Gastrointestinal Imaging

Trauma, splenic

The spleen is the most commonly injured intra-abdominal organ. Both blunt and penetrating trauma may cause damage. Clinical diagnosis relies on left upper quadrant pain and tenderness. There may be concomitant rib fractures. Haemodynamically unstable patients should undergo immediate surgery. However, many patients undergo cross-sectional imaging or ultrasound in order to monitor splenic injury.

CT must include intravenous contrast enhancement (Fig.1). Subcapsular haematomas are isodense and become hypodense relative to normal parenchyma after intravenous contrast enhancement. However, occasionally the haematoma may appear hyperdense. Laceration of the splenic parenchyma may result in a change in appearance from hypo- to hyperdense on scanning. Ultrasound and Doppler may also offer good diagnostic possibilities in these patients.

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Fig.1

Road traffic accident with trauma to the left flank. CT after intravenous contrast injection shows the spleen to be lacerated with bleeding in the left upper quadrant.
Trauma, splenic, Fig.1