Computed tomography of blunt spleen injury: a pictorial review

Abstract

The spleen is one of the organs most frequently injured in blunt abdominal trauma. Computed tomography (CT) scanning can accurately detect splenic injury and is currently the imaging modality of choice in assessing clinically stable patients with blunt abdominal trauma. The CT features of spleen injury include lacerations, subcapsular or parenchymal haematomas, active haemorrhage, and vascular injuries. We present a pictorial review of the spectrum of CT findings for blunt splenic injuries. This article will be a useful reference for radiologists and surgeons as CT scan is widely used for the assessment of splenic injuries and contributes to the current trend towards nonsurgical management of this injury.

Keywords: abdomen; blunt injuries; computed tomography; medical imaging; spleen; trauma.

Figure 1:

Splenic laceration seen on contrast-enhanced computed tomography scan as linear irregular hypodense area (arrow). It was proven intraoperatively in this 15-year-old boy who was injured when his motorcycle skidded. He had an uneventful recovery after splenectomy.

Figure 2:

Parenchymal haematoma (arrow) seen on contrast-enhanced computed tomography scan as focal hypodense area within the enhanced splenic parenchyma with an intact capsule. This patient was injured in a motor vehicle collision and was managed conservatively.

Figure 3a:

Subcapsular haematoma (arrow) seen as perisplenic collection that indents the underlying parenchyma.

Figure 3b:

Perisplenic blood collection (arrow) seen as collection surrounding the spleen with no mass effect to adjacent parenchyma.

Figure 4:

Haemoperitoneum from splenic injury in a 30-year-old man after being assaulted. Computed tomography scan showed massive haemoperitoneum (arrows) due to laceration at splenic hilum. This was confirmed intraoperatively with blood loss of 1L. There was no other intraabdominal injury.

Figure 5:

Active haemorrhage from splenic injury seen as contrast extravasation (arrow) in 18-year-old boy injured after motor vehicle accident. Blood loss of 2L was noted intraoperatively and splenectomy was done for this patient.

Figure 6:

Grade I spleen injury in a 17-year-old girl involved in motor vehicle accident. Coronal reformatted computed tomography showed a capsular tear less than 1 cm in the lower pole (arrow). She was managed conservatively with uneventful recovery. Note the minimal perisplenic collection.

Figure 7:

Grade I spleen injury in a 35-year-old male injured in an industrial accident. Axial contrast-enhanced computed tomography scan showed subcapsular hemorrhage (arrow) less than 10% of surface area. He was managed conservatively and recovered well.

Figure 8:

Grade II splenic injury in a 13-year-old boy injured after a fight. Computed tomography scan showed subcapsular haematoma involving 30%–40% of splenic surface area (arrow). He was managed conservatively with uneventful recovery.

Figure 9:

Grade II splenic injury in a 14-year-old girl injured in motor vehicle accident. Computed tomography scan was done 2 days after the accident demonstrated intraparenchymal haematoma (arrow) less than 4 cm in diameter with no capsular tear. Surgery was performed in this case for continuous blood loss. There were lacerations of left broad ligament with bleeding from branches of left ovarian artery (images not shown). Splenic capsule was intact.

Figure 10:

Grade II splenic injury in a 30-year-old man after being assaulted. Computed tomography scan showed a 2-cm laceration at the hilum (arrow) which was confirmed intraoperatively.

Figure 11:

Grade III splenic injury in a 15-year-old boy injured during football match. Axial contrast-enhanced computed tomography scan showed multiple lacerations and intraparenchymal haematoma (arrow). He was managed conservatively and recovered fully

Figure 12:

Grade III spleen injury in a 32-year old man injured in motor vehicle accident. Axial contrast-enhanced computed tomography scan showed multiple intraparenchymal lacerations with subcapsular haematoma (arrow). Splenectomy was done with blood loss of 300 mL.

Figure 13:

Grade III splenic injury in an 18-year-old boy, injured when his motorcycle hit a buffalo. Axial contrast-enhanced computed tomography scan showed a laceration at upper pole (arrow). Intraoperative findings confirmed a 6-cm laceration with haemoperitoneum of about 1L. Splenectomy was performed.

Figure 14:

Grade IV splenic injury in a 17-year-old boy injured in motor vehicle accident. Coronal reformatted computed tomography showed multiple lacerations causing major devascularisation of the spleen. Splenectomy was performed for this patient.

Figure 15:

Grade V splenic injury in an 18-year old man after his motorbike hit a lorry. Axial contrast-enhanced computed tomography scan showed shattered spleen with large-volume haemoperitoneum which was confirmed intraoperatively. Note the focal high attenuation (arrow) due to active hemorrhage. Splenectomy was done for this patient.

Figure 16:

Grade V splenic injury in a 17-year old boy involved in motor vehicle accident. Axial computed tomography showed non-perfusion of the spleen on this post contrast image. Perisplenic hyperdensity (short arrow) was due to contrast extravasation. He also had left renal injury (long arrow).

Figure 17:

Splenic abscess as a complication of splenic injury in a 43-year-old man. He presented about 1 week after trivial trauma due to persistent abdominal pain. Computed tomography scan showed intraparenchymal haematoma with multiple air pockets within; this was confirmed intraoperatively.