Delayed rupture of the spleen: traumatic pseudoaneurysms and A-V fistula

Case contributed by Dr Chris O'Donnell

Presentation

Assault 1 week prior to final presentation. Managed conservatively, now sudden onset of severe left upper quardrant pain.

Patient Data

Age: 30
Gender: Male
CT

Presentation CT - arterial and portal venous phase study

Prominent perisplenic haematoma (sentinel clot) with marked liquid blood around the liver. Multiple splenic pseudoaneurysms with an associated traumatic A-V fistula characterised by early filling of the splenic vein on the arterial phase of the study. Note leak of contrast into the left subphrenic space indicating that there is active bleeding requiring urgent treatment (in this case splenectomy).

CT

CT scan 1 week prior - at the time of initial trauma

Initial CT at the time of trauma shows a minor splenic laceration/contusion with minor sentinel clot and free blood around the liver. No contrast extravasation.

Case Discussion

Delayed splenic rupture typically occurs 7-10 days following the original injury due to lysis of clot on traumatised blood vessels. Note the multiple small punctate contrast pools on arterial phase CT. This is the CT equivalent of the angiographic appearance termed 'Seurat spleen' because of a likeness to the pointillistic artwork of French impressionist Georges Seurat. There is also a traumatic A-V fistula characterised by contrast pooling and early filling of the splenic vein.

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Case information

rID: 27738
Case created: 17th Feb 2014
Last edited: 20th Nov 2015
System: Haematology
Inclusion in quiz mode: Included

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