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1
Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr.,
H-1307, Stanford, CA 94305-5105.
2
Department of Diagnostic Radiology, University of Maryland Medical Center,
University of Maryland Hospital, 22 S. Greene St., Baltimore, MD 21201.
3
Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop
St., Pittsburgh, PA 15213.
4
Department of Radiology, Brooke Army Medical Center, 3851 Roger Brooke Dr.,
Fort Sam Houston, TX 78234-6200.
5
Department of Radiology, Albert Einstein College of Medicine, Jack and Pearl
Resnick Campus, 1300 Morris Park Ave., Bronx, NY 10461.
6
Department of Radiology, Los Angeles County/University of Southern California
Medical Center, Box 631, 1200 N. State St., Los Angeles, CA 90033.
OBJECTIVE. We evaluated the incidence and organ distribution of arterial extravasation identified using contrast-enhanced helical CT in patients who had sustained abdominal visceral injuries and pelvic fractures after blunt trauma.
SUBJECTS AND METHODS. Five hundred sixty-five consecutive patients from four level I trauma centers who had CT scans showing abdominal visceral injuries or pelvic fractures were included in this series. The presence or absence of arterial extravasation, as well as the anatomic sites of arterial extravasation, was noted. We obtained clinical follow-up data, including surgical or angiographic findings.
RESULTS. In our series, 104 (18.4%) of 565 patients had arterial extravasation. Of the 104 patients, 81 (77.9%) underwent surgery, embolization, or both. The combined rate of surgery or embolization in patients with arterial extravasation was statistically higher than expected at all four institutions (p <0.001). The spleen was the most common organ injured, occurring in 277 (49.0%) of 565 patients, and arterial extravasation occurred in 49 (17.7%) of 277 patients with splenic injury. Several other visceral injuries were associated with arterial extravasation, including hepatic, renal, adrenal, and mesenteric injuries.
CONCLUSION. Based on the limited reports of arterial extravasation in the nonhelical CT literature, the percentage (18%) of clinically stable patients in our study with CT scans showing arterial extravasation was higher than anticipated. This finding likely reflects the improved diagnostic capability of helical CT. Although the spleen and liver were the organs most commonly associated with arterial extravasation, radiologists should be aware that arterial extravasation may be associated with several other visceral injuries.
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