Image
Splenic laceration without coil embolization
- Image ID
- MPX1844_synpic20208
- Case U_id
- MPX1844
- Modality
- CT · CT - GI & IV Contrast
- Plane
- Axial
- Location
- Gastrointestinal (Abdomen)
- Age / Sex
- 20 / male
- Caption
- Helical axial CT with IV contrast demonstrates a jagged defect with middle of the splenic parenchyma adjacent a extending peripherally through the capsule. Associated fluid densities are seen adjacent to the liver and spleen consistent with intraperitoneal hemorrhage. Active extravasation of contrast is not present in this hemodynamically stable patient.
- ACR Codes
- 7.4
Clinical case
- History
- 20 yo male mountain biking accident victim with a chief complain of abdominal pain.
- Findings
- CT demonstrates parenchymal splenic injuries and may demonstrate active extravasation of contrast if active hemorrhage is present. Fluid densities within the dependent portions of the peritoneal cavity are often seen. Angiography may demonstrate active hemorrhage and or mass effect secondary to adjacent hematoma causing compression. Active hemorrhage would warrant proximal coil embolization to improve hemodynamic status.
- Differential Diagnosis
- Splenic laceration with or without frank hemorrhage, other visceral trauma with subsequent peritoneal fluid collections.
- Case Diagnosis
- Splenic laceration without coil embolization
- Diagnosis By
- Imaging
Topic
- Category
- Trauma
- ACR Code
- 7.4
Disease discussion
The spleen is the most frequently injured intraperitoneal organ in blunt abdominal trauma. Clinically, patients present with an appropriate history as well as the possible presence of upper abdominal, left upper quadrant, flank, or referred left shoulder pain. Plain film findings of splenic injury can be subtle and include medial displacement of the stomach, downward or medial displacement of the splenic flexure, elevation of the left hemidiaphragm, scoliosis of the spine with leftward concavity, sentinel loops over the left upper quadrant, pleural effusions or atelectasis at the left lung base, and associated rib fractures. CT is greater than 95% sensitive in the detection of splenic trauma but is not reliable with respect to determining the need for surgical intervention. Types of splenic injury include intrasplenic laceration, splenic fracture, subcapsular hematoma, perisplenic hematoma, and delayed splenic rupture. Coil embolization of the spleen is performed by placing coils proximally within the splenic artery (possible because of the spleen’s rich collateral network).