- Spleen is the most commonly injured abdominal organ in blunt trauma
- 40% of rib fractures are associated with splenic injuries
- 40% of splenic injuries are associated with rib fractures
- Splenic lacerations are seen as an area of low attenuation on contrast enhanced CT scan
- Most of the splenic injuries are managed surgically
Notes:
Spleen is the 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
