Delayed rupture of the spleen - traumatic pseudoaneurysms and A-V fistula
Presentation
Assault 1 week prior to final presentation. Managed conservatively, now sudden onset of severe left upper quardrant pain.
Patient Data
Presentation
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).
1 wk prior at time of 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.
Unable to process the form. Check for errors and try again.