Pediatric Abdominal Trauma Imaging

Carlos J. Sivit, MD


Appl Radiol. 2013;42(5):8-13. 

In This Article

Active Hemorrhage

A unique contribution of CT to the evaluation of abdominal trauma is the ability to identify an active hemorrhage. The diagnosis of an active hemorrhage at CT is predicated on the identification of a contrast "blush" or a high-attenuation jet after IV contrast enhancement (Figure 7).[20–21] An active hemorrhage results in attenuation values of > 90 HU. The attenuation of extravasated contrast is usually similar to that seen in adjacent blood vessels. The rate of active bleeding required for detection at CT is unclear. Although identifying an active hemorrhage during a CT scan denotes ongoing bleeding at the examination, it does not predict continued bleeding, and most children with an active hemorrhage detected during a CT scan do not require operative intervention. This is particularly the case when the active hemorrhage is contained within a solid viscus and thus surrounded by organ parenchyma, which can tamponade the site of bleeding. In various reports, 20% or fewer of children with hepatic or splenic injury and an active hemorrhage required operative hemostasis.[22–25] However, it is imperative that these children—particularly younger children, who have a smaller circulating blood volume—be closely monitored.

Figure 7.

Active hemorrhage. Contrast-enhanced CT scan through the upper abdomen shows a high-attenuation collection representing intravenous contrast extravasation from a splenic arterial tear. Note the large hematoma surrounding the spleen.