Best Practice Case Studies-Splenic Laceration

Video Transcription

This is Barry Belosis, one of the musculoskeletal radiology fellows at Stanford University. 16-year-old previously healthy male defensive back, concerned for splenic laceration.  In the emergency setting, focused abdominal sonography for trauma could be performed to evaluate for fluid in the abdominal quadrants.  CT, abdomen, and pelvis with contrast should be performed in unstable patients with negative FAST or in those stable patients with positive FAST.  FAST could either be repeated or a CT could be performed depending on the patient's clinical picture. The patients in this case have the CT, abdomen, and pelvis with contrast.  Here on our axial imaging at the level of the spleen, we can see a dark band or hypodensity traversing the body of the spleen consistent with splenic laceration.  We can also see this hypodensity throughout the abdomen consistent with hemoperitoneum. At an axial slice just below the spleen, we can see that the defect goes all the way  and involves the splenic hilum. There is also adjacent subscapular hematoma and again we can see the hemoperitoneum.  In the setting of trauma, CT, abdomen, and pelvis with delayed imaging is usually performed to look for active contrast extravasation such as in this patient.  In our coronal reformat, we can see that there is a large laceration of the spleen and on our delayed imaging, we can see that in the superior aspect of the spleen is a hypodensity  not seen on our portal venous face. This is consistent with active contrast extravasation. We can also see a large hemoperitoneum throughout the abdomen.  The AAST or American Association for the Surgery of Trauma has a spleen injury scale that we use to grade splenic injury.  As you can see, splenic contusion is not one of the criteria. When we're looking at the grading system, we look at the subscapular hematoma in relation  to the surface area of the spleen, the parenchymal laceration depth, any evidence of vascular injury, or a shattered spleen.

Video Summary

Barry Belosis, a musculoskeletal radiology fellow at Stanford University, discusses a 16-year-old male with a suspected splenic laceration following trauma. In such cases, a focused abdominal sonography for trauma (FAST) is used to identify fluid in the abdomen. CT scans with contrast are essential for unstable patients with negative FAST results or stable individuals with positive FAST. This patient's CT reveals a splenic laceration and hemoperitoneum, requiring assessment using the AAST spleen injury scale. The scan shows a subscapular hematoma and active contrast extravasation, indicating significant splenic injury.

Meta Tag

Edition 2nd Edition

Related Case 2nd Edition, Case 01

Topic Abdomen

Keywords

2nd Edition, Case 01

2nd Edition

Abdomen

splenic laceration

FAST

CT scan

AAST spleen injury scale

hemoperitoneum