Related Experiment Video
Updated: Mar 20, 2026
Focused Assessment with Sonography for Trauma FAST Exam: Image Acquisition
Published on: September 22, 2023
Hepatic and splenic blush on computed tomography in children following blunt abdominal trauma: Is intervention
Martha-Conley E Ingram1, Ragavan V Siddharthan, Andrew D Morris
1From the School of Medicine, Emory University, Atlanta, Georgia (M.-C.E.I.); Department of Surgery, Oregon Health Sciences University, Portland, Oregon (R.V.S.); Department of Surgery, Emory University, Atlanta, Georgia (A.D.M., S.J.H.); Section of Pediatric Surgery at Children's Healthcare of Atlanta, Department of Surgery, Emory University, Atlanta, Georgia (C.D.T., C.E.M., K.F.H., M.V.R., M.T.S.).
Insights
Pediatric blunt abdominal trauma with contrast blush on CT scans indicates higher injury grade. Most cases can be managed nonoperatively, guided by patient physiology, not solely imaging findings.
Area of Science:
- Pediatric Surgery
- Radiology
- Trauma Management
Background:
- No established guidelines exist for managing pediatric blunt abdominal trauma with contrast extravasation (blush) on CT scans.
- This study reports the experience of a Level 1 pediatric trauma center in managing hepatic and splenic blush.
Purpose of the Study:
- To evaluate the management and outcomes of pediatric patients with solid organ contrast blush after blunt abdominal trauma.
- To determine if contrast blush on CT scans correlates with injury severity and need for intervention.
Main Methods:
- Retrospective review of pediatric blunt abdominal trauma cases with liver or splenic injury from 2008-2014.
- Analysis of contrast blush presence on CT scans and correlation with injury grade, intensive care unit admission, blood product transfusion, and interventions.
Main Results:
- Of 318 patients, 30 (9%) showed solid organ blush, associated with higher injury grades and Injury Severity Scores (ISS).
- Patients with blush were more likely to be admitted to the ICU (90%) and receive blood products (50%).
- Eighty percent of isolated blush cases and 17% overall required nonoperative management or no intervention.
Conclusions:
- Contrast blush on CT in pediatric blunt abdominal trauma signifies a higher injury grade but does not uniformly necessitate invasive intervention.
- Nonoperative management of blush is suggested, with treatment decisions based on physiological changes rather than imaging alone.
Background:
There are no widely accepted guidelines for management of pediatric patients who have evidence of solid organ contrast extravasation ("blush") on computed tomography (CT) scans following blunt abdominal trauma. We report our experience as a Level 1 pediatric trauma center in managing cases with hepatic and splenic blush.
Methods:
All pediatric blunt abdominal trauma cases resulting in liver or splenic injury were queried from 2008 to 2014. Patients were excluded if a CT was unavailable in the medical record. The presence of contrast blush was based on final reports from attending pediatric radiologists. Correlations between incidence of contrast blush and major outcomes of interest were determined using χ and Wilcoxon rank-sum tests for categorical and continuous variables, respectively, evaluating statistical significance at p < 0.05.
Results:
Of 318 patients with splenic or liver injury after blunt abdominal trauma, we report on 30 patients (9%) with solid organ blush, resulting in 18 cases of hepatic blush and 16 cases of splenic blush (four patients had extravasation from both organs). Blush was not found to correlate significantly with age, gender, or type of injury (liver vs. splenic) but was found to associate with higher grades of solid organ injury (p = 0.002) and higher ISS overall (p < 0.001). Patients with contrast blush on imaging were more likely to be admitted to the intensive care unit (90% vs. 41%, p < 0.001), receive blood products, (50% vs. 12%, p < 0.001), and be considered for an intervention (p < 0.001). Eighty percent of patients with an isolated contrast blush of the spleen or liver did not require an operation. Only 17% of patients with blush required definitive treatment, such as embolization (n = 1), packing (n = 1), or splenectomy (n = 3). Blush had no significant correlation with overall survival (p = 0.13).
Conclusions:
The finding of a blush on CT from a splenic or liver injury is associated with higher grade of injury. These patients receive intensive medical management but do not uniformly require invasive intervention. From our data, we suggest that a blush can safely be managed nonoperatively and that treatment should be dictated by change in physiology.
Level Of Evidence:
Therapeutic study, level IV.
More Related Videos
04:40Bloodless Laparoscopic Partial Splenectomy Assisted by Bipolar Radiofrequency Excision Hemostatic Device
Published on: November 4, 2022
05:56Implementation of Non-invasive Point of Care Transient Elastography for Evaluation of Liver Disease in Pediatric Populations with Cystic Fibrosis
Published on: August 29, 2025
Related Concept Videos
01:27Imaging Studies III: Computed Tomography
01:10Computed Tomography
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...
01:28Imaging Studies for Cardiovascular System V: CT
01:30Radiological Investigation I: X-ray and CT
01:14Imaging Studies I: CT and MRI
Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History: