Correlation of Multidetector CT Findings with Splenic Arteriography and Surgery: Prospective Study in 392 Patients

Optimizing Trauma Multidetector CT Protocol for Blunt Splenic Injury: Need for Arterial and Portal Venous Phase Scans

“…Thus multiphase CT is helpful, and in many cases necessary, for accurate characterization of intrasplenic vascular injury (3,18). Previous investigations have utilized portal venous phase imaging followed by delayed excretory phase imaging (3,4,6,8,11) for evaluation of the imaged spleen. In our study, the combination of arterial and portal venous phase scans also allowed differentiation of contained from uncontained splenic injury; furthermore, the arterial phase images demonstrated intrasplenic pseudoaneurysms not visible in subsequent phases.…”

“…Accurate identification and characterization of splenic injury is a major goal of CT assessment after blunt abdominal trauma. Diagnosis of splenic vascular injuries, both contained (ie, pseudoaneurysms and arteriovenous fistulae) and uncontained (ie, active bleeding) is important because both types of lesions are associated with failure of nonsurgical management (6,7,11). Conversely, absence of contrast material extravasation on CT scans predicts successful splenic salvage (12,13).…”

“…Conversely, absence of contrast material extravasation on CT scans predicts successful splenic salvage (12,13). The distinction between contained and uncontained intrasplenic vascular injury is important as well; while contained vascular injuries are typically managed by means of angioembolization (14), active bleeding independently correlates with requirement for surgical intervention (11,(15)(16)(17), although angioembolization is increasingly utilized in such cases if the patient is hemodynamically stable enough to tolerate transportation to the angiography suite and an experienced angiographer is available.…”

The splenic injury outcomes trial

“…Prior work studying various techniques aimed at splenic preservation are retrospective and primarily single center studies. (11)(12)(13)(19)(20)(21)(22)(23)(24)(25) Even the most recent guidelines published regarding the management of BSI are largely based on expert opinion and retrospective studies (26,27). This lack of consensus extends to the American Association for the Surgery of Trauma (AAST), where a survey demonstrated variability in the optimal management of BSI (28).…”

Percutaneous drainage management of an abscess developed from conservatively treated retroperitoneal haematoma caused by acupuncture

“…Transcatheter arterial embolization of a retroperitoneal haemorrhage caused by trauma or another specific cause is a well-documented and commonly used procedure (Velmahos et al, 2002). However, there is not much discussion regarding a negative angiography after contrast extravasation on abdominal/pelvic CT. A discrepancy between abdominal/pelvic CT and the following angiography is possible because abdominal/ pelvic CT only has a 76% sensitivity and 80% positive predictive value for detecting bleeding or vascular injury (Marmery et al, 2008). Cerva et al (1996) provided a brief report regarding 30 patients with pelvic fractures and a discrepancy rate of approximately 11.1%.…”