Splenic trauma
* Best imaging modality: Contrast-enhanced CT
* Imaging findings:
+ CT:
Contrast-enhanced
#1. Parenchymal laceration: Jagged, linear, or stellate hypodensity
#2. Subcapsular hematoma: oval, lenticular, or crescentic hypodensity closely approximated to spleen border; may compress lateral margin of parenchyma
#3. Splenic fracture: laceration extending from outer capsule through splenic hilum
# 4.Arterial injury: active extravasation (linear high attenuation focus (80-370 HU) isodense to aorta or within 10 HU of an adjacent artery) or pseudoaneurysm (rounded area of high attenuation contiguous with vessel on either side)
+ Non-enhanced:
hemoperitoneum (>30 HU), perisplenic clot (> 45 HU), sentinel clot adjacent to spleen, layered or lamellated clot if intermittent bleeding
+ American Association of the Surgery of Trauma (AAST) Classification of Splenic Injury+
Grade Laceration Hematoma
I < 1 cm deep , Subcapsular, <1 cm diameter
II 1-3 cm deep , Subcapsular or central, 1-3 cm diameter
III 3-10 cm deep ,Subcapsular or central, 3-10 cm diameter
IV >10 cm deep, Subcapsular or central, >10 cm diameter
V - Splenic tissue maceration or devascularization
Angiography: Active extravasation (amorphous "blush" of contrast), pseudoaneurysm (rounded contrast collection)
Abdominal radiograph: Left upper quadrant mass, widening distance between flank stripe and descending colon (sign of fluid / hematoma)
Ultrasound: Echogenic perisplenic focus (clot), hypo- or isoechoic regions (hematoma or laceration), free intraperitoneal fluid with low-level echoes (hemoperitoneum)
SOURCE : AUNT MINNIE DOT COM
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