Splenic laceration

Case contributed by Dr Jeremy Jones

Presentation

Knocked off bike by car. Generalized abdominal pain. Normotensive. Not tachycardic.

Patient Data

Age: 12 years
Gender: Male
Ultrasound

Large volume free fluid within the abdomen. Normal liver, pancreatic bed and kidneys with normal vascularity.

The spleen is abnormal with focal hypoechogenicity paired with lack of vascularity.

CT

Isolated splenic trauma with a laceration extending towards the hilum (Grade II). No evidence of extravasation. Normal pancreas, mesenteric root, liver and kidneys. Otherwise normal enhancement.

Case Discussion

Ultrasound can be a useful tool in the assessment of pediatric trauma, especially in the well, haemodynamically stable patient. 

Correlation between CT findings and Ultrasound (in the hands of a professional) can be high. In some cases, a good quality ultrasound and low clinical concern can obviate the need for CT completely. However, CT is often required to confirm grade of injury and to definitively rule out associated injuries.

CT in children can be confined to the area of interest (in this case, just the upper abdomen) and should be protocolled as a dual bolus technique.

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