Breathing motion artefact mildly limits assessment, particularly on the portal venous phase.

Moderate volume haemoperitoneum. No free abdominal gas. Large laceration involves the superior pole of the spleen with injury to a branch of the major splenic artery. Multiple sites of arterial blush within the anterior/superior splenic pole with active extravasation of contrast anteriorly, into the peritoneal cavity.

No hepatic injury identified. Unremarkable appearance of the gallbladder, pancreas, adrenal glands and kidneys within the limitations. No small or large bowel dilatation. Mild colonic diverticular disease is uncomplicated. Unremarkable pelvic organs. No inguinal or abdominopelvic lymphadenopathy by size criteria.

Normal calibre abdominal aorta. Normal opacification of the coeliac axis, SMA, bilateral renal arteries and IMA. Accessory right renal artery. The common hepatic artery arises directly from the aorta (normal anatomic variant).

Left lower rib fractures (as described in the chest CT report). No acute lumbosacral spine or pelvic fracture.

Impression

Large laceration involves the superior pole of the spleen with active bleeding into the peritoneum anteriorly, in keeping with an AAST grade 5 injury. Associated moderate volume haemoperitoneum. The common hepatic artery arises directly from the aorta, adjacent to the coeliac axis which gives rise to the left gastric artery and splenic artery.

Grade 5 splenic injury with numerous small traumatic pseudoaneurysms (Seurat spleen) and a large dominant lesion (culprit lesion on the CT) in the midpolar region.

The culprit lesion was treated with distal artery coil embolisation. A proximal artery plug embolisation was then performed to reduce the perfusion pressure.