jalal jalalshokouhi-m.d. [email protected] spleen trauma in adults
TRANSCRIPT
The spleen is the organ that is most frequentlyinjured by blunt abdominal trauma. The extentof the injury can range from subcapsularhemorrhage and parenchymal contusion, to aparenchymal laceration (with or without
capsular injury), or a complete splenic rupture.
The detection of a subcapsular hemorrhage is important
because there is the potential of a lifethreatening hemorrhage in the event of a capsular rupture.
Injury to the vascular pedicle leadsto splenic infarcts of variable extent. CT hasgreater than 95%sensitivity in the detection ofsplenic injuries and is indicated whenever
ultrasound findings are inconclusive.
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Even if a parenchymal defect cannot be
directly visualized, the detection of perisplenic
blood clots (so called sentinel clots,
patchy hyperattenuating structures with CT
numbers > 60 HU as compared to 35-45 HU
of a hemoperitoneum) provides an indirect
sign of parenchymal injury.
Faint focal hyperenhancing regions in anotherwise homogenous splenic parenchymamay be an indicator of laceration and are as-'sociated with an increased risk of delayedrupture. Strongly hyperenhancing regionssuggest a traumatic false aneurysm.Splenic laceration may be mimicked bybeam-hardening or streak artifacts due toribs, an air-contrast interface in the stomach,nasogastric tubes, or monitor material.
The streaks usually extent beyond the splenicparenchyma. Fissures in a lobulated spleenshould not be mistaken for a splenic lacerationor rupture.An over-distended stomach compressingthe medial border of the spleen may obscure asmall laceration.
Splenic artery aneurysm
Splenic hemorrhage
Hemorrhage and laceration, fracture
Peri-splenic hematoma or fluid and tear
Laceration and intra peritoneal fluid or hemorrhage
Intera peritoneal fluid or blood,splenic fracture
MRI of spleen fracture
Tumor or fracture
Infarction, tumor, rupture
Splenic explosion
Splenic fracture
Splenomegaly, partial tear, fluid and plural effusion
Splenic hematoma
Splenic fracture
Spleen
Pleural and pulmonary reactions during splenic rupture
