Pseudoaneurysm Screening after Pediatric High Grade Solid Organ Injury.

Area of Science:

• Pediatric Trauma Surgery
• Diagnostic Imaging
• Vascular Surgery

Background:

• High-grade solid organ injuries in children can lead to pseudoaneurysms (PSA).
• Optimal screening strategies for pediatric PSA remain undefined.
• Delayed CT angiography (dCTA) and contrast-enhanced ultrasound (CEUS) are potential screening tools.

Purpose of the Study:

• To determine the yield of dCTA and CEUS in diagnosing pseudoaneurysms (PSA) in pediatric patients with high-grade solid organ injuries.
• To evaluate the current practices and outcomes of PSA screening in this population.

Main Methods:

• Retrospective review of patients under 18 with AAST grade ≥3 abdominal solid organ injury (01/2017-10/2021).
• Exclusion criteria included transfers, death within 48 hours, and immediate organ removal.
• Selective PSA screening using dCTA or CEUS based on attending physician discretion.

Main Results:

• Forty-two patients met inclusion criteria; 26% underwent PSA screening.
• Delayed CT angiography (dCTA) was used in 21% and contrast-enhanced ultrasound (CEUS) in 5% of patients.
• One pseudoaneurysm was diagnosed via dCTA following splenic injury; CEUS identified no PSAs.

Conclusions:

• Pseudoaneurysm screening is infrequently performed in pediatric high-grade solid organ injuries.
• Concerns regarding radiation from dCTA may influence screening choices, favoring CEUS.
• Further research is needed to establish PSA incidence and the diagnostic accuracy of dCTA and CEUS.