Abdul Q Alarhayem1, John G Myers1, Daniel Dent1, Daniel Lamus1, Jorge Lopera1, Lily Liao1, Ramon Cestero1, Ronald Stewart1, Brian J Eastridge2. 1. Departments of Surgery and Radiology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78260, USA. 2. Departments of Surgery and Radiology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78260, USA. Electronic address: Eastridge@uthscsa.edu.
Abstract
BACKGROUND: "Blush," defined as a focal area of contrast pooling within a hematoma, is frequently encountered in patients with severe blunt torso trauma. Contemporary clinical practice guidelines recommend the use of angiography with embolization in all hemodynamically stable patients with evidence of active extravasation. Patients presenting with blush visualized on computed tomography (CT), but not demonstrated on subsequent angiography, present a challenging clinical dilemma. The purpose of this study was to study the natural course of patients with this blush disparity between CT and angiography. METHODS: The study was conducted as a retrospective analysis of patients who underwent angiography after initial CT scans revealed blush after blunt abdominal trauma at a level I trauma center (January 2005 to December 2014). RESULTS: A total of 143 patients with blunt splenic injuries were found to have CT blush and underwent catheter angiography. Of the 143 patients with blush on CT, 24 (17%) showed no evidence of blush on angiography. Patients with CT-angiographic discrepancy were more than twice as likely to rebleed compared with those with angiographic evidence of blush (25% vs 10%, P < .05). This is due to the fact that although all patients with blush on angiography underwent embolization, only 7/22 of those with no evidence of blush were embolized. Sixty-eight patients with blunt liver injuries demonstrated blush on CT and underwent catheter angiography. Of the 68 patients with blush on CT, 22 patients (33%) showed no evidence of blush on angiography. None of these 22 patients underwent angioembolization. The rebleeding rate in this cohort was 32% (7/22). Again, this was more than twice the rate observed in patients who did have angiographic evidence of blush and were embolized (11%, 5/46). CONCLUSIONS: CT imaging has enhanced our ability to detect contrast extravasation after injury, and evidence of blush on CT suggests the presence of active hemorrhage. This analysis suggests that in clinical situations in which CT blush is noted secondary to blunt trauma to the spleen or liver, a negative angiogram still carries a significant risk of recurrent hemorrhage; consideration for empiric embolization at the time of the initial procedure even in the absence of blush on angiographic evaluation is thus warranted. Prospective studies are needed to validate these findings and to assess the utility of this clinical paradigm.
BACKGROUND: "Blush," defined as a focal area of contrast pooling within a hematoma, is frequently encountered in patients with severe blunt torso trauma. Contemporary clinical practice guidelines recommend the use of angiography with embolization in all hemodynamically stable patients with evidence of active extravasation. Patients presenting with blush visualized on computed tomography (CT), but not demonstrated on subsequent angiography, present a challenging clinical dilemma. The purpose of this study was to study the natural course of patients with this blush disparity between CT and angiography. METHODS: The study was conducted as a retrospective analysis of patients who underwent angiography after initial CT scans revealed blush after blunt abdominal trauma at a level I trauma center (January 2005 to December 2014). RESULTS: A total of 143 patients with blunt splenic injuries were found to have CT blush and underwent catheter angiography. Of the 143 patients with blush on CT, 24 (17%) showed no evidence of blush on angiography. Patients with CT-angiographic discrepancy were more than twice as likely to rebleed compared with those with angiographic evidence of blush (25% vs 10%, P < .05). This is due to the fact that although all patients with blush on angiography underwent embolization, only 7/22 of those with no evidence of blush were embolized. Sixty-eight patients with blunt liver injuries demonstrated blush on CT and underwent catheter angiography. Of the 68 patients with blush on CT, 22 patients (33%) showed no evidence of blush on angiography. None of these 22 patients underwent angioembolization. The rebleeding rate in this cohort was 32% (7/22). Again, this was more than twice the rate observed in patients who did have angiographic evidence of blush and were embolized (11%, 5/46). CONCLUSIONS: CT imaging has enhanced our ability to detect contrast extravasation after injury, and evidence of blush on CT suggests the presence of active hemorrhage. This analysis suggests that in clinical situations in which CT blush is noted secondary to blunt trauma to the spleen or liver, a negative angiogram still carries a significant risk of recurrent hemorrhage; consideration for empiric embolization at the time of the initial procedure even in the absence of blush on angiographic evaluation is thus warranted. Prospective studies are needed to validate these findings and to assess the utility of this clinical paradigm.
Authors: Maria Cristina Firetto; Francesco Sala; Marcello Petrini; Alessandro A Lemos; Tiberio Canini; Stefano Magnone; Gianluca Fornoni; Ivan Cortinovis; Sandro Sironi; Pietro R Biondetti Journal: Emerg Radiol Date: 2018-04-27
Authors: Mauro Podda; Belinda De Simone; Marco Ceresoli; Francesco Virdis; Francesco Favi; Johannes Wiik Larsen; Federico Coccolini; Massimo Sartelli; Nikolaos Pararas; Solomon Gurmu Beka; Luigi Bonavina; Raffaele Bova; Adolfo Pisanu; Fikri Abu-Zidan; Zsolt Balogh; Osvaldo Chiara; Imtiaz Wani; Philip Stahel; Salomone Di Saverio; Thomas Scalea; Kjetil Soreide; Boris Sakakushev; Francesco Amico; Costanza Martino; Andreas Hecker; Nicola de'Angelis; Mircea Chirica; Joseph Galante; Andrew Kirkpatrick; Emmanouil Pikoulis; Yoram Kluger; Denis Bensard; Luca Ansaloni; Gustavo Fraga; Ian Civil; Giovanni Domenico Tebala; Isidoro Di Carlo; Yunfeng Cui; Raul Coimbra; Vanni Agnoletti; Ibrahima Sall; Edward Tan; Edoardo Picetti; Andrey Litvin; Dimitrios Damaskos; Kenji Inaba; Jeffrey Leung; Ronald Maier; Walt Biffl; Ari Leppaniemi; Ernest Moore; Kurinchi Gurusamy; Fausto Catena Journal: World J Emerg Surg Date: 2022-10-12 Impact factor: 8.165
Authors: Federico Coccolini; Giulia Montori; Fausto Catena; Yoram Kluger; Walter Biffl; Ernest E Moore; Viktor Reva; Camilla Bing; Miklosh Bala; Paola Fugazzola; Hany Bahouth; Ingo Marzi; George Velmahos; Rao Ivatury; Kjetil Soreide; Tal Horer; Richard Ten Broek; Bruno M Pereira; Gustavo P Fraga; Kenji Inaba; Joseph Kashuk; Neil Parry; Peter T Masiakos; Konstantinos S Mylonas; Andrew Kirkpatrick; Fikri Abu-Zidan; Carlos Augusto Gomes; Simone Vasilij Benatti; Noel Naidoo; Francesco Salvetti; Stefano Maccatrozzo; Vanni Agnoletti; Emiliano Gamberini; Leonardo Solaini; Antonio Costanzo; Andrea Celotti; Matteo Tomasoni; Vladimir Khokha; Catherine Arvieux; Lena Napolitano; Lauri Handolin; Michele Pisano; Stefano Magnone; David A Spain; Marc de Moya; Kimberly A Davis; Nicola De Angelis; Ari Leppaniemi; Paula Ferrada; Rifat Latifi; David Costa Navarro; Yashuiro Otomo; Raul Coimbra; Ronald V Maier; Frederick Moore; Sandro Rizoli; Boris Sakakushev; Joseph M Galante; Osvaldo Chiara; Stefania Cimbanassi; Alain Chichom Mefire; Dieter Weber; Marco Ceresoli; Andrew B Peitzman; Liban Wehlie; Massimo Sartelli; Salomone Di Saverio; Luca Ansaloni Journal: World J Emerg Surg Date: 2017-08-18 Impact factor: 5.469