Post-traumatic liver and splenic pseudoaneurysms in children: Diagnosis, management, and follow-up screening using contrast enhanced ultrasound (CEUS)
Post-traumatic liver and splenic pseudoaneurysms in children: Diagnosis, management, and follow-up screening using contrast enhanced ultrasound (CEUS)
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DOI：
10.1016/j.jpedsurg.2015.10.074
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发表时间：
2016-02-01
影响因子：
2.4
通讯作者：
Makin, Erica
中科院分区：
文献类型：
--
作者：
Durkin, Natalie;Deganello, Annamaria;Makin, Erica
工作背景：腹部钝性和穿透性创伤后假性动脉瘤（PA）形成是实体器官损伤的公认并发症，通常通过对比增强CT（CECT）成像诊断。延迟性破裂是一种潜在的危及生命的事件，尽管其在儿科创伤中的发生率尚不清楚。对比增强超声（CEUS）是一种新的无辐射替代CECT的潜力，以确定PA。方法：一个连续的情况下，显著的肝脏和脾脏损伤承认单机构（三级和四级转诊）超过12年的时间进行了回顾性分析。从2011年开始，使用SonoVue（TM）作为对比剂，在损伤后（5-10天）常规进行CEUS。最初，CECT和CEUS进行串联，以确保准确correlations.Results：从2002年1月至2014年12月，101（73 M）儿童[中位年龄为14.2（1.3-18）岁]与肝脏和脾脏损伤入院。损伤包括：肝脏[n = 57，3级（1-5）]、脾脏[n = 35，3级（1-5）]和肝/脾联合损伤[n = 8，（1-4）]。中位损伤严重度评分（ISS）为13（2-72）。损伤的主要机制为钝性创伤n = 73（72%）和穿透性创伤n = 28（28%）。17名儿童（17%）发生PA。6例儿童出现症状（35%），5例继续栓塞[7（3-11）天]。CECT（n= 4）和CEUS（n= 2）检测到这些。11名儿童仍无症状[在中位5（4-8）天通过CECT（n= 8）和CEUS（n= 3）检测到]。1例因间歇性出血而接受栓塞治疗。CEUS检测PA的敏感性为83%，特异性为92%（PPV = 71%，NPV = 96%）。无论是肝外伤还是脾外伤，损伤等级与PA的存在之间均无相关性（P = 0.4），PA大小与症状之间也无相关性（P=0.68）。脾PA患儿年龄明显小于肝PA患儿（P = 0.03）。随访影像学证实16例PA消退。结论：PA的发病率高于以前在儿科文献中报道的（
Background: Pseudoaneurysm(PA) formation following blunt and penetrating abdominal trauma is a recognized complication in solid organ injury, usually diagnosed by contrast-enhanced CT (CECT) imaging. Delayed rupture is a potentially life-threatening event, although its frequency is not known in pediatric trauma. Contrast enhanced ultrasound (CEUS) is a novel radiation-free alternative to CECT with the potential to identify PA.Methods: A retrospective review of consecutive cases of significant liver and splenic injuries admitted to single institution (tertiary and quaternary referrals) over more than a 12 year period was performed. From 2011, CEUS was performed routinely postinjury (5-10 days) using SonoVue (TM) as contrast. Initially, CECT and CEUS were performed in tandem to ensure accurate correlation.Results: From January 2002-December 2014, 101 (73 M) children [median age was 14.2 (1.3-18) years] with liver and splenic injuries were admitted. Injuries included: liver [n = 57, grade 3 (1-5)], splenic [n = 35, grade 3 (1-5)], and combined liver/spleen [n = 8, (1-4)]. Median Injury Severity Score (ISS) was 13 (2-72). The predominant mechanisms of injury were blunt trauma n = 73 (72%) and penetrating trauma n = 28 (28%). Seventeen children (17%) developed PA. Six children became symptomatic (35%), and five went on to have embolization [at 7 (3-11) days]. These were detected by CECT (n= 4) and CEUS (n= 2). Eleven children remained asymptomatic [detected by CECT (n= 8) and CEUS (n= 3) at median 5 (4-8) days]. One underwent embolization owing to evidence of interval bleeding. Sensitivity of CEUS at detection of PA was 83%, with specificity of 92% (PPV = 71%, NPV = 96%). There was no association between grade of injury and presence of PA in either liver or splenic trauma (P = 0.4), nor was there an association between size of PA and symptoms (P=0.68). Children sustaining splenic PA were significantly younger than those with hepatic PA (P = 0.03). Follow-up imaging confirmed resolution of PA in 16 cases. One child was lost to follow-up.Conclusions: The incidence of PA is higher than previously reported in the pediatric literature (