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Fri Oct 6 21:35:17 BST 2006

Contrast blush on CT is indicative of active extravasation OR Pseudo
aneurism......sounds like this patient has the latter with drop in Hct
and development of new symptoms after NOM.......  SAE Vs splenectomy
should be highly considered.....give vaccines now...
good luck
juan

Juan C Duchesne, M.D.
University of Mississippi Medical Center
Assistant Professor of Surgery/Trauma and Critical Care
2500 North State Street
Jackson MS 39216
>>> pbjorn at emh.org 10/06/06 11:18 AM >>>
Adult female MVC.  Left rib fx's 10-12, known splenic inj, read as Grade
I in spite of contrast blush (not intended as the thrust of this
thread).  

The patient was admitted for two nights, stable throughout, and
discharged with her cooperation and enthusiasm.  She was prescribed
house arrest for a week, drastically limited activity, and an office
visit to follow.

As fate would have it, on post-injury day 6 she suffered a sudden sharp
LUQ pain with what sounds like a brief vagal response.  She reported
immediately to her local ED, where another CT shows both a persistent
blush plus intraperitoneal hemorrhage (second image).  

At the local hospital, vitals were stable (she was in fact hypertensive
consistent with her medical history) and her labs were unremarkable (H&H
12 and 35, roughly identical to previous discharge numbers).  She was
admitted to the local hospital for observation, but her counts slipped
overnight (10 & 27), and so she was transferred back to us.  She arrives
stable and without any major complaints.  Even a little hungry.

Interested in what others would plan for her.  Observe?  Coil?  Both?
Other?

Pret Bjorn, RN

 <<FirstImage.jpg>>  <<SecondImage.jpg>> 

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