Splenic trauma

Changed by Henry Knipe, 7 Jul 2014
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Splenic trauma can occur after blunt or penetrating trauma or secondary to medical intervention (i.e. iatrogenic). The spleen is the most frequently injured organ after blunt trauma. 

Clinical presentation

Patients may present wiht left upper quadrant/left chest pain, left shoulder tip pain (referred from diaphragmatic irritation) and signs of hypotension or shock.

Epidemiology

In blunt trauma, the spleen can account for up to 49% of abdominal organ injuries 2. 

Pathology

Types
Grading 
Associations

Splenic trauma is associated with injuries to other intra-abdominal organs 1:

In penetrating trauma, the spleen is more likely to be injured than bowel 6. 

Radiographic features

Ultrasound
  • FAST scanning may be performed to determine the presence of free fluid - absence of free fluid does not rule out splenic injury 1
  • disruption to the splenic echotexture indicating laceration or hypoechoic regions representing haematoma may be present 1
CT

CT is the modality of choice for assessing splenic trauma: 

  • splenic parenchyma should be be assessed in portal venous phase as the heterogenous contrast-enhancement seen on arterial phase can mimic splenic laceration/contusion; arterial phase scanning can be useful in detecting vascular injuries such as pseudoaneurysm and AV fistula 3-5
  • lacerations appears as linear or branching hypodensities 3
  • subcapsular haematomas can be seen as low-density fluid adjacent to the spleen that distorts the splenic architexture 2
  • active haemorrhage appears as highly-density (80-95HU) material due to the extravasation of contrast media that increases in size on delayed imaging 2-3
  • pseudoaneurysms and AV fistulas have a similar appearance to active haemorrhage on initial scanning but do not increase in size on delayed phases 3

Treatment and prognosis

Most splenic injuries in haemodynamically stable patients are treated non-surgically. Angio-embolisation plays an important role in treating high-grade splenic injuries (both in haemodynamically stable and unstable patients; practive varies from institution-to-institution).

Complications include 2:

  • -</ul><h5>Grading </h5><ul><li><a href="/articles/splenic_injury_grading">AAST splenic injury grading system</a></li></ul><h5>Associations</h5><p>Splenic trauma is associated with injuries to other intra-abdominal organs <sup>1</sup>:</p><ul>
  • +</ul><h5>Grading </h5><ul><li><a href="/articles/splenic-injury-grading">AAST splenic injury grading system</a></li></ul><h5>Associations</h5><p>Splenic trauma is associated with injuries to other intra-abdominal organs <sup>1</sup>:</p><ul>
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Case 91: splenic rupture (gross pathology)
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Case 19: seurat spleen
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