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

Case contributed by Chris O'Donnell


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

Patient Data

Age: 30 years
Gender: Male

Presentation CT - arterial and portal venous phase study


Prominent perisplenic hematoma (sentinel clot) with marked liquid blood around the liver. Multiple splenic pseudoaneurysms with an associated traumatic A-V fistula characterized 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 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 characterized by contrast pooling and early filling of the splenic vein.

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