Splenic trauma
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Splenic trauma can occur after blunt or penetrating trauma or secondary to medical intervention (i.e. iatrogenic). The spleen is the most frequently injured organ after blunt trauma.
Clinical presentation
Patients may present with left upper quadrant/left chest pain, left shoulder tip pain (referred from diaphragmatic irritation) and signs of hypotension or shock.
Epidemiology
In blunt trauma, the spleen can account for up to 49% of abdominal organ injuries 2.
Pathology
Types
- laceration
- haematoma - subcapsular (more common) or intraparenchymal
- active haemorrhage
- pseudoaneurysm or AV fistulas (in ~15% of splenic trauma 4)
- infarct (rare) 7
Grading
Associations
Splenic trauma is associated with injuries to other intra-abdominal organs 1:
- left hemidiaphragm
- left lobe of the liver
- left kidney
- left adrenal gland
- pancreatic tail
In penetrating trauma, the spleen is more likely to be injured than bowel 6.
Radiographic features
Ultrasound
- FAST scanning may be performed to determine the presence of free fluid - absence of free fluid does not rule out splenic injury 1
- disruption to the splenic echotexture indicating laceration or hypoechoic regions representing haematoma may be present 1
CT
CT is the modality of choice for assessing splenic trauma:
- splenic parenchyma should be be assessed in portal venous phase as the heterogenous contrast-enhancement seen on arterial phase can mimic splenic laceration/contusion; arterial phase scanning can be useful in detecting vascular injuries such as pseudoaneurysm and AV fistula 3-5
- lacerations appears as linear or branching hypodensities 3
- subcapsular haematomas can be seen as low-density fluid adjacent to the spleen that distorts the splenic architexture 2
- active haemorrhage appears as highly-density (80-95HU) material due to the extravasation of contrast media that increases in size on delayed imaging 2-3
- pseudoaneurysms and AV fistulas have a similar appearance to active haemorrhage on initial scanning but do not increase in size on delayed phases 3
Treatment and prognosis
Most splenic injuries in haemodynamically stable patients are treated non-surgically. Angio-embolisation plays an important role in treating high-grade splenic injuries (both in haemodynamically stable and unstable patients; practive varies from institution-to-institution).
Complications include 2:
- delayed rupture (~5% in non-surgically treated patients)
- pseudocysts (<1%)
- splenic abscess formation
- splenic artery pseudoaneuyrsm
-<p><strong>Splenic trauma</strong> can occur after blunt or penetrating trauma or secondary to medical intervention (i.e. iatrogenic). The <a href="/articles/spleen-1">spleen</a> is the most frequently injured organ after blunt trauma. </p><h4>Clinical presentation</h4><p>Patients may present with left upper quadrant/left chest pain, left shoulder tip pain (referred from diaphragmatic irritation) and signs of hypotension or shock.</p><h4>Epidemiology</h4><p>In blunt trauma, the spleen can account for up to 49% of abdominal organ injuries <sup>2</sup>. </p><h4>Pathology</h4><h5><strong>Types</strong></h5><ul>- +<p><strong>Splenic trauma</strong> can occur after blunt or penetrating trauma or secondary to medical intervention (i.e. iatrogenic). The <a href="/articles/spleen-1">spleen</a> is the most frequently injured organ after blunt trauma.</p><h4>Clinical presentation</h4><p>Patients may present with left upper quadrant/left chest pain, left shoulder tip pain (referred from diaphragmatic irritation) and signs of hypotension or shock.</p><h4>Epidemiology</h4><p>In blunt trauma, the spleen can account for up to 49% of abdominal organ injuries <sup>2</sup>.</p><h4>Pathology</h4><h5><strong>Types</strong></h5><ul>
-</ul><h5>Grading </h5><ul><li><a href="/articles/splenic-injury-grading">AAST splenic injury grading system</a></li></ul><h5>Associations</h5><p>Splenic trauma is associated with injuries to other intra-abdominal organs <sup>1</sup>:</p><ul>- +</ul><h5>Grading</h5><ul><li><a href="/articles/splenic-injury-grading">AAST splenic injury grading system</a></li></ul><h5>Associations</h5><p>Splenic trauma is associated with injuries to other intra-abdominal organs <sup>1</sup>:</p><ul>
-</ul><p>In penetrating trauma, the spleen is more likely to be injured than <a href="/articles/bowel-trauma">bowel</a> <sup>6</sup>. </p><h4>Radiographic features</h4><h5>Ultrasound</h5><ul>- +</ul><p>In penetrating trauma, the spleen is more likely to be injured than <a href="/articles/bowel-trauma">bowel</a> <sup>6</sup>.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><ul>
-</ul><h5>CT</h5><p>CT is the modality of choice for assessing splenic trauma: </p><ul>- +</ul><h5>CT</h5><p>CT is the modality of choice for assessing splenic trauma:</p><ul>
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