title: Blunt splenic trauma: can contrast enhanced sonography be used for the screening of delayed pseudoaneurysms?
abstract: OBJECTIVE
  To assess the value of contrast-enhanced sonography (CES) for the detection of delayed post-traumatic splenic pseudo-aneurysms, usually considered an indication for angiographic embolization.
  
  
  METHODS
  Sixty-three consecutive hemodynamically stable trauma patients in whom admission CT displayed a splenic injury of grade II or higher (AAST classification), without evidence of vascular involvement, were included in the study. CES of the spleen using a second generation contrast agent was systematically performed within 48-72 h after admission, for the detection of a pooling of contrast media suggestive of pseudoaneurysm. Within 6h after contrast-enhanced sonography, all patients underwent an abdominal CT for control purposes. CES results were compared to CT findings, which were considered the reference standard. This study received approval from the institutional ethical board.
  
  
  RESULTS
  CES showed a blush of contrast consistent with a pseudoaneurysm in 6 of the 63 patients. All were confirmed at subsequent control CT. Pooling of contrast was found at CT in 2 patients in whom contrast-enhanced sonography was negative. There was no false positive CES examination for the suspicion of pseudoaneurysms. When compared to CT, the sensitivity, specificity, positive and negative predictive values of CES to suggest a pseudoaneurysms, were 75% (6/8), 100% (55/55), 100% (6/6), and 96% (55/57), respectively.
  
  
  CONCLUSIONS
  Our data suggest that CES may be useful for the screening of delayed traumatic splenic pseudoaneurysms: if a negative CES does not absolutely rule out a pseudoaneurysm, a positive CES warrants an angiography, without need of control CT.
authors.affiliation: Department of Radiology, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland. Electronic address: Pierre-Alexandre.Poletti@hcuge.ch.
authors.forename: Pierre-Alexandre
authors.initials: PA
authors.lastname: Poletti
authors.forename: Christoph D
authors.initials: CD
authors.lastname: Becker
authors.forename: Daniel
authors.initials: D
authors.lastname: Arditi
authors.forename: Sylvain
authors.initials: S
authors.lastname: Terraz
authors.forename: Nicolas
authors.initials: N
authors.lastname: Buchs
authors.forename: Kathirkamanathan
authors.initials: K
authors.lastname: Shanmuganathan
authors.forename: Alexandra
authors.initials: A
authors.lastname: Platon
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging* / Q000209:etiology*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010743:Phospholipids; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013161:Splenic Rupture / Q000150:complications* / Q000000981:diagnostic imaging*; D013459:Sulfur Hexafluoride; D014463:Ultrasonography / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: Contrast media; Injuries; Spleen; Therapeutic embolization; Ultrasonography