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Periportal tracking in pediatric blunt abdominal trauma. Correlation with liver enzymes and liver injury
1Department of Radiology, Loyola University Medical Center, Maywood, IL 60153.
Insights
Periportal tracking on CT scans in children with blunt abdominal trauma is graded. Grade 3 periportal tracking (PPT) showed higher liver enzyme levels but did not always indicate significant liver injury.
Area of Science:
- Radiology
- Pediatric Imaging
- Trauma Imaging
Background:
- Blunt abdominal trauma in children necessitates accurate diagnostic imaging.
- Computed tomography (CT) is a key modality for evaluating abdominal injuries.
- Periportal tracking (PPT) is a CT finding that requires further characterization in pediatric trauma.
Purpose of the Study:
- To determine the frequency and significance of periportal tracking (PPT) on CT in pediatric blunt abdominal trauma.
- To correlate CT-identified PPT with liver enzyme levels and actual liver injury.
- To assess the clinical implications of different grades of PPT.
Main Methods:
- Retrospective analysis of CT scans and medical records from 243 pediatric patients.
- Categorization of periportal tracking into four grades (0-3) based on CT findings.
- Correlation of PPT grades with liver enzyme levels and CT-demonstrated liver parenchymal injury.
Main Results:
- Grade 3 PPT (circumferential involvement) was identified in 20 out of 243 children.
- Children with grade 3 PPT had a higher incidence of CT-detected liver parenchymal injury (20% vs. 0.5% for grades 0-2).
- Sixteen children with grade 3 PPT and no CT liver injury showed significantly elevated liver enzymes compared to lower grades.
Conclusions:
- Grade 3 periportal tracking on CT in pediatric blunt abdominal trauma is associated with elevated liver enzymes.
- Isolated grade 3 PPT, without other CT evidence of injury, did not indicate clinically significant liver injury.
- Periportal tracking grading on CT can aid in the assessment of blunt abdominal trauma severity in children.
Abstract:
This is a retrospective study of the computed tomography (CT) examinations and medical records of 243 consecutive pediatric patients sent for CT studies after blunt abdominal trauma. The purpose of the study was to determine the frequency and significance of periportal tracking identified by CT, and correlate this finding with liver enzyme levels and liver injury. Periportal tracking (PPT) was divided into four grades (0-3) depending upon the distribution of decreased attenuation adjacent to the portal vessels. Circumferential PPT extending to the periphery of the liver (grade 3) was found in 20/243 children. They had a higher incidence of liver parenchymal injury seen on CT 20% versus 0.5% in combined PPT grades 0-2. Sixteen children with grade 3 PPT and no liver injury had significantly elevated liver enzymes as compared to children with combined 0-2 grade PPT. Eleven of the 20 children with grade 3 PPT had no other CT evidence of intraabdominal injury and none of these patients developed intraabdominal hemorrhage. Thus, grade 3 periportal tracking as an isolated abnormality did not indicate a clinically significant liver injury in any patient.