Marco Antonio Cura MD, Presenter: Nothing to Disclose

Jung Inkyung, Abstract Co-Author: Nothing to Disclose

Fadi M. El-Merhi MD, Abstract Co-Author: Nothing to Disclose

Jorge Enrique Lopera MD, Abstract Co-Author: Nothing to Disclose

Rajeev Suri MD, Abstract Co-Author: Nothing to Disclose

Ghazwan M. Faozi Kroma MD, Abstract Co-Author: Nothing to Disclose

Current imaging methodology for diagnosis of bleed in abdominal/pelvic injuries includes CT scan and angiography, with angiography reserved often for those patients needing endovascular therapy. The objective of the study was to evaluate the accuracy of contrast-enhanced CT to demonstrate the presence of arterial injury that requires endovascular treatment in patients with blunt spleen trauma.  

This is a retrospective analysis of consecutive patients with blunt spleen trauma at a level 1 trauma center. CT demonstrated splenic injury in all patients. The presence of contrast extravasation on CT, American Association for the Surgery of Trauma (AAST) splenic injury CT grade, technical and clinical successes and occurrence of complications were evaluated. Sensitivity, specificity, predictive values, and accuracy of CT in detecting vascular injury were calculated based on results of angiography. Patients were followed until discharged.

A total of 107 patients were included in the study, 70 (65.4 %) were males, the mean age was 34.3 years (r 3-86). CT contrast extravasation was present in 46 (43.8%) of 105 patients; ASST was class I in 18 (16.8%) ; II in 16 (15%): III in 33 (30.8%); IV in 32 (29.9 %) ; and V in 8 (7.5%) of 107 patients. Selective spleen angiograms demonstrated splenic arterial injury in 64 (59.8%) of 107 cases. 68 (63.6%) of 107 patient had splenic artery embolization. Splenectomies were performed in 9 (8.4%) of 107 cases, 7 in spleens embolized and 2 in spleens with no embolization. One spleen after single vessel embolization with microcoils required repeat embolization at new sites of bleeding. The success rate of nonoperative management was 90.6 %. The mean hospitalization duration was 11.1 days (r1-90). Overall, CT had a sensitivity of 65.63%; specificity of 86.05%; negative and positive predictive values of 62.71% and 87.50%, respectively; and accuracy of 73.83% in detecting arterial injury compared with selective splenic angiography.

CT can add important information which helps to triage patients with blunt splenic trauma by demonstrating arterial injuries. There are arterial injuries that are not identified on CT.

The spleen is the most frequently injured solid organ in blunt abdominal trauma. CT is a useful diagnostic tool that help to triage patients into the surgical and nonsurgical treatment arms.

Cura, M, Inkyung, J, El-Merhi, F, Lopera, J, Suri, R, Kroma, G, Correlation of Computed Tomography CT Findings with Splenic Angiography in Blunt Spleen Trauma.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8007654.html