Differential diagnosis of pediatric blunt abdominal trauma

• Liver laceration
• Periportal edema
• Splenic laceration
• Inhomogenous splenic enhancement
• Pancreatitis
• Pancreatic laceration
• Adrenal laceration
• Renal laceration
• Ureteral laceration
• Bladder rupture
• Duodenal hematoma
• Bowel perforation
• Hypoperfusion complex

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