Subcapsular splenic hematoma

Subcapsular splenic hematomas are a type of splenic hematoma that occurs beneath the splenic capsule.

Pathology

They can occur in both traumatic and non-traumatic situations.

Associations

• abdominal: splenic trauma ³, a subcapsular hematoma is part of imaging criteria for grades I-III of the AAST splenic injury grading system
• infectious mononucleosis ¹
• pancreatitis ^2,5
• cocaine use ⁷

Radiographic features

CT

Imaging in the portal venous phase is best for detection. CT typically shows a crescentic/lenticular perisplenic collection where attenuation values depend on the age of the hematoma. The hematoma may flatten or indent
the lateral margin of the spleen ⁶.

• acute: hyperattenuating to isoattenuating ⁴,  then called subcapsular hemorrhage
• subacute: iso attenuating, within 1-2 days of bleeding, CT attenuation values of splenic hematomas may be equal to or greater than that of the splenic
  parenchyma ⁶
• established/chronic: hypoattenuating