PSEUDOANEURYSM FORMATION AFTER TRAUMATIC HIGH GRADE SOLID ORGAN INJURIES: FORMIDABLE FOE OR HARMLESS RADIOGRAPHIC FINDING?

Objectives: Widespread utilization of CT scans for the work up of trauma patients has led to increasing diagnosis of post-traumatic findings such as pseudoaneurysm (PSA) formation. While relatively rare, PSAs can have devastating consequences if they rupture, which leads to life-threatening hemorrhagic shock. Evidence for early detection of traumatic PSAs is lacking. The objective of this study was to present a case series of PSAs from trauma patients in order to develop practice-based guidelines for surveillance.

Methods: A retrospective chart review of consecutive adult trauma patients from two American College of Surgeons accredited trauma centers (Level 1 and Level 2) was performed. The Trauma registry was queried for patients from 2012-2020 diagnosed with traumatic solid organ injuries defined on imaging as grade 3 or higher using the American Association for the Surgery of Trauma (AAST) guidelines.

Results: A total of 1,260 patients were identified with high grade (AAST 3 or higher) solid organ injuries with 47 of these patients (3.7%) having a PSA. Penetrating trauma encompassed 23.4% of patients diagnosed with PSAs. The majority of the PSAs were identified in the spleen (n=21, 44.7%), kidney (n=15, 31.9%), and liver (n=11, 23.4%). One patient had pseudoaneurysms in two separate organs. The median AAST grade of solid organ injury was 4 (range 3-5). An initial CT scan finding of contrast blush and/or extravasation was found in 33 patients (70.2%) with 36 patients (76.6%) ultimately undergoing IR embolization. Only 12 patients (25.5%) had an abdominal CTA for surveillance prior to discharge. Re-admission was required for 3 patients (6.4%) to observe or treat the PSA and 1 patient (2.2%) re-presented with a ruptured PSA.

Conclusion: This case series describes the incidence of PSAs over an eight-year period for both penetrating and blunt trauma patients from two trauma centers. During the study period, there was no consistency in surveillance guidelines for PSAs with a small percentage of patients requiring re-admission for further intervention. Future studies are needed to determine the best practice for surveillance of PSAs, including which patient population is at the highest risk.