In many emergency departments, CT exams are the imaging study most frequently ordered for patients admitted with blunt abdominal trauma. However, pediatric surgeons and radiologists from Germany recommend that ultrasound combined with clinical assessment is just as effective, thus avoiding radiation exposure.
Focused abdominal sonography in trauma (FAST) can provide an immediate assessment of an injured child. It serves as a radiation-free screening tool in a hemodynamically stable child, and when free intra-abdominal fluid is detected in a hemodynamically unstable child, it supports a clinical decision for rapid blood transfusion and/or laparotomy.
The researchers conducted a retrospective study to formally validate the use of FAST, analyzing medical records of pediatric patients admitted to the Children's Medical Hospital of the University of Leipzig with intra-abdominal organ injury over a seven-year period commencing January 2000. The study was published in the May issue of the Journal of Pediatric Surgery (2010, Vol. 45:5, pp. 912-915).
Thirty-five patients were identified, ranging in age from 1 to 16 years. Seven of the patients presented with polytrauma, and the remainder had isolated injuries All patients underwent urgent clinical assessment, resuscitation, and FAST exams. The ultrasound exams identified 18 injuries of the spleen, 12 of the kidney, eight of the liver, and two of the pancreas.
Emergency laparotomies were performed immediately on two patients based on the initial ultrasound. CT exams were ordered for 11 patients, due to equivocal findings. However, the CT exam influenced treatment for only one child, who had a renal pelvis rupture with urinoma.
Almost 70% of the children avoided the radiation exposure of a CT scan, according to lead author Dr. Tobias Retzlaff, a pediatric surgeon at Klinikum Bad Salzungen in Bad Salzungen, and colleagues. They noted that in this study, ultrasound proved to be an effective imaging procedure for 34 of the 35 patients.
By Cynthia Keen
AuntMinnie.com staff editor
May 7, 2010
Related Reading
CT shows lab tests fail to predict pediatric trauma, May 6, 2004
Focused abdominal US in patients with trauma, February 12, 2001
Copyright © 2010 AuntMinnie.com
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
