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Sat Dec 1 13:27:43 GMT 2007

I generally do an ultrasound after 4-6 weeks.  It is
certainly less sensitive, but hopefully will pick up a
large lesion.  

Also, a CT scan is expensive and has a risk of
contrast nephropathy.  In my practice, a large
percentage of patients are older than 50 yrs (one
recent patient I had was an 83 years old grandma on an
ATV) and I feel concerned if someone orders a CT
without individualizing the decision.  As far as I
know, the literature is very ambivalent, but most
studies indicate that an imaging is probably not
needed.  

Sanjay

--- Ronald Simon <Traumamd at nyc.rr.com> wrote:

> I have always re imaged the spleen to prove healing.
> Once healed, nl 
> activity can be pursued. I always believed the
> injured spleen was more 
> susceptible to injury. Now with CT and angio, i
> don't worry about 
> delayed ruptures. I think these were just missed
> pseudoaneurysms that we 
> now catch. If one does not rescan, how to you advise
> a patient with a 
> grade 3 or 4 liver injury as far as returning to nl
> activities?
> ron simon
> 
> Robert F. Smith wrote:
> > For those who advocate rescanning, what is it that
> they need to see that the
> > presence of would make them confident that it's OK
> to take a helmet in the
> > gut and the absence would let them know it was
> unsafe?
> >
> > Rob Smith
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]
> > On Behalf Of caesar ursic
> > Sent: Friday, November 30, 2007 12:43 PM
> > To: Trauma &amp, Critical Care mailing list
> > Subject: Re: BIG NEWS - CT Causes Leukemia ?
> >
> > Ron, I did get your original post and responded
> (indirectly) above.  I think
> > I'm going to have to go back and re-read all the
> studies to convince myself
> > that the preponderance of evidence does (or does
> not?) truly support
> > re-scanning asymptomatic spleens after discharge. 
> I'll be surprised if it
> > is the latter.
> >
> > My own (and I suspect others') motivation in
> obtaining these scans is to
> > diagnose the occasional 'silent' post-traumatic
> intrasplenic pseudoaneurysm
> > that can suddenly rupture and bleed, as well as to
> 'document' early and
> > ongoing healing and resolution of hematomas, etc. 
> I suppose that ultrasound
> > can be used for this, but that its sensitivity is
> way below that of CT's. I
> > do remember reading posts by at least one other
> regular contributor to this
> > list ("Don' Think You Are, Know You Are
> -Morpheus") who routinely performs
> > surveillance angiography on the injured spleen for
> this very reason.
> >
> > Karim Brohi, what do you do at the Royal London
> Hospital?
> >
> > CM Ursic
> > Santa Fe, NM, USA
> >
> >
> >
> > On 11/30/07, Ronald Gross <Rgross at harthosp.org>
> wrote:
> >   
> >> Ceasar,
> >>
> >> I am puzzled as to why my posts haven't been
> getting through.  What I
> >> did say was that I do not scan and I do not allow
> the kids to return to
> >> contact sports until the FOLLOWING season.  I
> have not as yet heard from
> >> any others on the list as to their
> opinions/practices.
> >>
> >> Ron
> >>
> >>
> >>     
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> >   
> > begin:vcard
> fn:Ronald Simon, MD
> n:;Ronald Simon, MD
> org:Bellevue Hospital Center
> adr;dom:;;550 First Avenue NBV-15S5;New
> York;NY;10016
> title:Director of Trauma and Surgical Critical Care
> tel;work:212-263-5751
> version:2.1
> end:vcard
> 
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Sanjay Gupta MD
Tel: 412 335 6304

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reimaging the spleen