Annamaria Deganello MD, Presenter: Speaker, Bracco Group

Kleanthi Kalogerakou MD, MSc, Abstract Co-Author: Nothing to Disclose

Eleni Konstantatou MD, MSc, Abstract Co-Author: Nothing to Disclose

Maria E. Sellars MD, FRCR, Abstract Co-Author: Nothing to Disclose

Paul Singh Sidhu MRCP, FRCR, Abstract Co-Author: Speaker, Bracco Group Speaker, Siemens AG Speaker, Hitachi, Ltd

The spleen is the most commonly injured organ in children, and due to possible development of splenic pseudoaneurysm with risk of rupture, there is a need for close follow-up, normally with repeated CT. The purpose of this study is to illustrate the usefulness of CEUS for the detection and follow up of these lesions in children and young adults, sparing them the radiation burden of CT.

Retrospective single-centre review of CT database of pediatric and young adult patients scanned for abdominal trauma over a period of 2½ years (Jul 2011, date in which we introduced CEUS in the follow-up, to Dec 2013). CT scans were performed with post-contrast split-bolus or dual-phase protocol. We documented the number of patients with a splenic injury at presentation, and, out of these, patients diagnosed with a splenic pseudoaneurysm. We also recorded the imaging modality used to diagnose and follow-up these lesions. All CEUS scans where performed by experienced radiologists with no adverse effects and all adult patients and parents had given informed consent.

A total of 27 patients had a splenic injury at presentation; of these, 6 patients (Females=1, Male=5, mean age 16, range 6-23y) developed a post-traumatic splenic pseudoaneurysm. The mechanism of trauma was a fall in 3 cases, road traffic accident in 2 cases and stabbing in 1 case; 4 patients had a grade IV injury and 2 patients a grade III. One of the patients had a pseudoaneurysm at presentation, and in the other cases the diagnosis was made at follow-up, with CT, confirmed with CEUS in 3 patients and with CEUS in the 2 small children, when CT failed to demonstrate a pseudoaneurysm. 2 patients required coil embolization and in 4 cases the lesions resolved spontaneously: all patients were followed up with serial CEUS, which confirmed effective embolization and resolution respectively, without further need for CT.

Although the use of CEUS in children is “off-label”, our initial experience shows that its diagnostic accuracy equals that of CT. In all our cases, clear characterisation of splenic pseudoaneurysms with CEUS allowed a safe, radiation-free, conservative management of these young patients.

CEUS can be an alternative to CT for the detection and follow-up of post-traumatic splenic pseudoaneurysms, reducing a potentially high cumulative dose in this young population.

Deganello, A, Kalogerakou, K, Konstantatou, E, Sellars, M, Sidhu, P, Contrast-enhanced Ultrasound (CEUS) in Blunt Abdominal Trauma: Utility in the Identification of Post-traumatic Splenic Pseudoaneurysms in Children and Young Adults—Initial Experience.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045694.html