Radiology : Abdominal Trauma Imaging
Infants and children with bruising to the abdomen, even small bruises, should be carefully evaluated for abdominal trauma. Static images should not be relied upon to make a determination of intra-abdominal injury. In addition to evaluating bony elements, a CT scan can determine if there is free fluid/blood from intra-abdominal injury. It also may determine what organ is injured and give an idea of the extent of the injury. It is important to accompany and appropriately monitor the child/adolescent during the scan to rapidly determine and treat any change in condition. A prospective multi-center study supports consideration of abdominal CT scan for children suspected of physical abuse when either the AST or ALT level is >80 IU/L or with abdominal bruising, distention, decreased bowel sounds, or tenderness (Lindberg et al 2009). A more recent single-center retrospective study suggests abdominal CT may not be necessary in children who have AST ≤200 IU/L and ALT ≤125 IU/L and do not have signs or symptoms of abdominal injury (Lee et al 2024).
The role of ultrasound in trauma is largely to determine if there is free fluid in the abdomen of a patient deemed unstable for CT. Ultrasound is not sensitive for detecting liver or spleen injuries. The advantage of ultrasound imaging, particularly focused assessment with sonography for trauma (FAST) is that it can be performed at the bedside, thus eliminating the need to wait for additional resources. However, the utility of FAST in the clinically stable patient is unclear and it is currently not recommended for the evaluation of intra-abdominal injuries in suspected child abuse. Further studies are needed (Henry et al 2021).
