The value of routine follow-up imaging in pediatric blunt liver trauma

Purpose. To evaluate the utility of routine follow-up computed tomography ( CT) and/or ultrasound (US) scans in children with blunt hepatic trauma init ially managed non-operatively. Materials and methods. Review of the records of 66 children with proven blu nt liver injury on initial CT scan, who were initially managed non-operativ ely during the period January 1991 to December 1996. Follow-up CT and US st udies were analyzed and correlated with clinical outcome. Results. Of the 66 children, 30 were not followed with any imaging study, 2 6 were followed with US only, 7 with CT only and 3 with US and CT. Disappea rance of the Liver lesion(s) was seen in 25 patients (range: 6 days - 14 mo nths) and decrease in size was noted in 10. In one patient, who developed a bdominal and right shoulder pain 10 days after presentation with subsequent hemoglobin drop, CT showed contrast medium extravasation into a hepatic he matoma from portal vein injury that required surgery. Conclusion. Our series suggests that in asymptomatic patients, US and CT fo llow-up studies do not provide the additional information needed for patien t management Therefore, we believe that in asymptomatic children with blunt hepatic trauma who are clinically stable, routine follow-up imaging studie s are of very limited value.