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. 2018 Jan;4(1):E30-E34.
doi: 10.1055/s-0043-125311. Epub 2018 Apr 4.

Spontaneous and Traumatic Splenic Rupture: Retrospective Clinical, B-Mode and CEUS Analysis in 62 Patients

M Rosling  1 , C Trenker  2 , A Neesse  3 , C Görg  1
Affiliations

Spontaneous and Traumatic Splenic Rupture: Retrospective Clinical, B-Mode and CEUS Analysis in 62 Patients

M Rosling et al. Ultrasound Int Open. 2018 Jan.

Abstract

Introduction: Both B-mode ultrasound and contrast-enhanced ultrasound (CEUS) are well established procedures when diagnosing traumatic splenic ruptures (TSR). To date, there are no data about CEUS patterns in spontaneous splenic ruptures (SSR). It remains unknown whether TSR and SSR differ with respect to clinical characteristics, B-mode and CEUS characteristics.

Patients and methods: Between 12/2003 and 2/2010, n=33 SSRs and n=29 TSRs were diagnosed in a tertiary referral center. All patients were examined with B-mode and CEUS, and clinical data and the outcome were retrospectively analyzed.

Results: Patients with SSR were significantly older than patients with TSR (62 years vs. 44 years; p=0.01). The 4-week mortality was significantly higher in SSR than in TSR (36% vs. 0%; p=0.001). No differences between the grading of TSR and SSR could be shown in B-mode or in CEUS. Notably, CEUS was significantly superior to B-mode with respect to the grading of splenic ruptures (p=0.01). Therefore, therapeutic management was influenced by CEUS.

Conclusion: There are differences between SSR and TSR, especially concerning clinical data (age, course of disease and mortality). Regarding the sonographic pattern, SSR and TSR show identical grading. When splenic rupture is suspected, CEUS should always be performed to identify patients at risk who require interventional procedures.

Keywords: CEUS; rupture; spleen; splenic rupture.

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Conflict of interest statement

Conflict of Interest C. Görg received funding from Bracco Imaging. Bracco Imaging supported CEUS workshops at the University Hospital Marburg and Göttingen. The abstract of the study was presented as a poster to the “Ultraschall 3-Ländertreffen”, Leipzig 2017.

Figures

Fig. 1
Fig. 1
Underlying diseases in n=33 patients with spontaneous splenic rupture a ; cause of trauma in. n=29 patients with traumatic splenic rupture b .
Fig. 2
Fig. 2
a,b : 18-year-old patient in car accident. Diagnosis: traumatic splenic rupture (TSR) B-mode: no grading a CEUS: parenchymal hematoma, grade 2 b Value of CEUS: higher grading Value of CEUS for diagnosis: setting of diagnosis Value of CEUS for therapy: no value Therapy: conservative treatment.
Fig. 3
Fig. 3
a,b : 24-year-old patient with angiosarcoma. Diagnosis: spontaneous splenic rupture (SSR) B-mode: subcapsular hematoma, grade 3 a CEUS: parenchymal hematoma, splenic metastasis, active bleeding, grade 4 b Value of CEUS: higher grading Value of CEUS for diagnosis: advanced information regarding diagnosis Value of CEUS for therapy: yes Therapy: urgent splenectomy.
Fig. 4
Fig. 4
a-c : 40-year-old patient with acute leukemia Diagnosis: spontaneous splenic rupture (SSR) B-mode: nonspecific findings, grade 2 a CEUS: infarction, NTISP, grade 4 b Value of CEUS: higher grading Value of CEUS for diagnosis: setting of diagnosis Value of CEUS for therapy: yes Therapy: interventional radiologic embolization c .
See this image and copyright information in PMC

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