Contrast-enhanced ultrasound (CEUS) in urgent and emergent pediatric conditions: a comprehensive review

Approximately 30 million children visit emergency departments in the United States annually presenting with a wide spectrum of urgent and emergent traumatic and non-traumatic conditions. Prompt and accurate imaging evaluation is critical for diagnosis, risk stratification, and appropriate management. Contrast-enhanced ultrasound (CEUS) lacks ionizing radiation and has therefore emerged as a reliable and accurate imaging modality for assessing many pediatric conditions. Building on conventional ultrasound (US), CEUS uses ultrasound contrast agents (UCA) to enhance visualization of parenchymal perfusion and microvascularity and demonstrates diagnostic sensitivity comparable to that of contrast-enhanced computed tomography (CT) for several clinical scenarios. This paper reviews the expanding utilization of CEUS in urgent and emergent pediatric care, with particular emphasis on blunt abdominal trauma, and describes the characteristic imaging features of both traumatic and non-traumatic pathologies. Additionally, the basic principles, techniques, and limitations of CEUS are briefly addressed.