Splenic rupture with peri-splenic hematoma and hemoperitoneum
This young male presented to the Emergency Department with 2-3 hours of gradual onset, severe LUQ pain associated with nausea. He had a CT abdomen and pelvis performed.
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Splenic rupture with a moderate sized peri-splenic hematoma and hemoperitoneum. Can be better visualized on the coronal images.
2 case question available
This gentleman has a splenic rupture. This can be better visualized on the coronal images. The findings are rather subtle, but also note the small amounts of fluid which are tracking between the mesenteric fat. This fluid appears hyperdense relative to the surrounding fat.
Splenic rupture sits along the spectrum of splenic lacerations. Splenic lacerations are a common occurrence occurring after blunt traumatic injury 1. In the developed world, it is usually associated with motor vehicle accidents. In one study 3, 45% of patients with traumatic abdominal injury demonstrated some sort of splenic laceration.
Contrast enhanced CT is currently the diagnostic imaging tool of choice.
Features of blunt splenic injury include 2:
- lacerations: irregular, linear hypodensities
- non-perfused regions
- hematoma (subcapsular and parenchymal): hypodense regions which may be compressing the capsule, or within the parenchyma itself respectively
- active hemorrhage: area of high attenuation on CTA represents active bleeding
- hemoperitoneum: area of hypodensity due to old blood pooling in the paracolic gutters
- vascular injury
Patients with low grade splenic lacerations, who are haemodynamically stable and have a non-peritonitic abdomen are usually managed conservatively. Recently, there has been a push to manage haemodynamically unstable patients non-surgically, but with radiological angio-embolization 3.
Case contributed by A/Prof. Pramit Phal.
- 1. Kailidou E, Pikoulis E, Katsiva V et-al. Contrast-enhanced spiral CT evaluation of blunt abdominal trauma. JBR-BTR. 2005;88 (2): 61-5. Pubmed citation
- 2. Hassan R, Abd Aziz A, Md Ralib AR et-al. Computed tomography of blunt spleen injury: a pictorial review. Malays J Med Sci. 2012;18 (1): 60-7. Free text at pubmed - Pubmed citation
- 3. Hildebrand DR, Ben-Sassi A, Ross NP et-al. Modern management of splenic trauma. BMJ. 2014;348 (apr02 3): g1864. doi:10.1136/bmj.g1864 - Pubmed citation