CT diagnosis of pancreatic injury in children: significance of fluid separating the splenic vein and the pancreas.

OBJECTIVE: The purpose of our study was to evaluate the relationship of fluid between the splenic vein and the pancreas to fluid in the anterior pararenal space in children following blunt trauma and to assess the usefulness of detecting fluid separating the splenic vein and the pancreas in the CT diagnosis of pancreatic injury in children.

MATERIALS AND METHODS: Twenty-five of 1725 consecutive children who underwent abdominal CT following blunt trauma had surgically or autopsy-proven pancreatic injury or clinical pancreatitis. An additional 29 children who underwent CT for evaluation of blunt trauma did not have pancreatic injury and were prospectively noted to have fluid in the anterior pararenal space. CT findings (visceral injury or intraperitoneal or extraperitoneal fluid) were recorded at the time of initial interpretation in all children. The CT scans of these 54 children were reviewed for the presence of fluid separating the splenic vein and the pancreas.

RESULTS: Fluid separating the splenic vein and the pancreas was noted in 15 (60%) of 25 children with pancreatic injury and in 14 (48%) of 29 children who had fluid in the anterior pararenal space without pancreatic injury. In 14 of 15 children with pancreatic injury and fluid between the splenic vein and the pancreas, additional collections of peripancreatic fluid (anterior pararenal space or lesser sac) were also noted. In another four children with pancreatic injury, additional collections of peripancreatic fluid were noted in the absence of fluid between the splenic vein and the pancreas.

CONCLUSION: Fluid separating the splenic vein and the pancreas on CT scans is a nonspecific finding usually associated with fluid in the anterior pararenal space. Although it may be seen in conjunction with pancreatic injury, it is rarely the only abnormal CT finding in such an injury.