At ECR 2026, the session “The practical value of ultrasound in emergency” brought together four perspectives on where ultrasound can guide decisions, reduce unnecessary CT use and support targeted intervention. Across paediatric trauma, follow-up after abdominal injury, acute abdominal pain and musculoskeletal procedures, the speakers presented ultrasound not as a secondary option but as a method that can answer specific clinical questions quickly and safely when used in the right setting.
Contrast-Enhanced Ultrasound in Trauma Care
Katja Glutig focused on contrast-enhanced ultrasound in paediatric blunt abdominal trauma and framed the central issue clearly: “can contrast-enhanced ultrasound safely guide therapy in paediatric trauma?” She noted that CT remains the gold standard, especially in polytrauma, but also pointed to its disadvantages in children, including radiation exposure, transport and frequent sedation. In her account, many injured children are haemodynamically stable, and the urgent task is to determine whether there is an injury that changes management.
She described conventional ultrasound and FAST as well established, especially at the bedside and in unstable patients, while also acknowledging their limitations for smaller lesions. Contrast-enhanced ultrasound, she argued, adds the missing perfusion information in real time. As she put it, “injury appear as perfusion defects, non-enhancing areas or irregular enhancement patterns”, while active bleeding may be seen as “bubble leakage into the surrounding fluid collection.” She also stressed its safety and simplicity in children, with very small contrast doses and no serious side effects reported in the cases she cited.
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The examples centred on liver, spleen and kidney trauma. For the liver, she showed how CEUS can reveal contusions or lacerations not visible on B-mode imaging, helping separate patients who can be monitored conservatively from those needing higher-level care and further imaging. In splenic injury, she underlined the value of the venous phase and the ability of CEUS to distinguish smaller subcapsular haematomas from deeper lacerations and hilar injuries. For renal trauma, she highlighted both its strengths and its limits, noting that cortical lacerations and parenchymal haematomas can be depicted, while collecting system injuries remain more difficult because the contrast is not excreted in urine. Her conclusion was practical: “CEUS really guides management decisions.” At the same time, she warned that it “is not universal solution and should be not overestimated”, especially in unstable children or in bowel and pancreatic injury.
Follow-Up Imaging and Conditional CT
Marco Di Serafino moved from diagnosis to follow-up, discussing CEUS in non-operative management. He described non-operative management as the standard of care for haemodynamically stable patients with solid organ injuries and argued that its success depends heavily on the quality and frequency of follow-up imaging. In his presentation, CEUS emerged as a tool that combines repeatability, bedside use and a favourable safety profile, with “no ionising radiation”, “no nephrotoxicity” and “real-time imaging.”
His discussion concentrated on what CEUS can do during surveillance: monitor healing, detect complications and assess vascular integrity. Arterial phase imaging, he explained, is particularly important for pseudoaneurysms and arteriovenous fistulas, while venous and delayed phases help assess regression or progression of parenchymal injury. He described CEUS as serving “two primary purposes”, namely “monitoring injury healing and detecting complications”, and said it is especially valuable in children when the target organ is adequately visible on grayscale imaging. He also insisted on its place within a broader pathway: “CEUS does not replace CT or MRI.” For worsening findings, he said plainly, “CT scan is mandatory.”
Raminta Luksaite-Lukste then widened the discussion to acute abdominal pain in the emergency department and challenged what she called the quiet drift from imaging strategy to imaging reflex. “Not every patient needs a CT scan,” she said, arguing that emergency imaging should be “sequential and conditional.” In her framework, imaging must follow clinical probability and CT should resolve uncertainty rather than replace reasoning. “Conditional CT concept means that CT becomes a consequence of structured decision-making,” she said, adding that it “should resolve uncertainty, not compensate for it.”
She made the case for ultrasound as a first-line triage tool in common scenarios such as right upper quadrant pain, appendicitis, hydronephrosis and uncomplicated diverticulitis, while also being explicit about when it should not be used. “Ultrasound is not a random modality in emergency, it is a triage modality,” she said. Yet she also stressed that some patients should go directly to CT, especially in time-critical conditions such as mesenteric ischaemia. Her broader point was that radiologists should take ownership of protocol decisions and work in real time with emergency teams. “Radiologists should shift from image reader to decision consultant,” she said.
Ultrasound-Guided Aspiration in Emergency MSK
Torsten Diekhoff turned to musculoskeletal emergencies and gave a practical talk on joint aspiration. He set out to show “how to aspirate a joint” and focused on access to “three and a half joints” that can be reached easily with ultrasound. His presentation was procedural, beginning with the required equipment and moving through the hip, shoulder, acromioclavicular joint and elbow.
The hip, in his view, is “probably the easiest joint to aspirate”, with a broad landing area and a straightforward approach when an effusion is present. The shoulder required more nuance, with anterior and posterior routes discussed separately and the posterior route preferred for aspiration because fluid is more likely to collect there. He also offered a practical technical point about needle handling, calling it “a very important and easy tip”: after passing through the skin, the needle should be rotated so that it glides over cartilage rather than damaging it and so that the opening faces the joint rather than soft tissue.
For the acromioclavicular joint, he used the case to illustrate an out-of-plane approach. For the elbow, he explained why the lateral route can be useful, but also warned about the possible obstacle of a plica and the need to scan first before choosing access. The overall message was that ultrasound guidance makes these procedures precise and adaptable across different clinical situations, from aspiration to injection and arthrography. As he concluded, “everything possible with ultrasound-guided joint injection or aspiration.”
Ultrasound was presented throughout the session as a practical decision tool rather than a generic alternative to CT. Whether assessing paediatric trauma, monitoring healing, choosing when CT is actually needed or guiding intervention in a painful joint, the emphasis remained the same: use the right modality for the right question, and use it with purpose.
Source & Image Credit: ECR 2026
