Controversies in emergency radiologyCT versus ultrasound in the evaluation of blunt abdominal trauma

There has been controversy regarding ultrasonography (US) versus CT in blunt abdominal trauma (BAT). Each modality has its strengths and weaknesses. US is fast and allows resuscitative efforts to proceed while the patient is being scanned. However, the sensitivity of US is inferior to that of CT, and there is user variability. CT is better at determining the extent, type, and grade of injury, resulting in a more tailored therapeutic plan and safe conservative management of many patients. However, CT involves ionizing radiation, cannot be performed portably, and requires only visual monitoring while scanning. Given each modality’s strengths and weaknesses we conclude that CT is the preferred examination when the BAT patient is stable or moderately stable, enough to be taken to CT. If a BAT patient is unstable, US is beneficial in screening for certain injuries or large hemoperitoneum prior to an exploratory laparotomy.