What is the appropriate workup for splenic issues in an infant with heart failure?

From the Guidelines

Infants with heart failure and suspected splenic issues should undergo a thorough diagnostic workup, with a focus on non-invasive imaging techniques, such as ultrasonography (US) and complete abdominal US, to avoid the use of CT scans whenever possible.

Diagnostic Procedures

• The role of E-FAST in the diagnosis of pediatric spleen injury is still unclear 1, but a positive E-FAST examination in children should be followed by an urgent CT in stable patients 1.
• Complete abdominal US may avoid the use of CT in stable patients 1.
• Contrast-enhanced CT scan is the gold standard in pediatric splenic trauma, but should be used judiciously due to radiation exposure concerns 1.
• Doppler US and contrast-enhanced US are useful to evaluate splenic vascularization 1.

Non-Operative Management

• Non-operative management (NOM) is recommended as first-line treatment for hemodynamically stable pediatric patients with blunt splenic trauma 1.
• NOM should only be attempted in centers capable of precise diagnosis and intensive management, with immediate access to diagnostics, interventional radiology, and surgery 1.
• Patients with moderate-severe blunt and all penetrating splenic injuries should be considered for transfer to dedicated pediatric trauma centers after hemodynamic stabilization 1.

Angiography/Angioembolization

• The vast majority of pediatric patients do not require AG/AE for CT blush or moderate to severe injuries 1.
• AG/AE may be considered in patients undergone to NOM, hemodynamically stable with signs of persistent hemorrhage not amenable of NOM, regardless the presence of CT blush once excluded extra-splenic source of bleeding 1.

From the Research

Diagnostic Approach

• The diagnostic approach for splenic issues in an infant with heart failure may involve imaging studies, such as ultrasound or CT scans, to assess spleen tissue elasticity and viscosity 2.
• Shear wave elastography (SWE) and shear wave dispersion (SWD) can be used to quantify tissue quality and predict adverse cardiac events 2.
• Laboratory tests, such as platelet counts, can also be used to predict splenic infarction in cases of splenic torsion 3.

Management Options

• Nonoperative management of neonatal splenic rupture is a viable option, with close monitoring and follow-up imaging to document healing 4.
• Embolization can be considered as an alternative to splenectomy when observation fails in cases of pediatric blunt splenic injury 5.
• Splenectomy may be necessary in some cases, such as splenic torsion or infarction, but spleen-preserving surgery should be considered when possible 3.

Clinical Considerations

• Splenic hemorrhage can be a cause of acute neonatal compromise, even in the absence of birth-related trauma, and should be considered in the differential diagnosis of neonatal cardiorespiratory instability 6.
• The interaction between the heart and spleen plays a crucial role in heart failure, and spleen shear wave elastography and dispersion can be used to stratify prognosis in patients with heart failure 2.