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Splenic
Laceration
Contributed by David Allen, MD
- Most frequently injured solid parenchymal
organ in blunt trauma to the abdomen
- Splenic injury often associated with other
organ injuries
- 20% with left rib fractures
- 25% with left renal injury
- 40% with splenic laceration have rib
fractures
- Subcapsular hematoma
- Crescentic low-attenuation area
- Usually along lateral margin
- Flattens normal convex margin of spleen
- Parenchymal lesion
- Indistinct splenic margin
- Inhomogeneous enhancement
- Fractured spleen
- Complete separation of fragments
- Intrasplenic hematoma
- Rounded mass
- Disrupted splenic capsule
- Often has associated hemoperitoneum
CT shows a subcapsular hematoma with a splenic
laceration extending from the capsule to the hilum with an
intraparenchymal hematoma (blue arrow).
Within the intraparenchymal and subcapsular hematomas are areas of
hyperdensity that represent active extravasation
(red arrow).
- Pitfalls in diagnosis
- Normal lobulation or cleft mimics tear
- Adjacent unopacified bowel loop
(jejunum) simulates splenic tissue
- Scans taken too early after bolus
- Spleen can be inhomogeneous due to
differential enhancement of red and white pulp
- Previous infarct can mimic laceration
- Perisplenic fluid from ascites or lavage
mimics hemoperitoneum
- Grades of laceration
- Grade I: small laceration < 1cm and
small subcapsular hematoma
- Grade II: moderate laceration 1-3cm and
moderate subcapsular hematoma
- Grade III: large laceration > 3cm not
involving hilum with large subcapsular hematoma
- Grade IV: laceration involving the hilum
- Grade V: destroyed spleen
- If part of hematoma is isodense to
arterial blood on an enhanced CT there is active extravasation
- Treatment
- Follow clinically
- Arterial embolization/coiling
- Splenorrhaphy
- Splenectomy
- Treatment options
- The higher the grade the more likely the
need for an intervention
- Grade I and II are usually followed
clinically unless they worsen
- Grade IV and V usually require surgery
- 15% of low-grade lacerations develop a
delayed hemorrhage after 2 days
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