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Post-traumatic intrasplenic pseudoaneurysms with delayed rupture: color Doppler sonographic and CT findings
S Fitoz1, C Atasoy, E Düşünceli
1Department of Radiology, University of Ankara, School of Medicine, Ibn-i Sina Hospital, Sihhiye, Turkey.
Insights
Post-traumatic intrasplenic pseudoaneurysms are rare in children and can lead to delayed splenic rupture. This case highlights the importance of early diagnosis and treatment for these rare splenic injuries.
Area of Science:
- Pediatric Surgery
- Vascular Surgery
- Radiology
Background:
- Post-traumatic pseudoaneurysms of the spleen are uncommon in pediatric patients.
- These lesions can lead to delayed splenic rupture, necessitating prompt diagnosis and intervention.
Observation:
- A 12-year-old boy presented with delayed splenic rupture.
- Imaging revealed a splenic hematoma with two pseudoaneurysms.
- Abdominal sonography and CT demonstrated intrasplenic pseudoaneurysms with turbulent arterial flow.
Findings:
- The pseudoaneurysms were identified within a splenic hematoma.
- Color Doppler sonography and contrast-enhanced CT confirmed the presence and arterial supply of the pseudoaneurysms.
- CT identified an intrasplenic arterial branch supplying the larger pseudoaneurysm.
Implications:
- Early diagnosis of post-traumatic intrasplenic pseudoaneurysms in children is critical to prevent splenic rupture.
- Advanced imaging techniques like Doppler sonography and CT are essential for accurate diagnosis.
- Prompt management strategies are crucial for favorable outcomes in pediatric splenic trauma.
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.