splenic injury

Spleen is most commonly injured solid abdominal organ. Most often due to blunt trauma and often (30-60%) associated with other organ injuries. 25% of left renal injury and 20% of left rib fractures are associated with splenic injury. 40% of splenic lacerations are associated with rib fractures. 20% of splenic injuries occur during surgical procedures. Spontaneous rupture can occur in an abnormal spleen, like in infectious mononucleosus or malaria. Subcapsular hematoma is seen as cresentic/lentiform low attenuation. Parenchymal lacerations are seen as irregularly low attenuation areas. Fracture is seen as complete seperation. Disruption of the capsule causes intraperitoneal hemorrhage. Late complications include splenic pseudocyst.

Grading:
Grade 1 – Minor subcapsular tear or haematoma
Grade 2 – Parenchymal injury not extending to the hilum
Grade 3 – Major parenchymal injury involving vessels and hilum
Grade 4 – Shattered spleen

Management:
Isolated grade 1 and 2 are suitable for conservative management. The patients with cardiovascular instability need surgery, which include repair, spleen conservation surgery (at least 20% of spleen is preserved) and splenectomy. Approximately 30% fail conservative management.

References:
Roberts JL et al. CT in abdominal and pelvic trauma. RadioGraphics 1993; 13: 735

IMAGE GALLARY:

Patient 1:
Splenic contusion, capsular breech with minimal perisplenic lacerations:

Patient underwent splenectomy.

Patient 2:
Large splenic contusion, capsular breech and large perisplenic collection.

Managed conservatively.
Follow-up ultrasound with microbubble shows a small area of infarct


Patient 3: Massive splenic injury