intraparenchymal hematoma. Contrast-enhanced CT scan through upper abdomen shows splenic laceration and associated intraparenchymal hematoma.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8 —15-year-old boy with splenic injury and retroperitoneal extension of hemorrhage. Contrast-enhanced CT scan through upper abdomen shows splenic laceration associated with blood in anterior pararenal space surrounding pancreas.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9 —10-year-old girl with renal contusion. Contrast-enhanced CT scan through mid abdomen shows rounded focus of low attenuation in midpole of left kidney indicative of contusion.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10 —12-year-old boy with subcapsular renal hematoma. Contrast-enhanced CT scan through mid abdomen shows large left-sided subcapsular hematoma compressing renal parenchyma.

View larger version (51K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11 —10-year-old girl with perinephric hematoma. Sagittal reformation of contrast-enhanced CT scan through mid abdomen shows renal laceration associated with perinephric hematoma distributed through perirenal space.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12A —14-year-old boy with renal collecting system injury. Contrast-enhanced CT scan through mid abdomen shows left renal laceration with surrounding perinephric hematoma.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12B —14-year-old boy with renal collecting system injury. Delayed image obtained 5 minutes after A shows extravasation of IV contrast material into perirenal space.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13 —11-year-old girl with segmental renal infarct. Coronal reformation of contrast-enhanced CT scan through mid abdomen shows multiple peripheral wedged-shaped renal parenchymal defects.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14 —15-year-old boy with vascular injury of left kidney. Contrast-enhanced CT scan through mid abdomen shows devascularization of left kidney after left renal artery avulsion.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 15 —11-year-old boy with pancreatic transection. Contrast-enhanced CT scan through upper abdomen shows pancreatic transection at junction of head and body.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 16 —10-year-old girl with pancreatic injury and associated peripancreatic fluid. Contrast-enhanced CT scan through upper abdomen shows fluid is in anterior pararenal space surrounding pancreas. Also note fluid dissecting between splenic vein and pancreas.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 17 —12-year-old boy with acute pancreatitis after pancreatic trauma. Contrast-enhanced CT scan through upper abdomen shows stranding of peripancreatic fat and ill-definition of pancreatic borders.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 18A —11-year-old boy with pancreatic pseudocyst. Contrast-enhanced CT scan through upper abdomen shows laceration through head of pancreas.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 18B —11-year-old boy with pancreatic pseudocyst. Follow-up CT scan obtained 5 weeks after A shows focal fluid collection representing pancreatic pseudocyst is in head of pancreas and is extending into anterior pararenal space.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 19 —8-year-old boy with active hemorrhage. Contrast-enhanced CT scan through mid abdomen shows linear high-attenuation collection representing IV contrast extravasation from splenic arterial tear.

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 20 —11-year-old boy with active hemorrhage. Contrast-enhanced CT scan through pelvis shows high-attenuation fluid representing active hemorrhage. At surgery tear of right iliac vein was noted.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 21 —12-year-old boy with hepatic pseudoaneurysm. Contrast-enhanced CT scan through upper abdomen shows focal, rounded, enhancing lesion in posterior segment of right hepatic lobe. Also note large hepatic subcapsular hematoma.

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 22A —12-year-old girl with active hepatic hemorrhage that did not require laparotomy. Contrast-enhanced CT scan through upper abdomen shows hepatic laceration with focal area of increased attenuation representing active hemorrhage. Patient was managed nonoperatively.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 22B —12-year-old girl with active hepatic hemorrhage that did not require laparotomy. Follow-up CT scan obtained 2 weeks after A shows resolving low-attenuation hematoma within liver.

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 23 —8-year-old boy with duodenal hematoma. Contrast-enhanced CT scan through upper abdomen shows rounded duodenal hematoma to left of midline.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 24 —10-year-old girl with bowel rupture associated with extraluminal air. Contrast-enhanced CT scan through upper abdomen shows extraluminal air.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 25 —9-year-old boy with bowel rupture associated with oral contrast extravasation. CT scan through upper abdomen shows extravasated high-attenuation oral contrast material in peritoneal cavity.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 26A —12-year-old boy with bowel rupture associated with large amount of "unexplained" peritoneal fluid. Contrast-enhanced CT scan through upper abdomen shows large amount of peritoneal fluid in perihepatic and perisplenic spaces.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 26B —12-year-old boy with bowel rupture associated with large amount of "unexplained" peritoneal fluid. CT scan through mid abdomen shows large amount of fluid in right and left paracolic spaces. Patient did not have any other abnormalities at CT. At surgery, jejunal rupture was noted.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 27 —9-year-old boy with bowel rupture associated with bowel wall discontinuity. Contrast-enhanced CT scan through upper abdomen shows discontinuity in wall of duodenum indicative of bowel wall rupture.

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 28 —15-year-old girl with intraperitoneal bladder rupture. Contrast-enhanced CT scan through upper pelvis shows high-attenuation fluid in lateral pelvic recess secondary to intraperitoneal bladder rupture.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 29 —12-year-old girl with extraperitoneal bladder rupture. Contrast-enhanced CT scan through pelvis shows high-attenuation fluid adjacent to right pelvic side wall and low-attenuation fluid posterior to rectum. These fluid collections are extraperitoneal in location, consistent with extraperitoneal bladder rupture.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 30A —2-year-old girl with hypoperfusion complex. Contrast-enhanced CT scans through upper (A) and mid (B) abdomen show diffuse intestinal dilatation with fluid, intense contrast enhancement of bowel wall, and diminished caliber of great vessels indicative of systemic hypoperfusion.

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 30B —2-year-old girl with hypoperfusion complex. Contrast-enhanced CT scans through upper (A) and mid (B) abdomen show diffuse intestinal dilatation with fluid, intense contrast enhancement of bowel wall, and diminished caliber of great vessels indicative of systemic hypoperfusion.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 31 —3-year-old boy with hypoperfusion complex and absence of pancreatic enhancement. Contrast-enhanced CT scan through upper abdomen shows absence of pancreatic enhancement. Pancreas appeared normal at surgery. Findings were thought to be secondary to systemic hypoperfusion.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 32 —2-year-old boy with hypoperfusion complex associated with free peritoneal fluid. Contrast-enhanced CT scan through mid abdomen shows diffuse intestinal dilatation with fluid, intense contrast enhancement of bowel wall, and diminished caliber of great vessels indicative of systemic hypoperfusion. Also note free peritoneal fluid in both paracolic spaces.

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