Splenic Injury

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Blunt trauma to the upper abdomen most commonly results in injury to the spleen. The injury can result in a subcapsular hematoma, parenchymal laceration, or a even a complete rupture. A subcapsular hematoma commonly appears as a crescent shaped hypodense collection of fluid (blood) that compresses the lateral margin of the spleen. A splenic laceration appears as an irregular linear or wedge shaped hypodense defect in the border of the spleen with free blood within the peritoneum (with or without an associated subcapsular hematoma). A ruptured spleen results in extravasation of intravenous contrast material into the splenic parenchyma.

Clinical Information

12 year female sustained blunt trauma to left upper quadrant.

CT Findings

Complex Grade IV splenic injury with multiple large fractures through the splenic parenchyma.
Large peripheral subcapsular hematoma around the superior and lateral aspects of the spleen.
High density material within the main central laceration consistent with contrast extravasation indicating a small amount of active bleeding.
Free fluid throughout the abdomen and pelvis consistent with blood.

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AAST organ injury scale for splenic injuries – modified CT version (Federle et al 1998)

Grade	Injury	Description
I	Hematoma	Subcapsular, nonexpanding, <10% surface area
	Laceration	Capsular tear, nonbleeding, <1cm parenchymal depth
II	Hematoma	Subcapsular, nonexpanding, 10-15% surface area Intraparenchymal, <2cm diameter, nonexpanding
	Laceration	Capsular tear, active bleeding, 1-3cm parenchymal depth
III	Hematoma	Subcapsular, >50% surface area or expanding Ruptured subcapsular hematoma with active bleeding Intraparenchymal, >2cm diameter or expanding
	Laceration	>3cm parenchymal depth
IV	Hematoma	Ruptured intraparenchymal hematoma with active bleeding
	Laceration	Involving segmental or hilar vessels producing devascularization >25%
V	Laceration	Shattered spleen
	Vascular	Hilar vascular injury that devascularizes spleen

Advance one grade for multiple injuries to same organ up to grade III


Source: Prokop, M & Galanski, M (2003) ‘Spiral and multislice computed tomography of the body’, Thieme, Stuttgart, p510.