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Significance of periportal low-attenuation zones following blunt trauma in children
C J Sivit1, G A Taylor, M R Eichelberger
1Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC.
Insights
Periportal low-attenuation zones are common in pediatric blunt abdominal trauma, indicating a higher risk of intra-abdominal injury, physiological instability, and mortality. These CT findings are crucial for assessing injury severity in children.
Area of Science:
- Radiology
- Pediatric Imaging
- Trauma Imaging
Background:
- Blunt abdominal trauma in children necessitates accurate diagnostic tools.
- Periportal low-attenuation zones on CT scans are an understudied finding in pediatric trauma.
Purpose of the Study:
- To determine the frequency of periportal low-attenuation zones in children with blunt abdominal trauma.
- To assess associated intra-abdominal injuries and clinical outcomes in these children.
Main Methods:
- Retrospective review of CT scans from 400 children with blunt abdominal trauma.
- Analysis of periportal low-attenuation zones, associated injuries, and clinical data including Trauma Score and mortality.
Main Results:
- Periportal low-attenuation zones were identified in 15% of children.
- These zones were significantly associated with intra-abdominal injury (60% vs. 11%), particularly hepatic and adrenal injuries.
- Presence of these zones correlated with lower Trauma Scores and a higher mortality rate (13% vs. 1%).
Conclusions:
- Periportal low-attenuation zones are a significant finding in pediatric blunt abdominal trauma.
- Their presence indicates a higher likelihood of intra-abdominal injury, physiological compromise, and increased mortality.
- These CT findings aid in risk stratification and management of pediatric trauma patients.
Abstract:
The CT scans of 400 consecutive children evaluated with CT following blunt abdominal trauma were evaluated to determine the frequency of periportal low-attenuation zones, assess patterns of associated intraabdominal injury, and examine clinical outcome. Periportal low-attenuation zones were noted in 60 children (15%). The presence of these zones was associated with a significantly higher incidence of intraabdominal injury (60% versus 11%, p = 0.0001). Injuries most frequently associated with zones of periportal low-attenuation included hepatic (n = 23, 38%), and adrenal (n = 14, 23%). Children who had periportal low-attenuation zones tended to be more physiologically unstable as evidenced by a lower Trauma Score (diffuse, 11.9; focal, 13.4) than children without the zones (15.1, p = 0.0001). The presence of these zones was also associated with a significantly higher mortality rate (13% versus 1%, p = 0.0001). Ten children who had periportal low-attenuation zones and no hepatic injury on CT had a normal appearing liver on gross inspection at surgery or autopsy. In conclusion, periportal low-attenuation zones are common in children who have hepatic injury. These zones may be seen in conjunction with non-hepatic visceral injury or in the absence of intraabdominal injury. The presence of zones of periportal low-attenuation is associated with a higher index of physiologic instability, and higher mortality.