title: Multidetector computed tomography of acute vascular injury in blunt abdominal/pelvic trauma: imaging predictors of treatment.
abstract: OBJECTIVE
  The purpose of this study was to analyze the multidetector computed tomography (MDCT) morphologic characteristics of non-aortic acute vascular injuries (AVI) in patients with blunt abdominopelvic trauma that predict treatment.
  
  
  METHODS
  CT scans of 65 trauma patients with non-aortic AVI were reviewed. AVI morphology was categorized as linear or round. The organ of involvement, location of hemorrhage, initial size of hematoma, and hemodynamic status were recorded. Expansion rates of the hematoma were calculated in 40 patients who had delayed imaging. Multivariate regression was used to analyze the morphologic features of AVI and treatment.
  
  
  RESULTS
  Patients with linear AVI were four times more likely to require aggressive treatment (surgery or embolization) than those with a round morphology, independent of the hemodynamic status. There was no main effect of the organ involved, location of hemorrhage, initial bleed size, or expansion rate on the probability of aggressive treatment.
  
  
  CONCLUSIONS
  The location, initial size, and expansion rate of AVI are not significant predictors of aggressive treatment with surgery or embolization. Linear morphology of AVI, however, is more likely to require aggressive treatment than round AVI, independent of the hemodynamic status. Linear AVI likely reflects a spurting jet of active extravasation, whereas round AVI likely represents a pseudoaneurysm or slow bleed.
authors.affiliation: Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA. melissa.sims@stanford.edu.
authors.forename: M E
authors.initials: ME
authors.lastname: Sims
authors.affiliation: Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA.|VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA, 94304, USA.
authors.forename: L K
authors.initials: LK
authors.lastname: Shin
authors.affiliation: The Lucas Center for MR Spectroscopy and Imaging, Stanford University School of Medicine, Mail Code 5488, Route 8, Stanford, CA, 94305-6488, USA.
authors.forename: J
authors.initials: J
authors.lastname: Rosenberg
authors.affiliation: Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Jeffrey
keywords: Abdominal trauma; Active extravasation; Emergency radiology; Pseudoaneurysm; Vascular trauma
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