Traumatic pseudoaneurysms of the liver and spleen in children: is routine screening warranted?

Safavi, Arash; Beaudry, Paul; Jamieson, Douglas H.; Murphy, James J.

doi:10.1016/j.jpedsurg.2011.02.035

Cited by 84 publications

(65 citation statements)

References 23 publications

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“…Angioembolization has been used for hemobilia with good success [46]. Use for pseudoaneurysms of the liver or spleen is controversial and probably unnecessary in most splenic pseudoaneurysms [47].…”

Section: Angioembolizationmentioning

confidence: 99%

Pediatric blunt abdominal trauma

Notrica

2015

Current Opinion in Critical Care

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Section: Angioembolizationmentioning

confidence: 99%

Pediatric blunt abdominal trauma

Notrica

2015

Current Opinion in Critical Care

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“…A study by Osterballe and colleagues found that follow up CT scans helped in detection of post traumatic pseudoaneurysms in liver trauma and suggested reimaging as part of the management of this patient population. [11] As PSAs in liver injury are usually associated with a high grade of injury [10] and are known to cause complications like upper GI hemorrhage [12] and spontaneous intraperitoneal hemorrhage from delayed rupture [10,13], the presence of an intraparenchymal PSA may be indicative of a more severe degree of injury to the liver than is apparent on the initial CT scan. An intraparenchymal hepatic PSA with an associated low hematocrit (less than 32%) on admission suggests that the patient might have been exposed to a more severe injury than identified on the admission CT. Further studies are needed to confirm these findings.…”

Section: Discussionmentioning

confidence: 99%

Traumatic Intraparenchymal Pseudoaneurysm on Initial Imaging Predicts Injury Progression in Patients with Nonoperative Major Blunt Liver Injury

Younan

Beasley

Papoy

et al. 2017

International Surgery

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Abstract:Objective: Identify factors that would predict which patients would benefit from repeat imaging after major blunt liver injury. Summary of Background Data: Most patients who present with hemodynamic stability and no evidence of peritonitis after blunt liver injury are successfully managed nonoperatively. Little information is available regarding the utility of reimaging major blunt liver injuries for patients who are managed nonoperatively. Methods: A retrospective review of patients admitted to a level I trauma center with major blunt liver injuries (AAST grades 3-5) was conducted. Inclusion criteria were those admitted from July 2012 to June 2014 with blunt liver trauma who survived the first 24 hours and underwent repeat imaging. Data included demographics, procedures performed and computerized tomography (CT) scan findings. Findings on the second CT scan were categorized as Unchanged, Worse, Improved, or Negative. Results: 128 patients had blunt major liver injuries; 66 patients underwent repeat imaging. The mean time to repeat CT was 1.95 days. On repeat CT 47 were "Unchanged", 3 "Worse", 14 "Improved" and 2 "Negative". Three patients underwent angiography. One required embolization of a pseudoaneurysm. In 63 patients (95%), the second CT did not change the management plan. The presence of a pseudoaneurysm was significantly related to a worsening of the second CT (p=0.0475). Patients with admission hematocrit (Hct) below 32% were more likely to have a worsened second CT (p=0.0370). Conclusions: A pseudoaneurysm on admission CT and Hct <32% predict major liver injury progression suggesting that routine reimaging is warranted in this group.

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“…These patients were successfully managed conservatively, but knowledge of the extent of solid organ injuries and reassurance of no active bleeding (absent contrast blush on CT) [15] is necessary to support the decision to manage these patients conservatively, preferably on a high dependency unit where any clinical deterioration could be immediately detected. In addition quantification of the extent of injury at the time of trauma provides guidance for planning follow-up imaging to assess for significant sequelae of solid organ injuries such as biliary leaks, urinomas and pseudoaneurysms (both hepatic and splenic) [16].…”

Section: Discussionmentioning

confidence: 99%

Focused Assessment with Sonography in Trauma (FAST) Scans Are Not Sufficiently Sensitive to Rule out Significant Injury in Pediatric Trauma Patients

Skerritt¹,

Haque²,

Makin³

2014

OJPed

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Aim: To assess the sensitivity and specificity of FAST scans in pediatric trauma in a dedicated pediatric trauma centre. Method: A 3-year (2008-2011) analysis of prospectively collected data looking at the results of FAST scans compared to Computed Tomography (CT) or laparotomy findings. Results: There were 482 pediatric trauma calls of which 166 patients had suspected intra-abdominal injury. 163 patients underwent CT scans of which 89 (55%) had FAST scans prior to CT. 3 patients had FAST scans without CT; 1 patient went straight to theatre (positive FAST) and 2 patients died in the department before any further imaging. The sensitivity of FAST scans to detect abdominal injury is 23% and the specificity is 97%. The injuries missed on FAST scan were: liver lacerations (n = 3), splenic lacerations (n = 5), 1 combined liver and kidney injury and 1 combined splenic injury and small bowel perforation. Conclusions: FAST scans in trauma have a low sensitivity in pediatric patients with the possibility of missing significant intra-abdominal injury. They do not obviate the need for CT scan when clinical suspicion is high.

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Traumatic pseudoaneurysms of the liver and spleen in children: is routine screening warranted?

Cited by 84 publications

References 23 publications

Pediatric blunt abdominal trauma

Pediatric blunt abdominal trauma

Traumatic Intraparenchymal Pseudoaneurysm on Initial Imaging Predicts Injury Progression in Patients with Nonoperative Major Blunt Liver Injury

Focused Assessment with Sonography in Trauma (FAST) Scans Are Not Sufficiently Sensitive to Rule out Significant Injury in Pediatric Trauma Patients

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