John R. Gaughen, Jr., M.D.

August 09, 2005


The spleen is the most commonly injured organ in blunt abdominal trauma. Post-traumatic pseudoaneurysm is an uncommon complication following splenic injury. A pseudoaneurysm forms when the vessel wall ruptures, with extravasated blood contained within the adventitia or surrounding parenchyma. Current literature supports conservative management of blunt splenic injury in hemodynamically stable patients. Along with active extravasation and arteriovenus fistula, pseudoaneurysm represents a predictor of failure of conservative management, and surgical or endovascular treatment is indicated. On contrast-enhanced CT, splenic pseudoaneurysms manifest as pooling of contrast material within the splenic parenchyma. Pseudoaneurysms are most evident on arterial phase imaging but can be seen in the portal venous phase. They may be identified at the time of initial (emergent) imaging or later as a cause of delayed splenic hemorrhage or as an incidental finding on follow-up imaging. Identification of a splenic pseudoaneurysm warrants catheter angiography, which offers both diagnostic and therapeutic options. Pseudoaneurysms manifest angiographically as contained collections of extravasated contrast material and are generally treated with coil embolization. Failure rates from embolization are low.

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