Blush at first sight significance of computed tomographic and angiographic discrepancy in patients with blunt abdominal trauma

Background "Blush," defined as a focal area of contrast pooling within a hematoma, is frequently encountered in patients with severe blunt torso trauma. Contemporary clinical practice guidelines recommend the use of angiography with embolization in all hemodynamically stable patients with evidence of active extravasation. Patients presenting with blush visualized on computed tomography (CT), but not demonstrated on subsequent angiography, present a challenging clinical dilemma. The purpose of this study was to study the natural course of patients with this blush disparity between CT and angiography. Methods The study was conducted as a retrospective analysis of patients who underwent angiography after initial CT scans revealed blush after blunt abdominal trauma at a level I trauma center (January 2005 to December 2014). Results A total of 143 patients with blunt splenic injuries were found to have CT blush and underwent catheter angiography. Of the 143 patients with blush on CT, 24 (17%) showed no evidence of blush on angiography. Patients with CT-angiographic discrepancy were more than twice as likely to rebleed compared with those with angiographic evidence of blush (25% vs 10%, P