CC BY-NC-ND 4.0 · Ultrasound Int Open 2018; 04(01): E30-E34
DOI: 10.1055/s-0043-125311
Original Article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2018

Spontaneous and Traumatic Splenic Rupture: Retrospective Clinical, B-Mode and CEUS Analysis in 62 Patients

Spontane und traumatische Milzruptur: Retrospektive Analyse klinischer, B-Bild und CEUS-Daten bei 62 Patienten
M. Rosling
3   Interdisziplinäre Ultraschallzentrum, Universitätsklinikum Gießen und Marburg, Philipps Universität Marburg
,
C. Trenker
1   Klinik für Hämatologie, Onkologie, Immunologie, Universitätsklinikum Gießen und Marburg, Philipps Universität Marburg
,
A. Neesse
2   Klinik für Gastroenterologie und gastrointestinale Onkologie, Universitätsklinikum Göttingen
,
C. Görg
3   Interdisziplinäre Ultraschallzentrum, Universitätsklinikum Gießen und Marburg, Philipps Universität Marburg
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 08. September 2017
revised 11. November 2017

accepted 06. Dezember 2017

Publikationsdatum:
04. April 2018 (online)

Abstract

Introduction Both B-mode ultrasound and contrast-enhanced ultrasound (CEUS) are well established procedures when diagnosing traumatic splenic ruptures (TSR). To date, there are no data about CEUS patterns in spontaneous splenic ruptures (SSR). It remains unknown whether TSR and SSR differ with respect to clinical characteristics, B-mode and CEUS characteristics.

Patients and Methods Between 12/2003 and 2/2010, n=33 SSRs and n=29 TSRs were diagnosed in a tertiary referral center. All patients were examined with B-mode and CEUS, and clinical data and the outcome were retrospectively analyzed.

Results Patients with SSR were significantly older than patients with TSR (62 years vs. 44 years; p=0.01). The 4-week mortality was significantly higher in SSR than in TSR (36% vs. 0%; p=0.001). No differences between the grading of TSR and SSR could be shown in B-mode or in CEUS. Notably, CEUS was significantly superior to B-mode with respect to the grading of splenic ruptures (p=0.01). Therefore, therapeutic management was influenced by CEUS.

Conclusion There are differences between SSR and TSR, especially concerning clinical data (age, course of disease and mortality). Regarding the sonographic pattern, SSR and TSR show identical grading. When splenic rupture is suspected, CEUS should always be performed to identify patients at risk who require interventional procedures.

 
  • References

  • 1 Tinkoff G, Esposito TJ, Reed J. et al. American association for the surgery of trauma organ injury scale I: Spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg 2008; 207: 646-655
  • 2 Cölle J. Die spontane, nicht traumatische Milzruptur: Klinik, sonographisches Befallsmuster und Verlauf. Dissertation, Phillips-Universität Marburg 2003;
  • 3 Weaver H, Kumar V, Spencer K. et al. Spontaneous splenic rupture: A rare life-threatening condition; Diagnosed early and managed successfully. Am J Case Rep 2013; 14: 13-15
  • 4 Wehbe R, Raffi S, Osborne D. Spontaneous splenic rupture precipitated by cough: a case report and a review of the literature. Scand J Gastroenterol 2008; 43: 634-637
  • 5 Piscaglia F, Nolsoe C, Dietrich CF. et al. The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): Update 2011 on non-hepatic applications. Ultraschall Med 2012; 33: 33-59
  • 6 Görg C, Cölle J, Görg K. et al. Spontaneous rupture oft the spleen: ultrasound patterns, diagnosis and follow-up. Br J Radiol. 2003; 76: 704-711
  • 7 Schwerk WB, Görg C. Splenic injury: Sonographic investigation. Bildgebung 1991; 58: 199-204
  • 8 American College of Surgeons Committee on Trauma. Advanced Trauma Life Support for Doctors, Student Course Manual (ATLS). 8th Edition 2008. Chicago: American College of Surgeons; 111-126
  • 9 Smith J, Caldwell E, D'Amours S. et al. Abdominal trauma: a disease in evolution. ANZ J Surg 2005; 75: 790-794
  • 10 Sterlacci W, Heiss S, Augustin F. et al. Splenic rupture, beyond and behind: A histological, morphometric and follow-up study of 254 cases. Pathobiology 2006; 73: 280-287
  • 11 Cokkinos D, Antypa E, Stefanidis K. et al. Contrast-enhanced ultrasound for imaging blunt abdominal trauma – indications, description of the technique and imaging review. Ultraschall Med. 2012; 33: 60-67
  • 12 Catalano O, Lobianco R, Sandomenico F. et al. Splenic trauma: evaluation with contrast-specific sonography and a second-generation contrast medium: Preliminary experience. J Ultrasound Med. 2003; 22: 467-477
  • 13 Gheju I, Venter MD, Beuran M. et al. Grade IV blunt splenic injury-the role of proximal angioembolization. A case report and review of literature. J Med Life 2013; 6: 369-375
  • 14 Görg C, Cölle J, Wied M, Schwerk WB, Zugmaier G. Spontaneous nontraumatic intrasplenic Pseudoaneurysma: Causes, sonographic diagnosis, and prognosis. JCU 2003; 31: 129-134