SPLENIC TRAUMA

Splenic injury poses a potentially life-

threatening situation. This risk is true

especially because the spleen is the

organ most commonly injured when

thoraco-abdominal trauma occurs, and

splenic injuries represent

approximately 25% of all blunt injuries

to the abdominal viscera .

Grade I : - Subcapsular hematoma of less than 10% of surface area

- Capsular tear of less than 1 cm in depth

Grade II - Subcapsular hematoma of 10-50% of surface area

- Intraparenchymal hematoma of less than 5 cm in

diameter

- Laceration of 1-3 cm in depth and not involving

trabecular vessels

Grade III - Subcapsular hematoma of greater than 50% of surface area

or expanding and ruptured subcapsular or parenchymal

hematoma

- Intraparenchymal hematoma of greater than 5 cm or

expanding

- Laceration of greater than 3 cm in depth or involving

trabecular vessels

Grade IV

Laceration involving segmental or

hilar vessels with devascularization of

more than 25% of the spleen

Grade V Shattered spleen or hilar vascular injury.

Spleen, trauma. Contrast-enhanced CT scan of the abdomen shows perisplenic fluid

without identification of a laceration in a patient who sustained blunt abdominal trauma. A

large amount of pelvic fluid was seen, prompting laparotomy during which a small

laceration was found; this is not evident on the scan.

Spleen, trauma. Contrast-enhanced CT scan of the

abdomen shows a massive fluid collection in the upper

abdomen. This was a chronic subcapsular splenic

hematoma and a grade III injury

Spleen, trauma. Contrast-enhanced CT scan of

the abdomen shows a complex lower pole splenic

laceration. This is a grade II injury.

Spleen, trauma. Contrast-enhanced CT scan of the abdomen shows a

complex laceration extending to the hilum. This is a grade IV injury.

This CT shows a contained splenic hematoma. This was treated by

observation and gradually resolved over several weeks

The splenic hematoma seen in Figure 2 has now

largely resolved, without surgery

SPLENIC RUPTURE WITH

HEMOPERITONEUM

This CT scan done with intravenous and oral contrast demonstrates the

presence of splenic laceration (arrow head) with associated hemorrhage

contained within the subcapsular region of the spleen. Note the absence

of hemoperitoneum

ACTIVE BLEEDING INTO SUBCAPSULAR SPLENIC

HEMATOMA WITH HEMOPERITONEUM

• The single arrow points to

the subcapsular fluid

collection around the

spleen. The areas of high

attenuation adjacent to

the arrow demonstrate the

rare demonstration of

extravasated

intravenously

administrative contrast

material, and represents

the radiologic equivalent

of active bleeding.

• Fluid within the right

paracolic gutter is

compatible with

hemoperitoneum.

• splenic injury:

• US (A) shows small

perisplenic fluid collection

though the spleen appears

normal. Because of

persistence of symptoms,

• CT scan (B) was performed

eight days later. It shows a

splenic fracture with a well-

marginated hematoma.

Delayed splenic rupture • Bleeding due to splenic injury

occurring more than 48 h after

blunt trauma following an

apparently normal CT

examination

• Due to ruptures of subcapsular

splenic haematomas.

Contrast blush

• A contrast blush is defined as an area of high density with density measurements within 10 HU compared to the nearby vessel (or aorta).

• The differential diagnosis is: – Active arterial extravasation

– Post-traumatic pseudoaneurysm

– Post-traumatic AV fistula

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