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Splenic Trauma
Michael R. Aquino, MD, MHSc
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Splenic laceration, fracture, or injury; blunt injury to spleen
          • Definitions

            • Parenchymal injury to spleen ± capsular disruption

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • Ultrasonographic Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Reporting Tips

                                          Selected References

                                          1. Di Renzo D et al: Contrast-enhanced ultrasonography (CEUS) in the follow-up of pediatric abdominal injuries: value and timing. J Ultrasound. 23(2):151-5, 2020
                                          2. Gates RL et al: Non-operative management of solid organ injuries in children: an American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review. J Pediatr Surg. 54(8):1519-26, 2019
                                          3. Notrica DM et al: Reimaging in pediatric blunt spleen and liver injury. J Pediatr Surg. 54(2):340-4, 2019
                                          4. Stylianos S: To save a child's spleen: 50 years from Toronto to ATOMAC. J Pediatr Surg. 54(1):9-15, 2019
                                          5. The American Association for the Surgery of Trauma: Injury Scoring Scale, Updated 2018. Accessed October 3, 2021. https://www.aast.org/resources-detail/injury-scoring-scale#spleen
                                          6. Armstrong LB et al: Contrast enhanced ultrasound for the evaluation of blunt pediatric abdominal trauma. J Pediatr Surg. 53(3):548-52, 2018
                                          7. Ntoulia A et al: Applications of contrast-enhanced ultrasound in the pediatric abdomen. Abdom Radiol (NY). 43(4):948-59, 2018
                                          8. Durkin N et al: Post-traumatic liver and splenic pseudoaneurysms in children: diagnosis, management, and follow-up screening using contrast enhanced ultrasound (CEUS). J Pediatr Surg. 51(2):289-92, 2016
                                          9. Ingram MC et al: Hepatic and splenic blush on computed tomography in children following blunt abdominal trauma: is intervention necessary? J Trauma Acute Care Surg. 81(2):266-70, 2016
                                          10. Bansal S et al: Contrast blush in pediatric blunt splenic trauma does not warrant the routine use of angiography and embolization. Am J Surg. 210(2):345-50, 2015
                                          11. Notrica DM et al: Nonoperative management of blunt liver and spleen injury in children: evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg. 79(4):683-93, 2015
                                          12. Polites SF et al: Benchmarks for splenectomy in pediatric trauma: how are we doing? J Pediatr Surg. 50(2):339-42, 2015
                                          13. Schuster T et al: Selective angioembolization in blunt solid organ injury in children and adolescents: review of recent literature and own experiences. Eur J Pediatr Surg. 23(6):454-63, 2013
                                          14. Martin K et al: The significance of pseudoaneurysms in the nonoperative management of pediatric blunt splenic trauma. J Pediatr Surg. 46(5):933-7, 2011
                                          15. Safavi A et al: Traumatic pseudoaneurysms of the liver and spleen in children: is routine screening warranted? J Pediatr Surg. 46(5):938-41, 2011
                                          16. Davies DA et al: What is the significance of contrast "blush" in pediatric blunt splenic trauma? J Pediatr Surg. 45(5):916-20, 2010
                                          17. van der Vlies CH et al: The failure rate of nonoperative management in children with splenic or liver injury with contrast blush on computed tomography: a systematic review. J Pediatr Surg. 45(5):1044-9, 2010
                                          18. Lynn KN et al: Pediatric blunt splenic trauma: a comprehensive review. Pediatr Radiol. 39(9):904-16; quiz 1029-30, 2009
                                          19. Holmes JH 4th et al: The failure of nonoperative management in pediatric solid organ injury: a multi-institutional experience. J Trauma. 59(6):1309-13, 2005
                                          20. Cloutier DR et al: Pediatric splenic injuries with a contrast blush: successful nonoperative management without angiography and embolization. J Pediatr Surg. 39(6):969-71, 2004
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Splenic laceration, fracture, or injury; blunt injury to spleen
                                                  • Definitions

                                                    • Parenchymal injury to spleen ± capsular disruption

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • Ultrasonographic Findings

                                                          • Angiographic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Staging, Grading, & Classification

                                                                    • Gross Pathologic & Surgical Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Di Renzo D et al: Contrast-enhanced ultrasonography (CEUS) in the follow-up of pediatric abdominal injuries: value and timing. J Ultrasound. 23(2):151-5, 2020
                                                                                  2. Gates RL et al: Non-operative management of solid organ injuries in children: an American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review. J Pediatr Surg. 54(8):1519-26, 2019
                                                                                  3. Notrica DM et al: Reimaging in pediatric blunt spleen and liver injury. J Pediatr Surg. 54(2):340-4, 2019
                                                                                  4. Stylianos S: To save a child's spleen: 50 years from Toronto to ATOMAC. J Pediatr Surg. 54(1):9-15, 2019
                                                                                  5. The American Association for the Surgery of Trauma: Injury Scoring Scale, Updated 2018. Accessed October 3, 2021. https://www.aast.org/resources-detail/injury-scoring-scale#spleen
                                                                                  6. Armstrong LB et al: Contrast enhanced ultrasound for the evaluation of blunt pediatric abdominal trauma. J Pediatr Surg. 53(3):548-52, 2018
                                                                                  7. Ntoulia A et al: Applications of contrast-enhanced ultrasound in the pediatric abdomen. Abdom Radiol (NY). 43(4):948-59, 2018
                                                                                  8. Durkin N et al: Post-traumatic liver and splenic pseudoaneurysms in children: diagnosis, management, and follow-up screening using contrast enhanced ultrasound (CEUS). J Pediatr Surg. 51(2):289-92, 2016
                                                                                  9. Ingram MC et al: Hepatic and splenic blush on computed tomography in children following blunt abdominal trauma: is intervention necessary? J Trauma Acute Care Surg. 81(2):266-70, 2016
                                                                                  10. Bansal S et al: Contrast blush in pediatric blunt splenic trauma does not warrant the routine use of angiography and embolization. Am J Surg. 210(2):345-50, 2015
                                                                                  11. Notrica DM et al: Nonoperative management of blunt liver and spleen injury in children: evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg. 79(4):683-93, 2015
                                                                                  12. Polites SF et al: Benchmarks for splenectomy in pediatric trauma: how are we doing? J Pediatr Surg. 50(2):339-42, 2015
                                                                                  13. Schuster T et al: Selective angioembolization in blunt solid organ injury in children and adolescents: review of recent literature and own experiences. Eur J Pediatr Surg. 23(6):454-63, 2013
                                                                                  14. Martin K et al: The significance of pseudoaneurysms in the nonoperative management of pediatric blunt splenic trauma. J Pediatr Surg. 46(5):933-7, 2011
                                                                                  15. Safavi A et al: Traumatic pseudoaneurysms of the liver and spleen in children: is routine screening warranted? J Pediatr Surg. 46(5):938-41, 2011
                                                                                  16. Davies DA et al: What is the significance of contrast "blush" in pediatric blunt splenic trauma? J Pediatr Surg. 45(5):916-20, 2010
                                                                                  17. van der Vlies CH et al: The failure rate of nonoperative management in children with splenic or liver injury with contrast blush on computed tomography: a systematic review. J Pediatr Surg. 45(5):1044-9, 2010
                                                                                  18. Lynn KN et al: Pediatric blunt splenic trauma: a comprehensive review. Pediatr Radiol. 39(9):904-16; quiz 1029-30, 2009
                                                                                  19. Holmes JH 4th et al: The failure of nonoperative management in pediatric solid organ injury: a multi-institutional experience. J Trauma. 59(6):1309-13, 2005
                                                                                  20. Cloutier DR et al: Pediatric splenic injuries with a contrast blush: successful nonoperative management without angiography and embolization. J Pediatr Surg. 39(6):969-71, 2004