Differential diagnosis of pediatric blunt abdominal trauma

Approach to the differential diagnosis of blunt abdominal trauma:

  • Liver laceration and Splenic laceration – 80% have hemoperitoneum but decision to operate based not on appearance of lesion but on hemodynamic status of patient
  • Periportal edema – is a mimic of liver laceration
  • Inhomogenous splenic enhancement – is a mimic of splenic laceration
  • Pancreatic laceration and Bowel perforation – is often a diagnosis made a day after presentation by seeing increasing free fluid on repeat imaging done to investigate increasing abdominal pain
  • Adrenal laceration – often associated with ipsilateral visceral injury
  • Renal laceration / Ureteral laceration / Bladder rupture – delayed images are crucial in correctly defining extent of injury
  • Duodenal hematoma – if missed initially presents with vomiting with feeding
  • Hypoperfusion complex – is an injury unique to children