reimaging the spleen

Sat Dec 1 14:17:44 GMT 2007

If I were the treating physician, re-imaging would seem like a reasonable
and prudent thing to do before sending the kid back into sport combat. Maybe
Dr. Sclafani could better speak to my philosophical misgivings, but it seems
to me in general imaging is for locating the source of pathology, not
conveying functional health. Plus I think it would be hard in humans to
prove what finding was the dividing line between "safe" and "not safe".

Rob Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Sanjay Gupta MD
Sent: Saturday, December 01, 2007 8:28 AM
To: Trauma &amp, Critical Care mailing list
Subject: Re: reimaging the spleen

I generally do an ultrasound after 4-6 weeks.  It is
certainly less sensitive, but hopefully will pick up a
large lesion.  

Also, a CT scan is expensive and has a risk of
contrast nephropathy.  In my practice, a large
percentage of patients are older than 50 yrs (one
recent patient I had was an 83 years old grandma on an
ATV) and I feel concerned if someone orders a CT
without individualizing the decision.  As far as I
know, the literature is very ambivalent, but most
studies indicate that an imaging is probably not
needed.  

Sanjay

--- Ronald Simon <Traumamd at nyc.rr.com> wrote:

> I have always re imaged the spleen to prove healing.
> Once healed, nl 
> activity can be pursued. I always believed the
> injured spleen was more 
> susceptible to injury. Now with CT and angio, i
> don't worry about 
> delayed ruptures. I think these were just missed
> pseudoaneurysms that we 
> now catch. If one does not rescan, how to you advise
> a patient with a 
> grade 3 or 4 liver injury as far as returning to nl
> activities?
> ron simon
> 
> Robert F. Smith wrote:
> > For those who advocate rescanning, what is it that
> they need to see that the
> > presence of would make them confident that it's OK
> to take a helmet in the
> > gut and the absence would let them know it was
> unsafe?
> >
> > Rob Smith
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]
> > On Behalf Of caesar ursic
> > Sent: Friday, November 30, 2007 12:43 PM
> > To: Trauma &amp, Critical Care mailing list
> > Subject: Re: BIG NEWS - CT Causes Leukemia ?
> >
> > Ron, I did get your original post and responded
> (indirectly) above.  I think
> > I'm going to have to go back and re-read all the
> studies to convince myself
> > that the preponderance of evidence does (or does
> not?) truly support
> > re-scanning asymptomatic spleens after discharge. 
> I'll be surprised if it
> > is the latter.
> >
> > My own (and I suspect others') motivation in
> obtaining these scans is to
> > diagnose the occasional 'silent' post-traumatic
> intrasplenic pseudoaneurysm
> > that can suddenly rupture and bleed, as well as to
> 'document' early and
> > ongoing healing and resolution of hematomas, etc. 
> I suppose that ultrasound
> > can be used for this, but that its sensitivity is
> way below that of CT's. I
> > do remember reading posts by at least one other
> regular contributor to this
> > list ("Don' Think You Are, Know You Are
> -Morpheus") who routinely performs
> > surveillance angiography on the injured spleen for
> this very reason.
> >
> > Karim Brohi, what do you do at the Royal London
> Hospital?
> >
> > CM Ursic
> > Santa Fe, NM, USA
> >
> >
> >
> > On 11/30/07, Ronald Gross <Rgross at harthosp.org>
> wrote:
> >   
> >> Ceasar,
> >>
> >> I am puzzled as to why my posts haven't been
> getting through.  What I
> >> did say was that I do not scan and I do not allow
> the kids to return to
> >> contact sports until the FOLLOWING season.  I
> have not as yet heard from
> >> any others on the list as to their
> opinions/practices.
> >>
> >> Ron
> >>
> >>
> >>     
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> >   
> > begin:vcard
> fn:Ronald Simon, MD
> n:;Ronald Simon, MD
> org:Bellevue Hospital Center
> adr;dom:;;550 First Avenue NBV-15S5;New
> York;NY;10016
> title:Director of Trauma and Surgical Critical Care
> tel;work:212-263-5751
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Sanjay Gupta MD
Tel: 412 335 6304

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