Splenic laceration - AAST grade IV

Injury to the spleen is usually secondary to blunt trauma.  The arterial vessels of the spleen lack anastomoses and the spleen can be divided into vascular segments, which allows for subtotal splenectomy or splenorraphy.  In this case, there is aevidence of laceration involvingextending to the trabecular vesselshilum, and an intraparenchymal haematomadevascularization which appears to involve >5 cm;25% of the spleen in keeping with AAST grade IIIIV splenic injury. The primary goal was to stop active bleeding from the lacerated segmental and trabecular vessels.  After selective embolization, the haemoglobin count of the patient stabilised.

Contrast-enhanced representative axial and coronal CT images of the upper abdomen showing patchy hypodense areas in the mid to inferior segment of the spleen extending to the hilum and is surrounded by irregular contrast enhancement, which constitutes >25% devascularization.

There is note of peripheral contrast extravasation seen in the perirenal space.  Free intraperitoneal fluid collection is also seen at the perihepatic, perisplenic, hepatorenal, and splenorenal regions.

Preliminary DSA studies prior to embolization, with catheter directed through the celiac axis and as well as selective angiography of the splenic artery, showing smudgy areas in the mid to inferior segment of the spleen.  This is indicative of active contrast extravasation from the lacerated segmental and trabecular vessels supplying this segmentregion.

Note contrast material filling the left renal collecting system, as a result of contrast injection from the CT exam.

The areas with active contrast extravasation were injected with polyvinyl alcohol (PVA) embolization particles.  Post embolization DSA showing selective occlusion of the trabecularsegmental branch vessels, previously noted to have smudgy appearance.  Patchy faint areas of opacification in the mid to inferior segment of the spleen indicative of the distribution of embolization particles.