Splenic injury - grade 5

Case contributed by Craig Hacking


High speed MVA. LUQ pain, seatbelt sign.

Patient Data

Age: 30 years
Gender: Male

Ruptured spleen with anterosuperior splenic laceration involving an anterior segmental vessel and active contrast extravasation extending into the peritoneum. Associated moderate volume hemoperitoneum. Subcapsular splenic hematoma covering >50% of the surface area and measuring up to 19mm in depth. Surrounding inflammatory stranding and rightward displacement of the adjacent peritoneal contents.

The liver, spleen, pancreas, kidneys and adrenal glands are normal with no evidence of injury. Small low density left renal cortical cysts.

The large and small bowel appear within normal limits. Prior gastric bypass. No pneumoperitoneum or intra-abdominal collection. No abdominal lymphadenopathy.

Normal contrast opacification of the abdominal aorta, IVC and portal vein.

Sclerotic focus in left iliac bone adjacent to the sacroiliac joint is likely a bone island. Bilateral L1 lumbar ribs. No fracture demonstrated.


AAST grade 5 splenic injury with active contrast extravasation into the peritoneum.

Case Discussion

The patient was stable enough to be transferred to a level 1 trauma center where interventional radiology successfully embolized the splenic arterial injury. The patient recovered well.

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