splenic trauma

Traumatische
Milzruptur mit subkapsulärem Hämatom. Zusätzlich Pleuraergüsse beidseits.
Wikipedia • CC BY-SA 4.0
School ager
in a motor vehicle collision. Axial CT with contrast of the abdomen shows multiple areas of low density throughout the spleen.The diagnosis was splenic laceration.
pediatricimaging.org • CC-by-nc-sa 4.0
Akute
Milzruptur in der Computertomographie, coronar reformartiert. Reichlich freie Flüssigkeit.
Wikipedia • CC BY-SA 3.0
School ager
in a motor vehicle accident with abdominal painAxial 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 pelvisThe diagnosis was splenic laceration with hemoperitoneum.
pediatricimaging.org • CC-by-nc-sa 4.0
Teenager who
crashed their all terrain vehicle with abdominal painAxial 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.The diagnosis was left renal laceration with ureteral transection and splenic laceration.
pediatricimaging.org • CC-by-nc-sa 4.0
Splenic
rupture as complication of acute pancreatitis. Splenic haematoma
www.eurorad.org • CC by-nc-sa-4.0
Computed
tomography of the spleen: how to interpret the hypodense lesion. Transverse contrast-enhanced CT images acquired during the late arterial phase. a A 23-year-old man who was involved in a motorcycle accident and suffered a splenic laceration with extensive intraparenchymal, subcapsular and perisplenic haematoma. b A 34-year-old woman who was involved in a motor vehicle accident and suffered a splenic laceration. Note the active contrast extravasation within the spleen (arrow)
insightsimaging.springeropen.com • CC-by-2.0
Imaging
findings of splenic emergencies: a pictorial review. Active bleeding after splenic injury. Axial contrast-enhanced CT images at early (a) and delayed (b) phase demonstrate splenic laceration (arrowhead in a) and active intraperitoneal bleeding (long arrows in a and b). Absence of clot formation results from active massive haemorrhage, as clot formation is not fast as bleeding. Extravasated contrast material can accumulate in a dependent part of the body without restriction of any clotted hematoma as of yet (arrow in b). Moreover, the presence of perihepatic fluid (short arrow in a ) supports the evidence of massive bleeding, since blood can act in a pattern similar to the free fluid, due to a decreased percentage of clot formation
insightsimaging.springeropen.com • Open Access
Imaging
findings of splenic emergencies: a pictorial review. Splenic hematoma. Axial contrast-enhanced CT of a 35-year-old man after a motor vehicle accident (MVA) demonstrates hematomas in splenic parenchyma with low-attenuated appearance (arrows). Perisplenic haemorrhage is also noted (arrowhead). The splenic capsule is intact
insightsimaging.springeropen.com • Open Access
Traumatische
Milzruptur in der Computertomographie, axial. Portalvenöse Kontrastmittelphase. Hypodense Irregularität im unteren Anteil der Milz als Korrelat des Parenchymrisses. Bandförmiger Saum am Unterrand als Zeichen von freier Flüssigkeit / Blut.
Wikipedia • CC BY-SA 3.0
Teenager with
abdominal pain after motor vehicle accident. Axial CT with contrast of the abdomen shows a laceration through the center of the spleen (above) and a large amount of hemoperitoneum in the pelvis (below).The diagnosis was splenic trauma.
pediatricimaging.org • CC-by-nc-sa 4.0
School ager
gymnast who fell onto a balance beam. Axial CT with contrast of the abdomen (above) shows a low-density laceration in the center of the spleen with a round focus of high intensity in the middle of it felt to represent active bleeding. Axial CT with contrast of the pelvis (below) shows a large amount of fluid in the pelvis posterior to the bladder.The diagnosis was splenic trauma with active splenic bleeding and a large amount of hemoperitoneum.
pediatricimaging.org • CC-by-nc-sa 4.0
Traumatische
Milzruptur in der Computertomographie, coronar rekonstruiert. Portalvenöse Kontrastmittelphase. Hypodense Irregularität im unteren Anteil der Milz als Korrelat des Parenchymrisses. Bandförmiger Saum am Unterrand als Zeichen von freier Flüssigkeit / Blut.
Wikipedia • CC BY-SA 3.0
Teenager who
fell while running and has left upper quadrant pain. Axial CT with contrast of the abdomen shows a triangular area of low density in the center of the spleen.The diagnosis was splenic laceration.
pediatricimaging.org • CC-by-nc-sa 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Splenic trauma can occur after blunt or penetrating trauma or secondary to medical intervention (i.e. iatrogenic). The spleen is the most frequently injured internal organ after blunt trauma.

Epidemiology

In blunt trauma, the spleen can account for up to 49% of abdominal organ injuries .

Clinical presentation

Patients may present with left upper quadrant, left chest pain, left shoulder tip pain (referred from diaphragmatic irritation), and signs of hypotension or shock.

Pathology

The spleen may be injured after blunt or penetrating trauma or may be iatrogenic (e.g. colonoscopy).

Types
Grading
Associations

Splenic trauma is associated with injuries to other intra-abdominal organs :

In penetrating trauma, the spleen is more likely to be injured than bowel .

Radiographic features

Ultrasound
  • FAST scanning may be performed to determine the presence of free fluid 
    • particularly in the upper abdomen
    • fresh blood is usually characterized as echoes free
    • absence of free fluid does not rule out splenic injury
  • disruption to the splenic echotexture indicating laceration or hypoechoic regions representing hematoma may be present
CT

CT is the modality of choice for assessing splenic trauma:

  • splenic parenchyma should be assessed in portal venous phase as the inhomogeneous splenic enhancement (zebra or psychedelic spleen) seen on arterial phase can mimic splenic laceration/contusion; arterial phase scanning can be useful in detecting vascular injuries such as pseudoaneurysm and AV fistula
  • lacerations appear as linear or branching hypodensities (geographic pattern) 
  • subcapsular hematomas can be seen as low-density fluid adjacent to the spleen that distorts the splenic architecture
  • active hemorrhage appears as a high-density (80-95 HU) material due to the extravasation of contrast media that increases in size on delayed imaging
  • pseudoaneurysms and AV fistulas have a similar appearance to active hemorrhage on initial scanning but do not increase in size on delayed phases and follow the blood pool
  • splenic clefts may be mistaken for a laceration
    • these are due to persistent lobulation of the spleen after development
    • in contrast to a laceration, a cleft is usually smooth with a rounded edge and are not associated with an adjacent subcapsular hematoma or perisplenic fluid
    • some larger clefts may contain fat

Treatment and prognosis

Most splenic injuries in haemodynamically-stable patients are treated non-surgically. Splenic artery embolization plays a major role in treating high-grade splenic injuries (both in haemodynamically-stable and -unstable patients; practice varies from institution-to-institution).

Complications

Complications of splenic trauma include :

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Milzhämatom:
kissing liver
and spleen sign
Wikipedia • CC BY-SA 3.0
Milzruptur
als Komplikation bei Pankreatitis
www.eurorad.org • CC by-nc-sa-4.0
Embolisation
der Milzarterie
CVIRendovasc.springeropen.com • CC-by-4.0
Seurat Milz
(Angiographie)
CVIRendovasc.springeropen.com • CC-by-4.0