Post-traumatic intrasplenic pseudoaneurysms with delayed rupture: Color Doppler sonographic and CT findings

Abstract

Post‐traumatic intrasplenic pseudoaneurysms are very rare in children. Since pseudoaneurysms may expand a splenic hematoma and cause delayed splenic rupture, early diagnosis and treatment are crucial. In this report, we describe the case of a 12‐year‐old boy with a delayed splenic rupture caused by a splenic hematoma containing 2 pseudoaneurysms. Abdominal sonography showed free intraperitoneal fluid and a mildly enlarged spleen with a large heterogeneous area occupying the upper half of the organ. Two anechoic lesions (15 and 4 mm) were seen inside the hematoma near the splenic hilum. Color Doppler sonography demonstrated turbulent arterial flow within the lesions, suggesting pseudoaneurysms. On CT, the lesions enhanced simultaneously with the splenic artery in the arterial phase of contrast enhancement. CT also showed an intrasplenic arterial branch leading to the larger of the 2 pseudoaneurysms. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:102–104, 2001.

The significance of pseudoaneurysms in the nonoperative management of pediatric blunt splenic trauma

“…The apparent healing of SAP in children and the success of NOM is attributed to children's thicker, more fibrous splenic capsule and denser, more elastic parenchyma [1,10]. However, the fear of delayed rupture persists, leading some authors to suggest routine follow-up imaging and embolization [2,[16][17][18]. Others are willing to follow these lesions clinically, given the high success of NOM and the risks of embolization [1,14,19].…”

Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention)

“…The follow-up was uneventful patients [83,84,102,108,109,110]. Although partial or total splenectomy has been traditionally performed to manage ruptured pseudoaneurysms in children [89,91,105], embolization has been recently described only in a few cases [90,100].…”

“…Delayed presentation or diagnosis is due to, respectively, progressive clot lysis at the site of arterial wall injury or to a technical failure in term of timing of contrast bolus injection on CT scan [84]. Although bolus-enhanced CT scan with prompt imaging after iodine injection is highly sensitive to detect intrasplenic vascular malformation [91,100,101,102], it may fail to demonstrate small areas of abnormal enhancement, only identifiable using high-resolution ultrasound. Magnetic resonance imaging could also be effective for the diagnosis of intrasplenic pseudoaneurysm by demonstrating a flow void within the pseudoaneurysm [101,102].…”

Posttraumatic Intrasplenic Pseudoaneurysm with High-Flow Arteriovenous Fistula: New Lessons to Learn

“…It can be observed that pseudoaneurysm is even bigger than the aorta. only 13 well reported cases [2][3][4][5][6][7][8][9][10][11][12][13] of this complication in the recent English literature searching in Medline (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) (Table 1 shows 12 cases; Owens [13] reported the last case, not included because the pseudoaneurysm has already ruptured).…”

“…Recently, there have been many publications regarding the treatment of this entity either by embolization [1,2] or conservatively [3,4]; both approaches may avoid the need for surgery and splenectomy. However, not all cases are amenable to such solution.…”