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.