Association between contrast extravasation on computed tomography scans and pseudoaneurysm formation in pediatric blunt splenic and hepatic injury: A multi-institutional observational study

J Pediatr Surg. 2020 Apr;55(4):681-687. doi: 10.1016/j.jpedsurg.2019.07.005. Epub 2019 Jul 15.


Purpose: We aimed to examine the association between contrast extravasation (CE) on initial computed tomography (CT) scan and pseudoaneurysm (PSA) development in pediatric blunt splenic and/or liver injury.

Methods: We conducted a multi-institutional retrospective study in cases of blunt splenic and/or hepatic injury who underwent an initial attempt of nonoperative management. A logistic regression model was used to compare PSA formation and CE on initial CT scan, and the area under the receiver operating characteristic curve (AUC) with and without CE was used to assess the predictive performance of CE for PSA formation.

Results: Of 236 cases enrolled from 10 institutions, PSA formation was observed in 17 (7.2%). Multivariate analysis showed a significant association between CE on initial CT scan and increased incidence of PSA formation (odds ratio, 4.96; 95% confidence interval, 1.37-18.0). There was no statistically significant association between the grade of injury and PSA formation. The AUC improved from 0.75 (0.64-0.87) to 0.80 (0.70-0.91) with CE.

Conclusion: Active CE on initial CT scan was an independent predictor of PSA formation. Selective use of follow-up CT in children who showed CE on initial CT may provide early identification of PSA formation, regardless of injury grade.

Level of evidence: Prognostic and epidemiological, level III.

Keywords: CT blush; Contrast extravasation; Pediatric trauma; Pseudoaneurysm; Spleen and liver injury.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adolescent
  • Aneurysm, False / epidemiology*
  • Aneurysm, False / etiology
  • Child
  • Child, Preschool
  • Cohort Studies
  • Extravasation of Diagnostic and Therapeutic Materials / epidemiology*
  • Female
  • Humans
  • Incidence
  • Japan / epidemiology
  • Liver / injuries*
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Prognosis
  • Retrospective Studies
  • Spleen / injuries*
  • Tomography, X-Ray Computed / adverse effects*