Delayed splenic pseudoaneurysm identification with surveillance imaging

Abstract

Routine follow up imaging after splenic injury identifies splenic artery pseudoaneurysm in a significant proportion of patients. Standardized surveillance imaging promotes prospective identification of pseudoaneurysms, allowing for interventions to maximize splenic salvage.

A rare case of delayed splenic rupture following initial negative CT scan imaging: A case report and review of the literature

“…SPA formation and presence is an important risk factor for consideration of DSR, even in cases of minor splenic injuries [15] . Previous literature supports that routine CT follow-up identifies a significant proportion of patients with SPA; thus, repeated CT screening for SPAs may aid in identifying patients most at risk for DSR [23] . Furthermore, most delayed splenic vascular injuries have also been noted to be only detected on or are much more conspicuous on arterial phase CT scan imaging versus with portal-venous CT scan [17] .…”

Therapeutic strategies for pseudoaneurysm following blunt liver and spleen injuries: a multicenter cohort study in the pediatric population.

“…A recent retrospective evaluation of adult splenic injuries from a level I trauma center in the United States reported that a relatively high proportion of patients who developed PA required subsequent splenectomy. 26 Despite the fact that some patients who undergo distal embolization of the splenic artery experience minor spleen infarcts, the procedure itself rarely results in splenectomy. 24,27 Conversely, if proximal embolization is performed on admission angiography and then a PA develops in the late phase, vascular access to the splenic artery during "secondlook" angiography is limited.…”

“…In the absence of data regarding the use of IR in children, most of our knowledge on this topic is extrapolated from the adult literature. A recent retrospective evaluation of adult splenic injuries from a level I trauma center in the United States reported that a relatively high proportion of patients who developed PA required subsequent splenectomy 26 . Despite the fact that some patients who undergo distal embolization of the splenic artery experience minor spleen infarcts, the procedure itself rarely results in splenectomy 24,27 .…”

Delayed splenic pseudoaneurysm: Who needs surveillance imaging and how should we manage it?

“…We agree that, despite multiple previous studies on this topic, it is still controversial whether follow-up imaging would be beneficial to prevent the feared complications of delayed splenic PSA (i.e., rupture) following successful nonoperative management (NOM). However, we believe that the results of Wallen et al 1 should be interpreted carefully for several reasons.…”

“…We read with interest the article by Wallen et al, 1 who reported that delayed formation of splenic pseudoaneurysm (PSA) was identified on follow-up computed tomography (CT) scan in 20% of patients with high-grade blunt splenic injury (BSI) managed nonoperatively (11%, 29%, and 40% in Grades III, IV, and V, respectively). We agree that, despite multiple previous studies on this topic, it is still controversial whether follow-up imaging would be beneficial to prevent the feared complications of delayed splenic PSA (i.e., rupture) following successful nonoperative management (NOM).…”