Splenic Trauma

  • Etiology: blunt abdominal trauma
  • Imaging: spectrum is contusion / laceration / fracture or fragmentation / vascular disruption / subcapsular hematoma, hemorrhage can dissect into anterior pararenal space, does not always have hemoperitoneum
  • 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
  • Note: active hemorrhage detection is focal or diffuse high attenuation area of > 90 Hounsfield units

Cases of Splenic Trauma

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 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.
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.