Pediatric Splenic Trauma

Etiology: Blunt abdominal trauma
Imaging CT:
— Spectrum is contusion to laceration to fracture or fragmentation to vascular disruption to subcapsular hematoma
— Hemorrhage can dissect into anterior pararenal space
— Does not always have hemoperitoneum
— Subcapsular hematoma deforms splenic contour
Note: Active hemorrhage detection is focal or diffuse high attenuation area of greater than 90 Hounsfield units
Note: American Association for the Surgery of Trauma (AAST) Injury Scoring Scale used to grade injury in order to help determine prognosis
DDX: Inhomogeneous splenic enhancement is a mimic of splenic trauma and is seen when scanning is done during arterial or early portal venous phases of contrast enhancement
Complications:
Treatment: Usually treated conservatively with watchful waiting and activity restriction
Clinical: Splenic laceration is common solid organ injury in blunt trauma

Radiology Cases of Splenic Trauma

Radiology Cases of Incorrect CT Technique Without the Use of Intravenous Contrast for the Assessment of Blunt Abdominal Trauma

CT without intravenous contrast using incorrect technique for the assessment of blunt abdominal trauma — Axial CT without contrast of the abdomen shows grossly unremarkable unenhanced solid organs of the abdomen without free air or free fluid.

Radiology Cases of False Positive Splenic Trauma

CT of inhomogenous enhancement of the spleen and liver laceration — Axial CT with contrast of the abdomen shows a stellate area of low density in the right lobe of the liver. The spleen does not have a laceration, instead it demonstrates inhomogenous opacification due to the image being obtained in the arterial phase – note how dense the contrast in the aorta is.

Radiology Cases of Active Arterial Bleeding in Splenic Trauma

CT of active splenic bleeding — Axial CT with contrast of the abdomen (above) shows a low-density laceration in the center of the spleen with a round focus of high intensity in the middle of it felt to represent active bleeding. Axial CT with contrast of the pelvis (below) shows a large amount of fluid in the pelvis posterior to the bladder.

Radiology Cases of Splenic Laceration

CT of splenic laceration. — Axial CT with contrast of the abdomen shows multiple areas of low density throughout the spleen.

CT of laceration of the spleen — Axial CT with contrast of the abdomen shows a triangular area of low density in the center of the spleen.

Radiology Cases of Splenic Laceration and Hemoperitoneum

CT of splenic trauma / splenic laceration — Axial CT with contrast of the abdomen shows multiple areas of low density in the spleen, a perisplenic fluid collection, and a large amount of free fluid in the pelvis

CT of splenic laceration — Axial CT with contrast of the abdomen shows a laceration through the center of the spleen (above) and a large amount of hemoperitoneum in the pelvis (below).

CT of renal trauma / renal laceration and ureteral trauma / ureteral transection and splenic trauma / splenic laceration — Axial and coronal CT with contrast of the abdomen immediate phase (above) shows low density in the superior and inferior poles of the left kidney and fluid in the left perirenal and pararenal spaces. There is also a large area of low density in the spleen. Delayed phase CT images (below) show extravasation of urine out of the ureter into the left pararenal space.

CT of hemoperitoneum due to splenic trauma — Axial CT with contrast of the abdomen shows the bladder in the center of the image partially filled with contrast and surrounded by a large amount of free fluid throughout the pelvis.