Presentation
Trauma patient, hemodynamically stable.
Patient Data
Mild amount of peri-splenic / pelvic free fluid, which is hyperdense denoting hemorrhagic nature.
The lower pole of the spleen shows ruptured parenchymal hematoma (measuring about 5.2 cm in its maximum dimension) with few short lacerations involving the both splenic surfaces. No evidence of vascular injury or active contrast extravasation. (Grade III splenic injury, AAST splenic injury grading system)
No other solid organ injury.
Note (in the bone window) mildly displaced fractures of the left 9th, 10th & 11th ribs.
Case Discussion
This is a case of polytrauma patient suffering from splenic injury due to fractured left lower ribs. The spleen is the most common solid organ injury.
Most splenic pathology is best assessed in the porto-venous phase, because the splenic parenchyma will show homogeneous enhancement in contrast to the arterial phase (where the spleen normally show mosaic enhancement due to difference in the enhancement between the red and white pulps; zebra spleen).
Always try to search for the cause and associations of the pathology in the available images, many times you will find them (such as the rib fractures here).
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