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Blunt Splenic Injury: Usefulness of Transcatheter Arterial Embolization in Patients with a Transient Response to Fluid Resuscitation¹

¹ From the Department of Traumatology and Critical Care Medicine, Kyorin University School of Medicine, 6–20-2 Shinkawa Mitaka-shi, Tokyo 181-8611, Japan. Received July 19, 2003; revision requested October 3; final revision received April 22, 2004; accepted June 17. Address correspondence to A.H. (e-mail: hagiwarapupu@jcom.home.ne.jp).

View larger version (139K): [in a new window]   Figure 1a. Images obtained in a 25-year-old man with grade IV splenic injury from a motorcycle accident. (a) Transverse contrast-enhanced CT scan shows splenic parenchymal fragmentation (arrowheads) with intra- and extraparenchymal extravasations of contrast material (straight arrows). Some free intraperitoneal fluid (curved arrows) is seen adjacent to the liver. (b) Anteroposterior selective splenic arteriogram shows multiple areas of extravasation (arrows) within the splenic parenchyma. The splenic artery was embolized by placing stainless steel coils in the main trunk via a standard 5-F catheter. (c) Anteroposterior celiac arteriogram obtained after TAE shows complete occlusion (large arrow) of the splenic artery, but the remaining splenic parenchyma is enhanced through collateral flow from the gastroepiploic artery (small black arrow), dorsal pancreatic artery (small white arrow), and great pancreatic artery (black arrowhead) to the caudal pancreatic artery (white arrowhead). Contrast material extravasation is not seen. (d) On day 7 after injury, transverse contrast-enhanced CT scan shows splenic fragmentation (arrows) and a large hematoma (arrowheads) around the fragments. (e) Anterior 99mTc-sulfur colloid scintigram obtained on day 8 shows preservation of splenic function (arrow).

View larger version (161K): [in a new window]   Figure 1b. Images obtained in a 25-year-old man with grade IV splenic injury from a motorcycle accident. (a) Transverse contrast-enhanced CT scan shows splenic parenchymal fragmentation (arrowheads) with intra- and extraparenchymal extravasations of contrast material (straight arrows). Some free intraperitoneal fluid (curved arrows) is seen adjacent to the liver. (b) Anteroposterior selective splenic arteriogram shows multiple areas of extravasation (arrows) within the splenic parenchyma. The splenic artery was embolized by placing stainless steel coils in the main trunk via a standard 5-F catheter. (c) Anteroposterior celiac arteriogram obtained after TAE shows complete occlusion (large arrow) of the splenic artery, but the remaining splenic parenchyma is enhanced through collateral flow from the gastroepiploic artery (small black arrow), dorsal pancreatic artery (small white arrow), and great pancreatic artery (black arrowhead) to the caudal pancreatic artery (white arrowhead). Contrast material extravasation is not seen. (d) On day 7 after injury, transverse contrast-enhanced CT scan shows splenic fragmentation (arrows) and a large hematoma (arrowheads) around the fragments. (e) Anterior 99mTc-sulfur colloid scintigram obtained on day 8 shows preservation of splenic function (arrow).

View larger version (164K): [in a new window]   Figure 1c. Images obtained in a 25-year-old man with grade IV splenic injury from a motorcycle accident. (a) Transverse contrast-enhanced CT scan shows splenic parenchymal fragmentation (arrowheads) with intra- and extraparenchymal extravasations of contrast material (straight arrows). Some free intraperitoneal fluid (curved arrows) is seen adjacent to the liver. (b) Anteroposterior selective splenic arteriogram shows multiple areas of extravasation (arrows) within the splenic parenchyma. The splenic artery was embolized by placing stainless steel coils in the main trunk via a standard 5-F catheter. (c) Anteroposterior celiac arteriogram obtained after TAE shows complete occlusion (large arrow) of the splenic artery, but the remaining splenic parenchyma is enhanced through collateral flow from the gastroepiploic artery (small black arrow), dorsal pancreatic artery (small white arrow), and great pancreatic artery (black arrowhead) to the caudal pancreatic artery (white arrowhead). Contrast material extravasation is not seen. (d) On day 7 after injury, transverse contrast-enhanced CT scan shows splenic fragmentation (arrows) and a large hematoma (arrowheads) around the fragments. (e) Anterior 99mTc-sulfur colloid scintigram obtained on day 8 shows preservation of splenic function (arrow).

View larger version (133K): [in a new window]   Figure 1d. Images obtained in a 25-year-old man with grade IV splenic injury from a motorcycle accident. (a) Transverse contrast-enhanced CT scan shows splenic parenchymal fragmentation (arrowheads) with intra- and extraparenchymal extravasations of contrast material (straight arrows). Some free intraperitoneal fluid (curved arrows) is seen adjacent to the liver. (b) Anteroposterior selective splenic arteriogram shows multiple areas of extravasation (arrows) within the splenic parenchyma. The splenic artery was embolized by placing stainless steel coils in the main trunk via a standard 5-F catheter. (c) Anteroposterior celiac arteriogram obtained after TAE shows complete occlusion (large arrow) of the splenic artery, but the remaining splenic parenchyma is enhanced through collateral flow from the gastroepiploic artery (small black arrow), dorsal pancreatic artery (small white arrow), and great pancreatic artery (black arrowhead) to the caudal pancreatic artery (white arrowhead). Contrast material extravasation is not seen. (d) On day 7 after injury, transverse contrast-enhanced CT scan shows splenic fragmentation (arrows) and a large hematoma (arrowheads) around the fragments. (e) Anterior 99mTc-sulfur colloid scintigram obtained on day 8 shows preservation of splenic function (arrow).

View larger version (153K): [in a new window]   Figure 1e. Images obtained in a 25-year-old man with grade IV splenic injury from a motorcycle accident. (a) Transverse contrast-enhanced CT scan shows splenic parenchymal fragmentation (arrowheads) with intra- and extraparenchymal extravasations of contrast material (straight arrows). Some free intraperitoneal fluid (curved arrows) is seen adjacent to the liver. (b) Anteroposterior selective splenic arteriogram shows multiple areas of extravasation (arrows) within the splenic parenchyma. The splenic artery was embolized by placing stainless steel coils in the main trunk via a standard 5-F catheter. (c) Anteroposterior celiac arteriogram obtained after TAE shows complete occlusion (large arrow) of the splenic artery, but the remaining splenic parenchyma is enhanced through collateral flow from the gastroepiploic artery (small black arrow), dorsal pancreatic artery (small white arrow), and great pancreatic artery (black arrowhead) to the caudal pancreatic artery (white arrowhead). Contrast material extravasation is not seen. (d) On day 7 after injury, transverse contrast-enhanced CT scan shows splenic fragmentation (arrows) and a large hematoma (arrowheads) around the fragments. (e) Anterior 99mTc-sulfur colloid scintigram obtained on day 8 shows preservation of splenic function (arrow).

View larger version (102K): [in a new window]   Figure 2a. Images obtained in a 37-year-old woman with grade IV splenic injury from a fall. (a) Transverse contrast-enhanced CT scan shows multiple areas of contrast material extravasation (straight black arrows) around the injured spleen with a perisplenic hematoma (arrowheads) and a small low-attenuation area (white arrows) in the quadrate lobe of the liver (abbreviated injury score: grade 2 liver injury). Free intraperitoneal blood (curved arrows) is seen around the spleen and liver. (b) Anteroposterior celiac arteriogram shows extravasation (arrow) extending beyond the splenic parenchyma from the middle branch of the splenic artery. TAE was performed as follows: Gelatin sponge particles were injected into the splenic arterial branch via a 3-F microcatheter, and steel coils were placed in the main trunk via a standard 5-F catheter. (c) Anteroposterior celiac arteriogram obtained after TAE shows complete occlusion (arrow) of the splenic artery. (d) On day 7 after injury, transverse contrast-enhanced CT scan shows an intrasplenic hematoma (arrow) with intraperitoneal blood (arrowheads) around the spleen. The noninjured splenic parenchyma is enhanced. (e) Posterior 99mTc-sulfur colloid scintigram also obtained on day 7 shows preservation of splenic function (arrows).

View larger version (148K): [in a new window]   Figure 2b. Images obtained in a 37-year-old woman with grade IV splenic injury from a fall. (a) Transverse contrast-enhanced CT scan shows multiple areas of contrast material extravasation (straight black arrows) around the injured spleen with a perisplenic hematoma (arrowheads) and a small low-attenuation area (white arrows) in the quadrate lobe of the liver (abbreviated injury score: grade 2 liver injury). Free intraperitoneal blood (curved arrows) is seen around the spleen and liver. (b) Anteroposterior celiac arteriogram shows extravasation (arrow) extending beyond the splenic parenchyma from the middle branch of the splenic artery. TAE was performed as follows: Gelatin sponge particles were injected into the splenic arterial branch via a 3-F microcatheter, and steel coils were placed in the main trunk via a standard 5-F catheter. (c) Anteroposterior celiac arteriogram obtained after TAE shows complete occlusion (arrow) of the splenic artery. (d) On day 7 after injury, transverse contrast-enhanced CT scan shows an intrasplenic hematoma (arrow) with intraperitoneal blood (arrowheads) around the spleen. The noninjured splenic parenchyma is enhanced. (e) Posterior 99mTc-sulfur colloid scintigram also obtained on day 7 shows preservation of splenic function (arrows).

View larger version (182K): [in a new window]   Figure 2c. Images obtained in a 37-year-old woman with grade IV splenic injury from a fall. (a) Transverse contrast-enhanced CT scan shows multiple areas of contrast material extravasation (straight black arrows) around the injured spleen with a perisplenic hematoma (arrowheads) and a small low-attenuation area (white arrows) in the quadrate lobe of the liver (abbreviated injury score: grade 2 liver injury). Free intraperitoneal blood (curved arrows) is seen around the spleen and liver. (b) Anteroposterior celiac arteriogram shows extravasation (arrow) extending beyond the splenic parenchyma from the middle branch of the splenic artery. TAE was performed as follows: Gelatin sponge particles were injected into the splenic arterial branch via a 3-F microcatheter, and steel coils were placed in the main trunk via a standard 5-F catheter. (c) Anteroposterior celiac arteriogram obtained after TAE shows complete occlusion (arrow) of the splenic artery. (d) On day 7 after injury, transverse contrast-enhanced CT scan shows an intrasplenic hematoma (arrow) with intraperitoneal blood (arrowheads) around the spleen. The noninjured splenic parenchyma is enhanced. (e) Posterior 99mTc-sulfur colloid scintigram also obtained on day 7 shows preservation of splenic function (arrows).

View larger version (96K): [in a new window]   Figure 2d. Images obtained in a 37-year-old woman with grade IV splenic injury from a fall. (a) Transverse contrast-enhanced CT scan shows multiple areas of contrast material extravasation (straight black arrows) around the injured spleen with a perisplenic hematoma (arrowheads) and a small low-attenuation area (white arrows) in the quadrate lobe of the liver (abbreviated injury score: grade 2 liver injury). Free intraperitoneal blood (curved arrows) is seen around the spleen and liver. (b) Anteroposterior celiac arteriogram shows extravasation (arrow) extending beyond the splenic parenchyma from the middle branch of the splenic artery. TAE was performed as follows: Gelatin sponge particles were injected into the splenic arterial branch via a 3-F microcatheter, and steel coils were placed in the main trunk via a standard 5-F catheter. (c) Anteroposterior celiac arteriogram obtained after TAE shows complete occlusion (arrow) of the splenic artery. (d) On day 7 after injury, transverse contrast-enhanced CT scan shows an intrasplenic hematoma (arrow) with intraperitoneal blood (arrowheads) around the spleen. The noninjured splenic parenchyma is enhanced. (e) Posterior 99mTc-sulfur colloid scintigram also obtained on day 7 shows preservation of splenic function (arrows).

View larger version (156K): [in a new window]   Figure 2e. Images obtained in a 37-year-old woman with grade IV splenic injury from a fall. (a) Transverse contrast-enhanced CT scan shows multiple areas of contrast material extravasation (straight black arrows) around the injured spleen with a perisplenic hematoma (arrowheads) and a small low-attenuation area (white arrows) in the quadrate lobe of the liver (abbreviated injury score: grade 2 liver injury). Free intraperitoneal blood (curved arrows) is seen around the spleen and liver. (b) Anteroposterior celiac arteriogram shows extravasation (arrow) extending beyond the splenic parenchyma from the middle branch of the splenic artery. TAE was performed as follows: Gelatin sponge particles were injected into the splenic arterial branch via a 3-F microcatheter, and steel coils were placed in the main trunk via a standard 5-F catheter. (c) Anteroposterior celiac arteriogram obtained after TAE shows complete occlusion (arrow) of the splenic artery. (d) On day 7 after injury, transverse contrast-enhanced CT scan shows an intrasplenic hematoma (arrow) with intraperitoneal blood (arrowheads) around the spleen. The noninjured splenic parenchyma is enhanced. (e) Posterior 99mTc-sulfur colloid scintigram also obtained on day 7 shows preservation of splenic function (arrows).