Multimedia
 | Media file 1: Spleen, trauma. Chest radiograph shows a peripherally calcified mass in the left upper quadrant under the diaphragm. The mass represents a calcified splenic hematoma. |
 | Media file 2: Spleen, trauma. Contrast-enhanced arterial-phase CT scan of the abdomen shows a mottled appearance of the spleen. This finding should not be mistaken for splenic injury. Confirmation of a normal spleen can be shown by repeat imaging in a later phase of contrast enhancement. The spleen then appears homogeneously enhanced. |
 | Media file 3: Spleen, trauma. Contrast-enhanced CT scan shows a localized area of dense contrast collection in the splenic hilum, with a massive amount of surrounding fluid/blood. Findings here are indicative of active extravasation of contrast in a patient with traumatic autosplenectomy. This is a grade V injury. |
 | Media file 4: Spleen, trauma. Contrast-enhanced CT scan of the abdomen in the equilibrium phase shows perisplenic fluid with mass effect on the spleen. The spleen appears compressed by the fluid, reminiscent of subcapsular fluid collections. In this patient, the fluid was secondary to pancreatic pseudocysts mimicking subcapsular hematomas. |
 | Media file 5: Spleen, trauma. Contrast-enhanced CT scan of the abdomen shows a perisplenic fluid collection with internal increased attenuation. The splenic border is displaced by mass effect. This was a subacute subcapsular hematoma. This is a grade I injury. |
 | Media file 6: Spleen, trauma. Contrast-enhanced CT scan of the abdomen shows some perisplenic fluid in the anterior aspect. A small well-defined irregularity is noted in the splenic wall posteriorly. This was a congenital splenic cleft in a patient with perisplenic fluid secondary to nonsplenic injury. |
 | Media file 7: Spleen, trauma. Contrast-enhanced CT scan of the abdomen shows congenital splenic clefts with perisplenic fluid secondary to metastatic ovarian carcinoma. This mimics a splenic injury. |
 | Media file 8: Spleen, trauma. Contrast-enhanced CT scan of the abdomen shows perisplenic fluid without identification of a laceration in a patient who sustained blunt abdominal trauma. A large amount of pelvic fluid was seen, prompting laparotomy during which a small laceration was found; this is not evident on the scan. |
 | Media file 9: Spleen, trauma. Contrast-enhanced CT scan of the abdomen shows a massive fluid collection in the upper abdomen. This was a chronic subcapsular splenic hematoma and a grade III injury. |
 | Media file 10: Spleen, trauma. Contrast-enhanced CT scan of the abdomen shows a complex lower pole splenic laceration. This is a grade II injury. |
 | Media file 11: Spleen, trauma. Contrast-enhanced CT scan of the abdomen shows a small hilar laceration. This is a grade III-IV injury. |
 | Media file 12: Spleen, trauma. Contrast-enhanced CT scan of the abdomen shows a complex laceration extending to the hilum. This is a grade IV injury. |
 | Media file 13: Spleen, trauma. Arteriogram obtained with a main splenic artery catheter injection shows multiple areas of parenchymal contrast agent extravasation. |
 | Media file 14: Spleen, trauma. Selective splenic arteriogram shows traumatic pseudoaneurysms with extravasation in the upper pole. |
 | Media file 15: Spleen, trauma. Arteriogram obtained with a main splenic artery injection after superselective coil embolization of pseudoaneurysms. Irregular contrast opacification is still present within an avascular area; it possibly represents another area of vascular injury. |
 | Media file 16: Spleen, trauma. Arteriogram obtained with a superselective splenic artery injection in the upper pole confirms a second zone of vascular disruption with contrast agent extravasation. |
 | Media file 17: Spleen, trauma. Angiogram obtained after superselective coil embolization of the upper pole artery shows adequate treatment without extravasation. |
 | Media file 18: Spleen, trauma. Final arteriographic image from a main splenic artery catheter injection after selective/superselective coil embolization. Approximately 50% of the spleen has been devascularized. No residual arterial vascular injury or extravasation is present. The patient recovered uneventfully. |
More on Spleen, Trauma |
| Overview: Spleen, Trauma |
| Imaging: Spleen, Trauma |
| Follow-up: Spleen, Trauma |
 Multimedia: Spleen, Trauma |
| References |
| « Previous Page |
References
Raikhlin A, Baerlocher MO, Asch MR, Myers A. Imaging and transcatheter arterial embolization for traumatic splenic injuries: review of the literature. Can J Surg. Dec 2008;51(6):464-72. [Medline].
Ransom KJ, Kavic MS. Laparoscopic splenectomy for blunt trauma: a safe operation following embolization. Surg Endosc. May 7 2008;[Medline].
Visrutaratna P, Na-Chiangmai W. Computed tomography of blunt abdominal trauma in children. Singapore Med J. Apr 2008;49(4):352-8; quiz 359. [Medline].
Fakhre GP, Berland T, Lube MW. One hundred consecutive splenectomies for trauma: is histologic evaluation really necessary?. J Trauma. Apr 2008;64(4):1139-41. [Medline].
Marmery H, Shanmuganathan K, Mirvis SE, Richard H 3rd, Sliker C, Miller LA, et al. Correlation of multidetector CT findings with splenic arteriography and surgery: prospective study in 392 patients. J Am Coll Surg. Apr 2008;206(4):685-93. [Medline].
Michels NA. The variational anatomy of the spleen and splenic artery. Am J Anatomy. 1942;70:21.
Kimbrell OC Jr. Sarcoidosis of the spleen. N Engl J Med. 1957;257:128-31.
Hurd WW, Katholi RE. Acquired functional asplenia. Association with spontaneous rupture of the spleen and fatal spontaneous rupture of the liver in amyloidosis. Arch Intern Med. Jun 1980;140(6):844-5. [Medline].
Tsuda K, Nakamura H, Murakami T, et al. Peliosis of the spleen with intraperitoneal hemorrhage. Abdom Imaging. 1993;18(3):283-5. [Medline].
Dachman AH, Ros PR, Murari PJ, et al. Nonparasitic splenic cysts: a report of 52 cases with radiologic-pathologic correlation. AJR Am J Roentgenol. Sep 1986;147(3):537-42. [Medline].
Franquet T, Montes M, Lecumberri FJ, et al. Hydatid disease of the spleen: imaging findings in nine patients. AJR Am J Roentgenol. Mar 1990;154(3):525-8. [Medline].
Buntain WL, Gould HR, Maull KI. Predictability of splenic salvage by computed tomography. J Trauma. Jan 1988;28(1):24-34. [Medline].
Trauma scoring. Trauma.org. Available at http://www.trauma.org/archive/scores/ois.html. Accessed October 2, 2007.
Orwig D, Federle MP. Localized clotted blood as evidence of visceral trauma on CT: the sentinel clot sign. AJR Am J Roentgenol. Oct 1989;153(4):747-9. [Medline].
Levine CD, Patel UJ, Silverman PM, Wachsberg RH. Low attenuation of acute traumatic hemoperitoneum on CT scans. AJR Am J Roentgenol. May 1996;166(5):1089-93. [Medline].
Federle MP, Jeffrey RB Jr. Hemoperitoneum studied by computed tomography. Radiology. Jul 1983;148(1):187-92. [Medline].
Schurr MJ, Fabian TC, Gavant M, et al. Management of blunt splenic trauma: computed tomographic contrast blush predicts failure of nonoperative management. J Trauma. Sep 1995;39(3):507-12; discussion 512-3. [Medline].
Salis A, Pais SO, Vennos A, Scalea T. Superselective embolization of a traumatic intrasplenic arteriovenous fistula. J Trauma. Jan 1999;46(1):186-8. [Medline].
Davis KA, Fabian TC, Croce MA, et al. Improved success in nonoperative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms. J Trauma. Jun 1998;44(6):1008-13; discussion 1013-5. [Medline].
Resciniti A, Fink MP, Raptopoulos V, et al. Nonoperative treatment of adult splenic trauma: development of a computed tomographic scoring system that detects appropriate candidates for expectant management. J Trauma. Jun 1988;28(6):828-31. [Medline].
Umlas SL, Cronan JJ. Splenic trauma: can CT grading systems enable prediction of successful nonsurgical treatment?. Radiology. Feb 1991;178(2):481-7. [Medline].
Elmore JR, Clark DE, Isler RJ, Horner WR. Selective nonoperative management of blunt splenic trauma in adults. Arch Surg. May 1989;124(5):581-5; discussion 586. [Medline].
Godley CD, Warren RL, Sheridan RL, McCabe CJ. Nonoperative management of blunt splenic injury in adults: age over 55 years as a powerful indicator for failure. J Am Coll Surg. Aug 1996;183(2):133-9. [Medline].
Longo WE, Baker CC, McMillen MA, et al. Nonoperative management of adult blunt splenic trauma. Criteria for successful outcome. Ann Surg. Nov 1989;210(5):626-9. [Medline].
Smith JS Jr, Wengrovitz MA, DeLong BS. Prospective validation of criteria, including age, for safe, nonsurgical management of the ruptured spleen. J Trauma. Sep 1992;33(3):363-8; discussion 368-9. [Medline].
Smith JS Jr, Cooney RN, Mucha P Jr. Nonoperative management of the ruptured spleen: a revalidation of criteria. Surgery. Oct 1996;120(4):745-50; discussion 750-1. [Medline].
Goodman LR, Aprahamian C. Changes in splenic size after abdominal trauma. Radiology. Sep 1990;176(3):629-32. [Medline].
Boulanger BR, McLellan BA, Brenneman FD, et al. Emergent abdominal sonography as a screening test in a new diagnostic algorithm for blunt trauma. J Trauma. Jun 1996;40(6):867-74. [Medline].
Goldberg BB, Goodman GA, Clearfield HR. Evaluation of ascites by ultrasound. Radiology. Jul 1970;96(1):15-22. [Medline].
Rozycki GS, Ochsner MG, Feliciano DV, et al. Early detection of hemoperitoneum by ultrasound examination of the right upper quadrant: a multicenter study. J Trauma. Nov 1998;45(5):878-83. [Medline].
Yoshii H, Sato M, Yamamoto S, et al. Usefulness and limitations of ultrasonography in the initial evaluation of blunt abdominal trauma. J Trauma. Jul 1998;45(1):45-50; discussion 50-1. [Medline].
Cogbill TH, Moore EE, Jurkovich GJ, et al. Nonoperative management of blunt splenic trauma: a multicenter experience. J Trauma. Oct 1989;29(10):1312-7. [Medline].
Sclafani SJ, Weisberg A, Scalea TM, et al. Blunt splenic injuries: nonsurgical treatment with CT, arteriography, and transcatheter arterial embolization of the splenic artery. Radiology. Oct 1991;181(1):189-96. [Medline].
Hagiwara A, Yukioka T, Ohta S, et al. Nonsurgical management of patients with blunt splenic injury: efficacy of transcatheter arterial embolization. AJR Am J Roentgenol. Jul 1996;167(1):159-66. [Medline].
Patel NY, Cogbill TH, Gundersen LH. Angioembolization of multiple intrasplenic pseudoaneurysms as a result of blunt trauma. J Vasc Surg. Aug 1996;24(2):299-301. [Medline].
Mozes MF, Spigos DG, Pollak R, et al. Partial splenic embolization, an alternative to splenectomy--results of a prospective, randomized study. Surgery. Oct 1984;96(4):694-702. [Medline].
Castaneda-Zuniga WR, Hammerschmidt DE, Sanchez R, Amplatz K. Nonsurgical splenectomy. AJR Am J Roentgenol. Nov 1977;129(5):805-11. [Medline].
Alwmark A, Bengmark S, Gullstrand P, et al. Evaluation of splenic embolization in patients with portal hypertension and hypersplenism. Ann Surg. Nov 1982;196(5):518-24. [Medline].
Doody O, Lyburn D, Geoghegan T, Govender P, Monk PM, Torreggiani WC. Blunt trauma to the spleen: ultrasonographic findings. Clin Radiol. Sep 2005;60(9):968-76. [Medline].
Gaunt WT, McCarthy MC, Lambert CS. Traditional criteria for observation of splenic trauma should be challenged. Am Surg. Jul 1999;65(7):689-91; discussion 691-2. [Medline].
Huebner S, Reed MH. Analysis of the value of imaging as part of the follow-up of splenic injury in children. Pediatr Radiol. Dec 2001;31(12):852-5. [Medline].
Killeen KL, Shanmuganathan K, Boyd-Kranis R, et al. CT findings after embolization for blunt splenic trauma. J Vasc Interv Radiol. Feb 2001;12(2):209-14. [Medline].
Myers JG, Dent DL, Stewart RM, et al. Blunt splenic injuries: dedicated trauma surgeons can achieve a high rate of nonoperative success in patients of all ages. J Trauma. May 2000;48(5):801-5; discussion 805-6. [Medline].
Shapiro MJ, Krausz C, Durham RM, Mazuski JE. Overuse of splenic scoring and computed tomographic scans. J Trauma. Oct 1999;47(4):651-8. [Medline].
Further Reading
Keywords
spleen trauma, splenic injury, spleen injury, blunt injury to the spleen, splenic trauma
