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Delayed splenic pseudoaneurysm identification with surveillance imaging.

Taylor E Wallen1, Katherine Clark, Matthew R Baucom

  • 1From the Department of Surgery, University of Cincinnati, Cincinnati, Ohio.

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Summary

Delayed computed tomography (CT) imaging is crucial for identifying splenic artery pseudoaneurysms in patients with blunt splenic injury. This surveillance helps prevent complications from delayed hemorrhage, improving patient outcomes.

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Area of Science:

  • Trauma Surgery
  • Diagnostic Imaging
  • Vascular Surgery

Background:

  • Nonoperative management of splenic injuries has a high success rate.
  • Delayed hemorrhage from splenic artery pseudoaneurysms occurs in 5-10% of patients.
  • Pseudoaneurysms may develop on delayed imaging.

Purpose of the Study:

  • To evaluate the safety and utility of delayed computed tomography (CT) imaging for blunt splenic injury.
  • To assess the incidence of pseudoaneurysms in nonoperatively managed splenic injuries.

Main Methods:

  • Retrospective review of traumatic splenic injuries (2018-2020) at a Level 1 trauma center.
  • Patients classified by injury grade (I-V).
  • Documented injury characteristics, hospital stay, procedures, and pseudoaneurysm presence.

Main Results:

  • 539 patients analyzed; 24% required splenectomy.
  • Follow-up CT identified 22 pseudoaneurysms in high-grade injuries (III-V).
  • 33% of grade III and 30% of grade IV pseudoaneurysms required splenectomy.

Conclusions:

  • Routine follow-up CT imaging is effective in identifying splenic artery pseudoaneurysms after high-grade splenic injury.
  • Standardized surveillance imaging aids in early detection and intervention.
  • Minimizing delayed splenic injury complications is facilitated by prospective identification of pseudoaneurysms.