reimaging the spleen

[SJASMD at aol.com]

In a message dated 12/1/2007 3:20:24 P.M. W. Europe Standard Time,  
rfsmithmd at comcast.net writes:

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


Rob
in 1979, when we started doing nonoperative management of splenic injuries  
using angiography as our triage criteria for need for hemostasis, it was  
somewhat difficult to get the patients in the scanner. We only had one, it  wasn't 
in the ED, etc
 
We were quite concerned about sending patients with untreated splenic  
injuries home so we Kept patients  in the hospital until CT showed healing  of the 
injury. We also performed angiography on many patients while they awaited  
discharge 3-8 weeks after their injury.
 
We noted fairly soon that the CT appearance of the spleen looked worse at  
two weeks but that most patients were pretty much healed by six weeks.
 
i think it was very interesting we never saw a false aneurysm when we  
repeated angiography or CT in patients who were managed by bedrest alone,  without 
embolization. Perhaps the extravasation that we saw on angio (our  criteria for 
embolization) was effectively managed by embolization and limited  the 
incidence of false aneurysms caused by nonoperative management. 
 
I guess we triaged patients at risk for development of false  aneurysm to 
embolization and thus never saw it.
 
Obviously we could never duplicate our practice in the 1980s in our current  
environment.   We progressively liberalized discharge until now we  send home 
uncomplicated patients with CT diagnosed splenic injuries based  on admission 
angio very early.
 
At this time, we do not do followup CT as a rule. I guess we just arent  
worried about false aneurysms if we treated them with embolization. I don't  think 
that CT can tell us whether solid healing has occurred anyway. I recommend  a 
six month hiatus before resuming the type of physical activity that caused 
the  injury. No evidence
 
 
 
sal



**************************************Check out AOL's list of 2007's hottest 
products.
(http://money.aol.com/special/hot-products-2007?NCID=aoltop00030000000001)