Blunt splenic trauma in adults: CT-based classification and correlation with prognosis and treatment

Nonsurgical management of blunt splenic injury in children is a well-established method to salvage splenic function; however, nonsurgical management of adult blunt splenic trauma remains controversial. To assess the value of preoperative abdominal CT in predicting the outcome of blunt splenic injury in adults, a CT-based injury-severity score consisting of four grades was devised and applied in 39 adult patients with blunt splenic injury as the sole or predominant intraperitoneal injury detected with preoperative CT. While patients with high grades of splenic injury generally required early surgery, eight (35%) of 23 patients with initial grade 3 or 4 injury were treated successfully without surgery, and four (29%) of 15 patients with grade 1 or 2 injury initially treated nonsurgically required delayed celiotomy (n = 3) or emergency rehospitalization. Results show that while CT remains an accurate method of identifying and quantifying initial splenic injury, as well as documenting progression or healing of critical injury, CT cannot reliably help predict the outcome of blunt splenic injury in adults. Treatment choices should therefore be based on the hemodynamic status of the patient and results of serial laboratory and bedside assessments.     

Helical computed tomography characteristics of splenic and hepatic trauma in children subjected to nonoperative treatment

The purpose of this study was to present the radiological characteristics of abdominal computed tomography (CT) in the follow-up of splenic and hepatic injury in children. Children (n=24) less than 13 years old who had suffered blunt abdominal trauma and were diagnosed with splenic and hepatic injury by CT scan prospectively were enlisted in the study. The CT was performed immediately after the injury was suspected, and 7 and 60 days after the trauma. The clinical course of the patients was observed (red blood transfusion requirement, associated abdominal injuries, and hospital stay). The splenic and hepatic injuries varied from grade II to grade IV of the American Association for the Surgery of Trauma. The CT showed a reduction in the volume of the injury 60 days after the trauma. In this article the radiological findings will be shown and correlated with the clinical course of the patients. This study shows that CT is advantageous for detecting and grading splenic and hepatic injuries. These injuries can be managed nonoperatively in hospitals where CT is available for the evaluation of pediatric patients. Electronic Publication     

Visceral injury without hemoperitoneum: A limitation of screening abdominal sonography for trauma

Abdominal sonography for the detection of hemoperitoneum has become increasingly popular as a screening test for visceral injury after blunt trauma. The purpose of this study was to determine the frequency, severity, and clinical significance (outcome) of abdominal organ injuries that occur without hemoperitoneum on the initial evaluation of blunt abdominal trauma patients.During a 12-month period, 3392 blunt trauma patients were admitted to our center. Sonographic studies were performed as an initial screening evaluation to determine the presence of hemoperitoneum in 772 (22.7%) of these patients. Abdominal visceral injuries were verified by computed tomography (CT) or surgery in 196 (5.8%) of all blunt trauma admissions. Sonography, CT, and operative findings were reviewed to determine the presence or absence of hemoperitoneum in patients with abdominal injury. Patients with abdominal visceral injury without hemoperitoneum were further analyzed to identify the type of injury and the management required.A total of 246 abdominal injuries were identified in 196 patients. Fifty (26%) patients with abdominal visceral injuries diagnosed by admission CT scan had no evidence of hemoperitoneum. Admission sonography performed in 15 (30%) of these 50 patients also showed no evidence of hemoperitoneum. Visceral injuries detected by CT in the patients without hemoperitoneum included 22 of 100 splenic injuries (22%), 18 of 91 hepatic injuries (20%), 12 of 26 renal injuries (46%), and 1 of 9 mesenteric injuries (11%). Surgery was required to manage injuries in 10 of these patients.Up to 26% of blunt trauma patients with abdominal visceral injuries do not have associated hemoperitoneum identified on admission abdominal CT or sonography. Dependence on hemoperitoneum as the sole criterion of abdominal visceral injury after blunt trauma will result in falsely negative examinations and will miss potentially significant injuries.     

Hemoperitoneum as the sole indicator of abdominal visceral injuries: a potential limitation of screening abdominal US for trauma.

PURPOSE: To determine, at screening ultrasonography, the prevalence, severity, and clinical outcome of clinically important abdominal visceral injuries, without associated hemoperitoneum, that result from blunt abdominal trauma. MATERIALS AND METHODS: Computed tomography (CT) was performed at admission in 466 patients with visceral injury. A retrospective review was performed of findings from surgery and contrast material-enhanced spiral and conventional CT performed to verify abdominal visceral injuries in 467 (4%) of 11,188 patients with blunt trauma. These patients were admitted to a level 1 trauma center over 33 months to determine the presence of hemoperitoneum and to identify the grade of injury. Medical records of patients with abdominal visceral injury without hemoperitoneum were reviewed for the management required and for results of focused abdominal sonography for trauma (FAST). RESULTS: A total of 575 abdominal visceral injuries were identified at CT and/or surgery. Findings of CT at admission (n = 156) and of surgery (n = 1) revealed no evidence of hemoperitoneum in 157 (34%) patients with abdominal visceral injury; 26 (17%) of whom also had negative FAST studies. Abdominal visceral injuries diagnosed in patients without hemoperitoneum included 57 (27%) of 210 splenic injuries, 71 (34%) of 206 hepatic injuries, 30 (48%) of 63 renal injuries, four (11%) of 35 mesenteric injuries, and two (29%) of seven pancreatic injuries. Surgical and/or angiographic intervention was required in 26 (17%) patients without hemoperitoneum. CONCLUSION: Reliance on the presence of hemoperitoneum as the sole indicator of abdominal visceral injury limits the value of FAST as a screening diagnostic modality for patients who sustain blunt abdominal trauma.     

Blunt trauma to the spleen: ultrasonographic findings

The spleen is the most frequently injured organ in adults who sustain blunt abdominal trauma. Splenic trauma accounts for approximately 25% to 30% of all intra-abdominal injuries. The management of splenic injury has undergone rapid change over the last decade, with increasing emphasis on splenic salvage and non-operative management. Identifying the presence and degree of splenic injury is critical in triaging the management of patients. Imaging is integral in the identification of splenic injuries, both at the time of injury and during follow-up. Although CT remains the gold standard in blunt abdominal trauma, US continues to play an important role in assessing the traumatized spleen. This pictorial review illustrates the various ultrasonographic appearances of the traumatized spleen. Correlation with other imaging is presented and complications that occur during follow-up are described.     

Blunt splenic trauma: delayed-phase CT for differentiation of active hemorrhage from contained vascular injury in patients

PURPOSE: To retrospectively evaluate delayed-phase computed tomography (CT) in the differentiation of active splenic hemorrhage requiring emergent treatment from contained vascular injuries (pseudoaneurysms or arteriovenous fistulas) that can be treated electively or managed conservatively. MATERIALS AND METHODS: The institutional review board approved this HIPAA-compliant retrospective study; the informed consent requirement was waived. Forty-seven patients with blunt splenic injury diagnosed at CT after blunt abdominal trauma were evaluated. Abdominal and pelvic dual-phase CT was performed; images were obtained 60-70 seconds and 5 minutes after contrast material injection. Scans were reviewed in consensus by two radiologists. Splenic injuries were graded with the American Association for the Surgery of Trauma Splenic Injury Scale. Patients with intrasplenic hyperattenuating foci on portal venous phase images were classified as having active splenic hemorrhage (group 1) or a contained vascular injury (group 2) on the basis of delayed-phase imaging findings. Findings suggestive of active hemorrhage included areas that remained hyperattenuating or increased in size on delayed-phase images. The clinical outcome of these patients was determined by reviewing their medical records. Relationships between several factors were tested with the Fisher exact test, including (a) the presence or absence of hyperattenuating foci and management and (b) the presence of contained vascular injury or active extravasation and management. RESULTS: Portal venous phase CT revealed a focal high-attenuation parenchymal contrast material collection in 19 patients: nine patients were classified as group 1 and 10 were classified as group 2. All patients in group 1 underwent emergent splenectomy, and all patients in group 2 were initially treated without surgery. Significant differences in management were noted on the basis of whether hyperattenuating foci were seen on portal venous phase images (P < .001) and whether hyperattenuating foci seen at portal venous phase imaging were further characterized as active splenic hemorrhage or a contained vascular injury at delayed-phase CT (P < .001). CONCLUSION: In blunt splenic injury, delayed-phase CT helps differentiate patients with active splenic hemorrhage from those with contained vascular injuries.     

Changes in splenic size after abdominal trauma

After blunt abdominal trauma, the spleen often increases in volume on serial computed tomographic (CT) scans. To determine the frequency and significance of such enlargement, the authors performed a retrospective analysis of 44 hemodynamically stable patients who had experienced recent blunt abdominal trauma. The severity of splenic, hepatic, or other visceral injuries seen on each CT scan was numerically scored, and the amount of intraperitoneal fluid was assessed. Twenty-five patients (57%) had over 10% enlargement (average enlargement, 56%) on follow-up scans. Increasing volume did not correlate with clinical deterioration or the need for splenectomy. It did correlate modestly with the amount of blood in the peritoneum on CT scans, the number of units of blood transfused, and two clinical indexes of systemic trauma. Therefore, an enlarging spleen is not a CT indicator of a deteriorating clinical condition. This phenomenon is most likely due to marked adrenergic stimulation after injury and changing fluid volumes.     

Hepatic and splenic injury in children: role of CT in the decision for laparotomy

Clinical and radiographic records of 274 children who were examined with abdominal computed tomography (CT) after blunt abdominal trauma were retrospectively evaluated to test the hypothesis that CT can assist in decisions to perform laparotomy in children with hepatic or splenic injury. CT demonstrated parenchymal injuries in 36 patients (13%) or 20 livers and 21 spleens. Injury to these organs was categorized as minor (39%), moderate (39%), and severe (21%) according to an assessment of the percentage of parenchymal involvement. Hemoperitoneum was detected in 27 of 36 patients (75%). One of 13 (4.7%) with a moderate to large splenic injury underwent splenorrhaphy because of persistent bleeding. One of 12 (5%) with a moderate to large hepatic injury required late operative intervention due to a large necrotic segment. Both children had a large amount of peritoneal fluid. Two of 16 patients (13%) with moderate to large hemoperitoneum required surgery for liver or splenic injury. The decision for laparotomy should not be based on the extent of injury as shown at CT but on the physiologic condition of the child.     

Bowel and mesenteric injury following blunt abdominal trauma: evaluation with CT

Computed tomography (CT) used in cases of blunt abdominal trauma has been found sensitive in detection of bowel and mesenteric injuries and discrimination of operable from nonoperable candidates. In 51 patients with suspected bowel or mesenteric injury following blunt abdominal trauma, CT correctly depicted bowel hematoma or mesenteric injury in 17 of 19 nonoperable patients (89%) and severe injuries in one patient who died preoperatively. In 26 of 28 patients who underwent therapeutic laparotomy (93%), initial CT enabled identification of surgically confirmed injuries. In two cases, initial scan misinterpretation delayed diagnosis of serious bowel injuries. The correct interpretation was rendered preoperatively and at blind retrospective review. CT findings that correlated with bowel or mesenteric injury requiring surgery were free peritoneal fluid (27 of 28, 96%), mesenteric infiltration (24 of 28, 86%), thick-walled bowel (17 of 28, 61%), associated abdominal injuries (12 of 28, 43%), and free air (nine of 28, 32%). In nonoperable cases, CT scans demonstrated bowel thickening (84%) but less frequently peritoneal fluid (21%), mesenteric infiltration (26%), or associated injuries (5%). In three of four patients who underwent nontherapeutic laparotomy, preoperative CT correctly imaged the limited abdominal injuries.     

Focused abdominal US in patients with trauma

PURPOSE: To evaluate the accuracy of focused abdominal ultrasonography (US) in detecting abdominal injuries that require in-hospital patient treatment in the setting of blunt abdominal trauma. MATERIALS AND METHODS: One thousand ninety patients with blunt abdominal trauma were assessed with focused abdominal US within 30 minutes of arrival at the hospital. Focused abdominal US results were positive if intra- or retroperitoneal fluid was detected. Patients with negative US results and no other major injuries were observed in the emergency department for 12 hours before discharge. Patients who deteriorated clinically after negative initial US underwent repeat US and/or emergency abdominopelvic computed tomography (CT). Patients with positive or indeterminate US results underwent emergency abdominopelvic CT. RESULTS: Nine hundred seventy-four (89%) patients had negative focused abdominal US results; eight of these underwent CT. Sixty-six (6%) had positive US results. Four (0.4%) had false-negative and 19 (1.7%) had false-positive US results. Twenty-seven (2.5%) had indeterminate US results; of these, five (18.5%) had positive CT results. One hundred twenty-four (11.4%) required emergency CT. After indeterminate cases were excluded, focused abdominal US had 94% sensitivity, 98% specificity, 78% positive predictive value, 100% negative predictive value, and 95% accuracy. CONCLUSION: Focused abdominal US has a high negative predictive value for major abdominal injury in patients with blunt abdominal trauma.     

CT detection of hepatic and splenic injuries: usefulness of liver window settings

OBJECTIVE. This study was designed to assess the usefulness of liver window settings when performing abdominal CT for the detection and characterization of hepatic and splenic injuries. SUBJECTS AND METHODS. We prospectively evaluated helical abdominal CT scans for hepatic and splenic injuries in 300 consecutive patients with blunt abdominal trauma over a 4-month period. There were 204 males and 96 females with a mean age of 34 years (age range, 1-87 years). For each patient, initial CT diagnosis of hepatic or splenic injury was made from images obtained with standard abdominal window settings. CT scans were then immediately reinterpreted using additional images obtained at narrow window width (liver windows). Changes in conspicuity and characterization of injury were recorded. All CT examinations were performed with helical 7-mm collimation at a pitch of 1.5 after oral ingestion of diluted barium and during bolus IV administration of 125 mL of ioversol at a rate of 2-3 mL/sec. RESULTS. We detected hepatic or splenic injuries in 34 patients (11.3%). There were 19 hepatic injuries and 18 splenic injuries. Three patients had injuries to both liver and spleen. Conspicuity of hepatic or splenic injuries was mildly increased (+1 H) on liver windows in 16 patients, whereas the injury was equally conspicuous on both liver window and standard window images in 19 cases. In no case did review of the liver windows result in a change in grade of injury or reveal an injury that was not seen on standard abdominal window images. The total increased cost for printing liver windows was $5748. CONCLUSION. Routine use of liver window settings for abdominal CT in trauma patients has little clinical usefulness and is not cost-effective.     

急诊床旁超声在腹部脏器闭合性损伤诊断中的应用价值

目的 探讨急诊床旁超声检查对腹部闭合性损伤的诊断应用价值.方法 应用便携式超声仪对184例外伤患者行急诊床旁超声检查,观察腹部脏器声像图有无异常改变,并重视观察腹腔内有无游离液体及气体.结果 超声诊断总符合率91.8%(169/184),其中单脏器损伤156例,符合率95.5%(149/156),多脏器损伤28例,符合率71.4%(20/28),漏诊21例,误诊3例,漏、误诊率13%(24/184).手术治疗119例;保守治疗65例,经CT、MRI检查及临床保守治疗证实.结论 急诊床旁超声检查对腹部闭合性损伤的诊断符合率高,为临床提供迅速、可靠的诊断信息.     

急诊床旁超声在腹部脏器闭合性损伤诊断中的应用价值

目的 探讨急诊床旁超声检查对腹部闭合性损伤的诊断应用价值.方法 应用便携式超声仪对184例外伤患者行急诊床旁超声检查,观察腹部脏器声像图有无异常改变,并重视观察腹腔内有无游离液体及气体.结果 超声诊断总符合率91.8%(169/184),其中单脏器损伤156例,符合率95.5%(149/156),多脏器损伤28例,符合率71.4%(20/28),漏诊21例,误诊3例,漏、误诊率13%(24/184).手术治疗119例;保守治疗65例,经CT、MRI检查及临床保守治疗证实.结论 急诊床旁超声检查对腹部闭合性损伤的诊断符合率高,为临床提供迅速、可靠的诊断信息.     

急诊床旁超声在腹部脏器闭合性损伤诊断中的应用价值

目的 探讨急诊床旁超声检查对腹部闭合性损伤的诊断应用价值.方法 应用便携式超声仪对184例外伤患者行急诊床旁超声检查,观察腹部脏器声像图有无异常改变,并重视观察腹腔内有无游离液体及气体.结果 超声诊断总符合率91.8%(169/184),其中单脏器损伤156例,符合率95.5%(149/156),多脏器损伤28例,符合率71.4%(20/28),漏诊21例,误诊3例,漏、误诊率13%(24/184).手术治疗119例;保守治疗65例,经CT、MRI检查及临床保守治疗证实.结论 急诊床旁超声检查对腹部闭合性损伤的诊断符合率高,为临床提供迅速、可靠的诊断信息.     

The role of arterial embolization in blunt splenic injury

Purpose

The aim of study was to evaluate the results of our experience with transarterial embolization based on a modified algorithm in patients with splenic injury.

Materials and methods

We collected data of patients admitted to our hospital from January 2006 to August 2008 for blunt splenic injury. During this period, 46 patients were admitted for splenic trauma, of whom 17 were treated surgically, 15 conservatively and 14 with percutaneous embolisation (13 men, mean age 44.8, mean injury severity score 18.5, six with grade IV and eight with contrast blush). Patients in shock were referred for laparotomy and splenectomy, whereas those who were haemodynamically stable or responsive to fluid resuscitation were further evaluated with computed tomography (CT). In the presence of imaging evidence of splenic injury ranging from grade I to grade III (n=15) a conservative approach was adopted, whereas haemodynamically unstable patients with grade V injury (n=17) were treated with splenectomy. Embolisation was performed in 14 patients with grade IV injury or in the event of contrast extravasation, regardless of injury grade. In patients with diffuse organ damage, we embolised the main splenic artery, whereas in the case of localised injury, embolisation was selective.

Results

Proximal embolization was required in eight cases and distal coil embolization in six. In 13 cases, we placed magnetic-resonance-compatible coils 4?C6 mm in diameter; only one patient was treated with gel-foam injection. Immediate technical success was achieved in all cases. In 13/14 patients (92.9%), no periprocedural complications were observed, whereas the remaining patient underwent splenectomy within 24 h due to recurrent bleeding.

Conclusions

On the basis of our algorithm, it is possible to reach a quick decision on the most appropriate treatment for patients presenting with blunt abdominal trauma, and splenic artery embolization seems to offer a reliable option in those with high-grade splenic injury or active bleeding.     

Pearls and pitfalls of hepatobiliary and splenic trauma: what every trauma radiologist needs to know

With the universal acceptance of contrast-enhanced computed tomography (CT) as the imaging modality of first resort in the assessment of blunt abdominal injury, the trauma radiologist must be able to accurately and rapidly identify the range of CT manifestations of the traumatized abdomen. In this article, we lay out the fundamental principles in CT interpretation of blunt trauma to the hepatobiliary system and spleen, including vascular injury, with a focus on technical and interpretive pearls and pitfalls. This review will help radiologists and trainees become more familiar with key aspects of abdominal CT trauma protocol selection, CT-based solid organ injury grading, and the various appearances and mimics of hepatobiliary and splenic injury.     

The role of follow-up imaging in paediatric blunt abdominal trauma

AIM: To assess the role of follow-up imaging in paediatric blunt abdominal trauma. METHOD: All children who underwent CT scanning of their abdomen at our institution following acute blunt injury between January 1997 and December 2000 were included in the study. Case notes where researched for details regarding mechanism of injury, initial clinical presentation, acute management, complications and follow-up until discharge. Reports of imaging investigations were retrieved from the RIS database. RESULTS: In the study period 75 children underwent CT scanning of their abdomen as a primary investigation for acute blunt abdominal trauma. Of these, 12 were normal, 52 showed evidence of intra-abdominal organ injury and 11 showed findings other than abdominal organ injury. Of the 52 children that sustained intra-abdominal organ injury, 48 (92 percent) were treated conservatively. 4 (8 percent) underwent emergency surgery, 3 for bowel injury and 1 for renal trauma. Of the 48 that were treated conservatively, 9 had a complicated clinical course with 7 showing complications on follow-up imaging. The remaining 39 children had an uneventful clinical course with follow-up imaging by CT or US in 34. None showed complications that required a change in management. CONCLUSION: In our series, follow-up imaging did not contribute to further management in children with an uncomplicated clinical course following blunt abdominal trauma.     

Blunt abdominal trauma: utility of 5-minute delayed CT with a reduced radiation dose

PURPOSE: To retrospectively evaluate the utility of 5-minute delayed computed tomography (CT) of the abdomen and pelvis by using a reduced radiation dose in patients with blunt abdominal trauma. MATERIALS AND METHODS: Institutional review board consent was obtained, and written informed consent was waived. The study was HIPAA compliant. A total of 662 patients (497 men, 165 women; mean age, 40.5 years; range, 18-94 years) were identified who were evaluated with CT after blunt abdominal trauma during a 1-year period. Delayed CT scans were acquired 5 minutes after intravenous contrast material injection by using a decreased tube current of 100 mAs. Injury was identified in 106 patients. Two radiologists blinded to initial CT scan interpretation reviewed these cases to determine the quality and utility of delayed scans. Disagreement was settled by consensus. Delayed scans were considered useful when they aided in (a) characterizing initial CT findings, (b) identifying findings not present at initial CT, (c) excluding injury suggested at initial CT, and (d) increasing reader confidence with regard to initial CT findings. RESULTS: All delayed scans were diagnostic. Delayed scans were useful in 27% (12 of 44) of patients with solid organ injury, 5.9% (one of 17) of patients with bowel or mesenteric injury, 4.5% (one of 22) of patients with pelvic fractures, and in none of the patients with free fluid only. Overall, delayed CT was useful in 2.1% (14 of 662) of all patients (95% confidence interval: 1.0, 3.2) referred for evaluation following blunt abdominal trauma. Utility increased to 13.2% (14 of 106) (95% confidence interval: 6.8, 19.7) in the group of patients with injury or suspected of having injury after initial CT. CONCLUSION: If delayed CT scans are acquired when patients with blunt abdominal trauma are evaluated, selective, rather than routine, acquisition is recommended and a reduced radiation dose seems adequate.     

Blunt bowel and mesenteric trauma: role of clinical signs along with CT findings in patients’ management

Background

Bowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair.

Material and methods

Between March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists. We included all adult patients who underwent contrast-enhanced CT of the abdomen and pelvis with CT findings of blunt bowel and/or mesenteric injury (BBMI). We divided CT findings into two groups: the first included three highly specific CT signs and the second included six less specific CT signs indicated as “minor CT findings.” The presence of abdominal guarding and/or abdominal pain was considered as “clinical signs.” Reference standards included surgically proven BBMI and clinical follow-up. Association was evaluated by the chi-square test. A logistic regression model was used to estimate odds ratio (OR) and confidence intervals (CI).

Results

Thirty-four (4.1%) out of 831 patients who sustained blunt abdominal trauma had BBMI at CT. Twenty-one out of thirty-four patients (61.8%) underwent surgical repair; the remaining 13 were treated conservatively. Free fluid had a significant statistical association with surgery (p?=?0.0044). The presence of three or more minor CT findings was statistically associated with surgery (OR?=?8.1; 95% CI, 1.2–53.7). Abdominal guarding along with bowel wall discontinuity and extraluminal air had the highest positive predictive value (100 and 83.3%, respectively).

Conclusion

In patients without solid organ injury (SOI), the presence of free fluid along with abdominal guarding and three or more “minor CT findings” is a significant predictor of early surgical repair. The association of bowel wall discontinuity with extraluminal air warrants exploratory laparotomy.

     

Using contrast-enhanced helical CT to visualize arterial extravasation after blunt abdominal trauma: incidence and organ distribution.

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.