Imaging abdomen trauma spleenic trauma part 3 dr ahmed esawy blunt abdominal trauma penetrating abdominal trauma fast abdominal ultrasound haemoperitoneum pneumoperitoneum american association of surgeon in trauma AAST SUBCAPSULAR HAEMATOMA PARENCHYMAL LACERATION SPLENIC RUPTURE SPLENIC CONTUSION

3. 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 .

4. Grade I :
- Subcapsular hematoma of less than 10% of surface area
- Capsular tear of less than 1 cm in depth

5. 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

6. 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

7. Grade IV
Laceration involving segmental or
hilar vessels with devascularization of
more than 25% of the spleen

8. Grade V
Shattered spleen or hilar vascular injury.

9. 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.

10. 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

11. Spleen, trauma. Contrast-enhanced CT scan of
the abdomen shows a complex lower pole splenic
laceration. This is a grade II injury.

12. Spleen, trauma. Contrast-enhanced CT scan of the abdomen shows a
complex laceration extending to the hilum. This is a grade IV injury.

13. This CT shows a contained splenic hematoma. This was treated by
observation and gradually resolved over several weeks

14. The splenic hematoma seen in Figure 2 has now
largely resolved, without surgery

15. SPLENIC RUPTURE WITH
HEMOPERITONEUM

16. 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

17. 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.

18. • 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.

19. 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.

20. 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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