Navarro O, Babyn P S, Pearl R H
Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada.
Pediatr Radiol. 2000 Aug;30(8):546-50. doi: 10.1007/s002470000257.
To evaluate the utility of routine follow-up computed tomography (CT) and/or ultrasound (US) scans in children with blunt hepatic trauma initially managed non-operatively.
Review of the records of 66 children with proven blunt liver injury on initial CT scan, who were initially managed non-operatively during the period January 1991 to December 1996. Follow-up CT and US studies were analyzed and correlated with clinical outcome.
Of the 66 children, 30 were not followed with any imaging study, 26 were followed with US only, 7 with CT only and 3 with US and CT. Disappearance of the liver lesion(s) was seen in 25 patients (range: 6 days - 14 months) and decrease in size was noted in 10. In one patient, who developed abdominal and right shoulder pain 10 days after presentation with subsequent hemoglobin drop, CT showed contrast medium extravasation into a hepatic hematoma from portal vein injury that required surgery.
Our series suggests that in asymptomatic patients, US and CT follow-up studies do not provide the additional information needed for patient management. Therefore, we believe that in asymptomatic children with blunt hepatic trauma who are clinically stable, routine follow-up imaging studies are of very limited value.
评估常规随访计算机断层扫描（CT）和/或超声（US）扫描在钝性肝外伤儿童初始非手术治疗中的作用。
回顾1991年1月至1996年12月期间66例初次CT扫描证实为钝性肝损伤且初始接受非手术治疗的儿童记录。对随访CT和US研究进行分析，并与临床结果相关联。
66例儿童中，30例未进行任何影像学随访，26例仅接受US随访，7例仅接受CT随访，3例接受US和CT随访。25例患者肝脏病变消失（范围：6天至14个月），10例病变大小减小。1例患者在就诊10天后出现腹痛和右肩痛，随后血红蛋白下降，CT显示造影剂从门静脉损伤处渗入肝血肿，需要手术治疗。
我们的系列研究表明，对于无症状患者，US和CT随访研究并不能提供患者管理所需的额外信息。因此，我们认为对于临床稳定的钝性肝外伤无症状儿童，常规随访影像学研究价值非常有限。
