Emergency Body CT > Trauma > Spleen(cont.)


Spleen (cont.)

Injury to the spleen can take the form of laceration, intrasplenic hematoma, subcapsular hematoma or infarction. Each of these etiologies displays different characteristic radiographic findings on CT. CT also identifies the extent of associated hemoperitoneum. Several classification systems for splenic injury have been constructed. One system classifies splenic injury in the following manner:

Class
Criteria
I Capsular disruption, subcapsular hematoma
II Peripheral laceration, hematoma < 3cm
III Fractures extending to the hilum, hematoma > 3cm
IV Shattered spleen, vascular disruption



Drawing of the Gay and Sistrom system
for classifying splenic lacerations.

 


Grade 4 splenic rupture (arrow).


Grade 3 splenic laceration (arrow) with hepatic
fluid (arrowhead).

Common pitfalls: one should not confuse splenic clefts for lacerations. If a question remains as to the presence of a laceration, one can rescan the spleen again with thinner slices. Contrast should be given again. It is almost never useful to rescan solid organ injury without I.V. contrast.

 


A splenic cleft (arrow). This normal variant can
be confused with a splenic laceration. Unlike a
laceration, the splenic cleft has smoothly curved
margins and is not associated with perisplenic fluid
such as blood.

 

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