Imaging of Pediatric Traumatic and Nontraumatic Abdominal and Pelvic Emergencies

Abdominal pain is one of the most frequent causes of emergency department (ED) visits in pediatric patients. The role of diagnostic imaging is to help the pediatric emergency physician and pediatric surgeon to clarify the cause of pain and whether it needs medical or surgical treatment. The differential diagnosis includes many entities, with often overlapping presentations. Therefore, it is essential to know the diagnostic findings which can be obtained with current techniques. Ultrasound (US) is presently the modality of choice for the initial evaluation of acute abdominal pain due to its diagnostic value and lack of ionizing radiation exposure. In nontraumatic abdominal and pelvic acute pain, computed tomography (CT) must be reserved for special cases only, and magnetic resonance imaging (MRI) is a possible alternative to CT. However, the cost and availability of MRI limit its utilization. Abdominal trauma is an additional common cause for ED imaging in children. CT is the reference standard method for victims of high-energy trauma. In minor trauma, mainly indirect low-energy trauma, ultrasound is also used. It is currently possible to improve the diagnostic accuracy of ultrasound with the use of IV contrast-enhanced ultrasound (CEUS). MRI is a method for patients who have had high-energy trauma in some selected, specific conditions such as pancreatic trauma and the follow-up of traumatic injuries.