Splenic trauma - AAST grade V

Case contributed by Dr Bruno Di Muzio

Presentation

Blunt trauma to the abdomen.

Patient Data

Age: 60 years

CT Abdomen and pelvis

CT

Left lower rib fractures involving the 6th to 9th ribs, being markedly displaced in the 9th. Associated local surgical emphysema in the chest wall that tracks superiorly. Small pneumothorax on the left. Bilateral dependent atelectasis in both posterior lower lobes. A small subpleural cyst is identified in the posterior segment of the left lower lobe may represent a pneumatocoele. The airways are normal. There is no mediastinal abnormality, no lymph node enlargement.

Major splenic trauma with laceration involving more than 50% of its volume and presenting with multiple internal foci of acute hemorrhage and clear active contrast extravasation within. Splenic hilum is preserved. Large subcapsular and subphrenic hematoma that tracks down to the pelvis. The liver, pancreas, and adrenal glands are normal. Kidneys have normal dimensions and enhancement, showing a few bilateral cortical cysts. No hydronephrosis. Scattered colonic diverticula, with no evidence of acute inflammation. Bowel is otherwise unremarkable. There is no free gas. No lymph node enlargement. No evidence of pelvic fractures.

Case Discussion

This case illustrates a grade V splenic trauma (AAST injury scale) with active bleeding. Multiple lower rib fractures on the left, associated with small left pneumothorax.

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