Question
A patient who has sustained splenic trauma and is being managed conservatively, certain CT scan findings might necessitate further intervention such as angiography. Which of the following CT findings typically would not require angiography in the context of conservative management of splenic trauma?
| A. |
Subcapsular hematoma covering 40% surface area
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| B. |
Significant hemoperitoneum
|
| C. |
Presence of pseudoaneurysm
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| D. |
Contrast extravasation
|
Show Answer
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Correct Answer » A
Explanation
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- Non-operative management (NOM) is the preferred treatment for hemodynamically stable patients with blunt splenic injury.
- Contrast-enhanced CT is the imaging modality of choice for evaluating splenic injuries and identifying patients who may benefit from angiography and splenic artery embolization (SAE).
- CT findings suggestive of active or potential ongoing bleeding increase the likelihood of failure of conservative management and often necessitate angiographic intervention.
Explanation of the Correct Answer
Option A. Subcapsular hematoma involving 40% of the splenic surface area – Correct
- A subcapsular hematoma covering more than 10% of the splenic surface area is a criterion for an AAST Grade II splenic injury.
- Although it indicates a higher-grade injury, a subcapsular hematoma alone is not an indication for angiography if there is no evidence of active vascular injury and the patient remains hemodynamically stable.
- Such patients can usually be managed with close observation and serial clinical assessment.
Why the Other Options are Incorrect
Option B. Significant hemoperitoneum
- Incorrect.
- A large volume of hemoperitoneum is associated with an increased risk of failure of non-operative management.
- In a hemodynamically stable patient, significant hemoperitoneum is a relative indication for angiography, especially when associated with moderate- or high-grade splenic injury.
Option C. Presence of pseudoaneurysm
- Incorrect.
- A splenic pseudoaneurysm represents a vascular injury with a high risk of delayed rupture and hemorrhage.
- Angiography with embolization is recommended even in hemodynamically stable patients.
Option D. Contrast extravasation
- Incorrect.
- Active contrast extravasation (“contrast blush”) indicates ongoing arterial bleeding.
- It is one of the strongest indications for urgent angiography and splenic artery embolization in stable patients.
