Splenic trauma - AAST grade IV

Case contributed by Dr Bruno Di Muzio

Presentation

Blunt left upper quadrant trauma at football. Positive FAST scan.

Patient Data

Age: 25 years
Gender: Male

There is no obvious active bleeding on arterial phase. Large volume of hemoperitoneum through the abdomen and pelvic recesses. There are numerous full-thickness lacerations through the splenic substance. The lacerations involve the mid and posterior part of the spleen crossing multiple segmental vessels. No active bleeding or contrast pooling on portal vein phase imaging. The liver and gallbladder are normal. Normal adrenals, kidneys, and pancreas. No small bowel dilatation. No free air. No evidence for large bowel injury. No lymphadenopathy. Normal urinary bladder. No skeletal abnormality. The lung bases and pleural spaces are normal. 

Case Discussion

This case illustrates typical imaging features of a major traumatic splenic injury, AAST grade IV: laceration involving segmental or hilar vessels with major devascularisation (>25% of the spleen).

This patient was treated with endovascular splenic artery embolization with a good clinical response and has been discharged a few days later.

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