Significance of periportal low-attenuation zones following blunt trauma in children

摘要

The CT scans of 400 consecutive children evaluated with CT following blunt abdominal trauma were evaluated to determine the frequency of periportal lowattenuation 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 lowattenuation 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 lowattenuation is associated with a higher index of physiologic instability, and higher mortality.