Shattered spleen - AAST grade V injury

Case contributed by Dr Ian Bickle

Presentation

Young male overseas worker falls from motorbike, which he is using following consumption of alcohol.

Patient Data

Age: 35 years
Gender: Male

The spleen is shattered.  On the dual phase images, active contrast extravastation is evident at the splenic hilum.

Large volume hemoperitoneum.

Left sided renal laceration.

Annotated images showing the active contrast extravastation from the splenic hilum on both arterial and portal venous phases.

Case Discussion

The spleen is 'shattered' into pieces, with active contrast extravasation at the splenic hilum, which extends across the midline towards the hepatic hilum.

High attenuation fluid in the upper abdomen and pelvis in keeping with hemoperitoneum.

This is the highest grade splenic injury (grade 5).

The patient proceeded to an emergency splenectomy, which confirmed the above, including 1.5 liters of blood in the peritoneum, and a bleeding vessel at the splenic hilum.

The concomitant left renal laceration managed conservatively.

Life lesson: motorbikes and alcohol are not sensible friends.

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