Splenic rupture (AAST grade III)

Case contributed by Bálint Botz
Diagnosis certain


Sustained a fall, vague abdominal pain.

Patient Data

Age: 20 years
Gender: Male

Diffuse intraperitoneal free fluid noted around the liver in Morrison's pouch, as well as adjacent to the spleen and within bowel loops in the pelvis. 

About 2 cm deep echogenic band in the mid-portion of the spleen. Note that the vascularity is nonetheless unremarkable, interrogated not only by power Doppler, but also by microvascular flow imaging. 

The patient was transferred to the CT suite with confirmed splenic laceration and hemoperitoneum. 

Diffuse free fluid redemonstrated, reaching 15-20 mm maximum thickness in the pelvis. Density (~30 HU) in line with blood. 

The splenic laceration appears more extensive on CT, displaying jagged margins and a maximum depth reaching 40 mm. 

Case Discussion

AAST grade III traumatic splenic laceration. Note that ultrasound can grossly underestimate the degree of parenchymal injury, however, it is highly sensitive for abdominal free fluid. 

Subsequent conservative management was successful. 

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