Gastrointestinal Imaging: Case Review Series, 2nd Edition by Robert D. Halpert

By Robert D. Halpert

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The patient shown in this case is a young man involved in a motor vehicle accident with a grade III splenic injury. You will note several deep splenic tears (shattered spleen) with both intra- and extrasplenic bleeding. Although there is intrasplenic segmental arterial injury, the splenic hilum and splenic artery are intact. There is bleeding in the upper abdomen around both the liver and spleen. The patient was successfully treated with vascular volume stabilization and splenic artery embolization.

However, the fact that the stalk permits the polyp to move with the patient, can occasionally make detection on both ACBE and CT quite difficult. The other two types are tubovillous adenomas and villous adenomas. Villous adenomas have the greatest risk for developing into a malignancy. Some researchers and clinicians consider a colonic villous adenoma a lowgrade malignancy regardless of what the histologic picture shows. 5 mm (diminutive polyps) have little or no malignant potential. Polyps 1 to 2 cm in size carry about a 10% risk.

Polyps come in at three histologically identifiable forms. The first, and most common (80%), is the tubular adenoma. These polyps are usually small and carry very little risk for malignant degeneration. They can be on long stalks (such as this case). However, the fact that the stalk permits the polyp to move with the patient, can occasionally make detection on both ACBE and CT quite difficult. The other two types are tubovillous adenomas and villous adenomas. Villous adenomas have the greatest risk for developing into a malignancy.

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