The significance of contrast blush on computed tomography in children with splenic injuries.

Details

Serval ID
serval:BIB_33848
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
The significance of contrast blush on computed tomography in children with splenic injuries.
Journal
Journal of Pediatric Surgery
Author(s)
Lutz N., Mahboubi S., Nance M.L., Stafford P.W.
ISSN
1531-5037 (Electronic)
ISSN-L
0022-3468
Publication state
Published
Issued date
2004
Volume
39
Number
3
Pages
491-494
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
PURPOSE: Most children and adults with blunt splenic injuries are treated nonoperatively by well-established management protocols. The "blush sign" is an active pooling of contrast material within or around the spleen seen during intravenous enhanced computed tomography (CT) scan. Adult treatment algorithms often include the "blush sign" as an indication for embolization or surgical intervention. This study was designed to evaluate the implications of the "blush sign" in children with blunt splenic injuries.
METHODS: A review was performed of all children with blunt splenic injuries treated between January 1996 and December 2001 at a level I pediatric trauma center using an established solid organ injury protocol. The demographic, CT imaging, and outcome data were recorded. Treatment was categorized as operative or nonoperative. A single pediatric radiologist retrospectively reviewed all available CT scans to confirm injury grade and the presence or absence of a "blush sign."
RESULTS: There were 133 eligible children admitted with blunt splenic trauma, with a mean age of 9.1 years (range, 1 to 15), including 86 children with an abdominal CT available for review. A "blush sign" on initial CT scan was noted in 6 children, all with grade 3 or above splenic injuries, 5 of who were treated nonoperatively. In this series, the single child with a "blush sign" who did not respond to nonoperative treatment had a severe polytrauma requiring urgent splenectomy and left nephrectomy. None of the children died of their splenic injury.
CONCLUSIONS: Although associated with higher grades of injury, the blush sign did not mandate embolization or surgical intervention in children with blunt splenic trauma in this series. Severe splenic injuries with a blush sign on the initial CT scan may be successfully treated nonoperatively when using an established treatment protocol. Management should be based primarily on physiological response to injury rather than the radiologic features of the injury.
Keywords
Abdominal Injuries/radiography, Abdominal Injuries/therapy, Adolescent, Child, Child, Preschool, Contrast Media, Humans, Infant, Injury Severity Score, Predictive Value of Tests, Retrospective Studies, Spleen/injuries, Spleen/radiography, Tomography, X-Ray Computed, Wounds, Nonpenetrating/radiography, Wounds, Nonpenetrating/therapy
Pubmed
Web of science
Create date
19/11/2007 13:33
Last modification date
20/08/2019 14:19
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