@article{ref1,
title="Easily missed pediatric handlebar injury",
journal="Pediatrics and neonatology",
year="2022",
author="Jaw, Twei-Shiun and Wang, Po-Shun",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="A 12-year-old girl, who fell from her bicycle, presented to the emergency department with severe epigastric pain and vomiting. Physical examination revealed torso contusion with a circular handlebar bruise over the upper anterior abdomen (Fig. 1a). Focused assessment with sonography for trauma (FAST) revealed no obvious fluid accumulation. Laboratory tests indicated elevated serum amylase (252 U/L) and lipase (>400 U/L) levels. Therefore, intravenous contrast-enhanced computed tomography (CT) with oral water-soluble contrast medium was performed to assess for any internal traumatic injury. CT images depicted a distended stomach, which was filled with hyperdense oral contrast medium. This creates the radiographic beam hardening artifacts with various linear hypodense stripes, making nearby subtle lesions more difficult to detect, such as the pancreas (Fig. 1b). After contrast enhancement, a focal, ill-defined, and poorly-enhanced lesion at the pancreatic head was observed, where the contusion injury was impressed (Fig. 1c). Follow-up serum amylase and lipase levels reached peak values in 2 days (amylase: 1041 U/L; lipase: >400 U/L) and gradually decreased to normal throughout the admission period. Abdominal Doppler sonography on the third day revealed a hypoechoic lesion at the pancreatic head (Fig. 1d). The patient received conservative treatment with total bowel rest and was discharged after two weeks...<p /> <p>Language: en</p>",
language="en",
issn="1875-9572",
doi="10.1016/j.pedneo.2022.03.023",
url="http://dx.doi.org/10.1016/j.pedneo.2022.03.023"
}