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E2129. From the Highway to the Playground: A Case-Based Review Of Pediatric Abdominopelvic Trauma
Authors
  1. Michelle LaRosa; Westchester Medical Center
  2. Benjamin Mann; Westchester Medical Center
  3. Kevin Thompson; Westchester Medical Center
  4. Daniel Kadosh; Westchester Medical Center
  5. Milana Flusberg; Westchester Medical Center
  6. Richard Hong; Westchester Medical Center
  7. Adele Brudnicki; Westchester Medical Center
Background
Accidents or unintentional injuries are the leading causes of morbidity and mortality in children ages 0 to 19 years in the United States, and abdominal injury is the third leading cause of traumatic death in children. Major etiologies of pediatric blunt abdominal trauma include motor vehicle accidents, pedestrian struck injuries, all-terrain vehicle crashes, handlebar injuries from bicycles or scooters, falls, and sports-related injuries. CT has been the imaging modality of choice for major trauma in the United States due to ease of acquisition, short scan time and high quality of imaging, despite concerns of radiation in children. Children have different anatomical proportions compared with adults, including small pliable ribs, a thin abdominal wall with decreased AP diameter, proportionally larger spleen and liver, and more anteriorly positioned kidneys with less perinephric fat, which make them more vulnerable to injuries. Furthermore, abdominopelvic injuries may contribute to silent hypovolemia, since children have a different physiological response and can maintain a near-normal blood pressure despite 25-30% blood volume loss. Abdominal exams in pre-verbal children can be unreliable, and multisystem injury can make diagnosis complex. Thus, radiological evaluation plays a critical role in diagnosis and management of pediatric patients after trauma.

Educational Goals / Teaching Points
Discuss the epidemiology and mechanism of injury in blunt pediatric trauma. Discuss the injuries and imaging findings, focusing on CT presentation. Review associated grading systems and imaging features that are important to patient management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Review of common solid organ injuries in blunt abdominal trauma, including injuries to the liver, spleen, kidneys, and pancreas and associated grading systems. Review of common hollow visceral injuries in blunt abdominal trauma, including injuries to the bowel and bladder. Review characteristic imaging features of hypoperfusion complex. Review characteristic imaging of these injuries in multiple imaging modalities with focus on CT.

Conclusion
After reviewing this educational exhibit, readers will be able to recognize the unique anatomy and physiology in pediatric trauma; recognize key imaging features of pediatric blunt abdominal injuries on CT; and discuss the injury patterns and treatments of pediatric blunt abdominal injuries.