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Splenic Trauma
Siva P. Raman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Splenic laceration or splenic fracture
          • Definitions

            • Splenic parenchymal injury ± capsule disruption

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • Ultrasonographic Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      Selected References

                                      1. Leung E et al: Contemporary endovascular management of splenic vascular pathologies. Clin Radiol. 75(12):960.e-34, 2020
                                      2. Morell-Hofert D et al: Validation of the revised 2018 AAST-OIS classification and the CT severity index for prediction of operative management and survival in patients with blunt spleen and liver injuries. Eur Radiol. 30(12):6570-81, 2020
                                      3. O'Neill SB et al: Changes in approach to solid organ injury: what the radiologist needs to know. Can Assoc Radiol J. 71(3):352-61, 2020
                                      4. Basaran A et al: Evaluation of intra-abdominal solid organ injuries in children. Acta Biomed. 89(4):505-12, 2019
                                      5. Shi H et al: CT of blunt splenic injuries: what the trauma team wants to know from the radiologist. Clin Radiol. 74(12):903-11, 2019
                                      6. Kozar RA et al: Organ injury scaling 2018 update: spleen, liver, and kidney. J Trauma Acute Care Surg. 85(6):1119-22, 2018
                                      7. Uyeda JW et al: Active hemorrhage and vascular injuries in splenic trauma: utility of the arterial phase in multidetector CT. Radiology. 270(1):99-106, 2014
                                      8. Boscak AR et al: Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans. Radiology. 268(1):79-88, 2013
                                      9. Post R et al: Computed tomography blush and splenic injury: does it always require angioembolization? Am Surg. 79(10):1089-92, 2013
                                      10. Singla S et al: Splenic injury during colonoscopy--a complication that warrants urgent attention. J Gastrointest Surg. 16(6):1225-34, 2012
                                      11. Salimi J et al: Diagnostic accuracy of CT scan in abdominal blunt trauma. Chin J Traumatol. 12(2):67-70, 2009
                                      12. Tang J et al: Comparison of gray-scale contrast-enhanced ultrasonography with contrast-enhanced computed tomography in different grading of blunt hepatic and splenic trauma: an animal experiment. Ultrasound Med Biol. 35(4):566-75, 2009
                                      13. Danelson KA et al: Volumetric splenic injury measurement in ct scans for comparison with injury score. Biomed Sci Instrum. 44:159-64, 2008
                                      14. Matsushima K: The efficacy of serial computed tomography (CT) for blunt splenic injury. J Trauma. 65(6):1570-1, 2008
                                      15. Marmery H et al: Optimization of selection for nonoperative management of blunt splenic injury: comparison of MDCT grading systems. AJR Am J Roentgenol. 189(6):1421-7, 2007
                                      16. Thorelius L: Emergency real-time contrast-enhanced ultrasonography for detection of solid organ injuries. Eur Radiol. 17 Suppl 6:F107-11, 2007
                                      17. Becker CD et al: The trauma concept: the role of MDCT in the diagnosis and management of visceral injuries. Eur Radiol. 15 Suppl 4:D105-9, 2005
                                      18. Chen LY et al: The role of diagnostic algorithms in the management of blunt splenic injury. J Chin Med Assoc. 68(8):373-8, 2005
                                      19. Cooney R et al: Limitations of splenic angioembolization in treating blunt splenic injury. J Trauma. 59(4):926-32; discussion 932, 2005
                                      20. Doody O et al: Blunt trauma to the spleen: ultrasonographic findings. Clin Radiol. 60(9):968-76, 2005
                                      21. Fata P et al: A survey of EAST member practices in blunt splenic injury: a description of current trends and opportunities for improvement. J Trauma. 59(4):836-41; discussion 841-2, 2005
                                      22. Haan JM et al: Nonoperative management of blunt splenic injury: a 5-year experience. J Trauma. 58(3):492-8, 2005
                                      23. Harbrecht BG et al: Is outcome after blunt splenic injury in adults better in high-volume trauma centers? Am Surg. 71(11):942-8; discussion 948-9, 2005
                                      24. Peitzman AB et al: Failure of observation of blunt splenic injury in adults: variability in practice and adverse consequences. J Am Coll Surg. 201(2):179-87, 2005
                                      25. Rhodes CA et al: Clinical outcome of active extravasation in splenic trauma. Emerg Radiol. 11(6):348-52, 2005
                                      26. Rozycki GS et al: Surgeon-performed bedside organ assessment with sonography after trauma (BOAST): a pilot study from the WTA Multicenter Group. J Trauma. 59(6):1356-64, 2005
                                      27. Sharma OP et al: Assessment of nonoperative management of blunt spleen and liver trauma. Am Surg. 71(5):379-86, 2005
                                      28. Shen HB et al: Clinical application of laparoscopic spleen-preserving operation in traumatic spleen rupture. Chin J Traumatol. 8(5):293-6, 2005
                                      29. Smith J et al: Abdominal trauma: a disease in evolution. ANZ J Surg. 75(9):790-4, 2005
                                      30. Shanmuganathan K: Multi-detector row CT imaging of blunt abdominal trauma. Semin Ultrasound CT MR. 25(2):180-204, 2004
                                      31. Wahl WL et al: Blunt splenic injury: operation versus angiographic embolization. Surgery. 136(4):891-9, 2004
                                      32. Katz S et al: Can ultrasonography replace computed tomography in the initial assessment of children with blunt abdominal trauma? J Pediatr Surg. 31(5):649-51, 1996
                                      33. Black JJ et al: Subcapsular hematoma as a predictor of delayed splenic rupture. Am Surg. 58(12):732-5, 1992
                                      34. Jeffrey RB Jr et al: Detection of active intraabdominal arterial hemorrhage: value of dynamic contrast-enhanced CT. AJR Am J Roentgenol. 156(4):725-9, 1991
                                      35. Jeffrey RB Jr: CT diagnosis of blunt hepatic and splenic injuries: a look to the future. Radiology. 171(1):17-8, 1989
                                      36. Orwig D et al: Localized clotted blood as evidence of visceral trauma on CT: the sentinel clot sign. AJR Am J Roentgenol. 153(4):747-9, 1989
                                      37. Federle MP et al: Splenic trauma: evaluation with CT. Radiology. 162(1 Pt 1):69-71, 1987
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Synonyms

                                                • Splenic laceration or splenic fracture
                                              • Definitions

                                                • Splenic parenchymal injury ± capsule disruption

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • CT Findings

                                                    • Ultrasonographic Findings

                                                      • Angiographic Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Staging, Grading, & Classification

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          Selected References

                                                                          1. Leung E et al: Contemporary endovascular management of splenic vascular pathologies. Clin Radiol. 75(12):960.e-34, 2020
                                                                          2. Morell-Hofert D et al: Validation of the revised 2018 AAST-OIS classification and the CT severity index for prediction of operative management and survival in patients with blunt spleen and liver injuries. Eur Radiol. 30(12):6570-81, 2020
                                                                          3. O'Neill SB et al: Changes in approach to solid organ injury: what the radiologist needs to know. Can Assoc Radiol J. 71(3):352-61, 2020
                                                                          4. Basaran A et al: Evaluation of intra-abdominal solid organ injuries in children. Acta Biomed. 89(4):505-12, 2019
                                                                          5. Shi H et al: CT of blunt splenic injuries: what the trauma team wants to know from the radiologist. Clin Radiol. 74(12):903-11, 2019
                                                                          6. Kozar RA et al: Organ injury scaling 2018 update: spleen, liver, and kidney. J Trauma Acute Care Surg. 85(6):1119-22, 2018
                                                                          7. Uyeda JW et al: Active hemorrhage and vascular injuries in splenic trauma: utility of the arterial phase in multidetector CT. Radiology. 270(1):99-106, 2014
                                                                          8. Boscak AR et al: Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans. Radiology. 268(1):79-88, 2013
                                                                          9. Post R et al: Computed tomography blush and splenic injury: does it always require angioembolization? Am Surg. 79(10):1089-92, 2013
                                                                          10. Singla S et al: Splenic injury during colonoscopy--a complication that warrants urgent attention. J Gastrointest Surg. 16(6):1225-34, 2012
                                                                          11. Salimi J et al: Diagnostic accuracy of CT scan in abdominal blunt trauma. Chin J Traumatol. 12(2):67-70, 2009
                                                                          12. Tang J et al: Comparison of gray-scale contrast-enhanced ultrasonography with contrast-enhanced computed tomography in different grading of blunt hepatic and splenic trauma: an animal experiment. Ultrasound Med Biol. 35(4):566-75, 2009
                                                                          13. Danelson KA et al: Volumetric splenic injury measurement in ct scans for comparison with injury score. Biomed Sci Instrum. 44:159-64, 2008
                                                                          14. Matsushima K: The efficacy of serial computed tomography (CT) for blunt splenic injury. J Trauma. 65(6):1570-1, 2008
                                                                          15. Marmery H et al: Optimization of selection for nonoperative management of blunt splenic injury: comparison of MDCT grading systems. AJR Am J Roentgenol. 189(6):1421-7, 2007
                                                                          16. Thorelius L: Emergency real-time contrast-enhanced ultrasonography for detection of solid organ injuries. Eur Radiol. 17 Suppl 6:F107-11, 2007
                                                                          17. Becker CD et al: The trauma concept: the role of MDCT in the diagnosis and management of visceral injuries. Eur Radiol. 15 Suppl 4:D105-9, 2005
                                                                          18. Chen LY et al: The role of diagnostic algorithms in the management of blunt splenic injury. J Chin Med Assoc. 68(8):373-8, 2005
                                                                          19. Cooney R et al: Limitations of splenic angioembolization in treating blunt splenic injury. J Trauma. 59(4):926-32; discussion 932, 2005
                                                                          20. Doody O et al: Blunt trauma to the spleen: ultrasonographic findings. Clin Radiol. 60(9):968-76, 2005
                                                                          21. Fata P et al: A survey of EAST member practices in blunt splenic injury: a description of current trends and opportunities for improvement. J Trauma. 59(4):836-41; discussion 841-2, 2005
                                                                          22. Haan JM et al: Nonoperative management of blunt splenic injury: a 5-year experience. J Trauma. 58(3):492-8, 2005
                                                                          23. Harbrecht BG et al: Is outcome after blunt splenic injury in adults better in high-volume trauma centers? Am Surg. 71(11):942-8; discussion 948-9, 2005
                                                                          24. Peitzman AB et al: Failure of observation of blunt splenic injury in adults: variability in practice and adverse consequences. J Am Coll Surg. 201(2):179-87, 2005
                                                                          25. Rhodes CA et al: Clinical outcome of active extravasation in splenic trauma. Emerg Radiol. 11(6):348-52, 2005
                                                                          26. Rozycki GS et al: Surgeon-performed bedside organ assessment with sonography after trauma (BOAST): a pilot study from the WTA Multicenter Group. J Trauma. 59(6):1356-64, 2005
                                                                          27. Sharma OP et al: Assessment of nonoperative management of blunt spleen and liver trauma. Am Surg. 71(5):379-86, 2005
                                                                          28. Shen HB et al: Clinical application of laparoscopic spleen-preserving operation in traumatic spleen rupture. Chin J Traumatol. 8(5):293-6, 2005
                                                                          29. Smith J et al: Abdominal trauma: a disease in evolution. ANZ J Surg. 75(9):790-4, 2005
                                                                          30. Shanmuganathan K: Multi-detector row CT imaging of blunt abdominal trauma. Semin Ultrasound CT MR. 25(2):180-204, 2004
                                                                          31. Wahl WL et al: Blunt splenic injury: operation versus angiographic embolization. Surgery. 136(4):891-9, 2004
                                                                          32. Katz S et al: Can ultrasonography replace computed tomography in the initial assessment of children with blunt abdominal trauma? J Pediatr Surg. 31(5):649-51, 1996
                                                                          33. Black JJ et al: Subcapsular hematoma as a predictor of delayed splenic rupture. Am Surg. 58(12):732-5, 1992
                                                                          34. Jeffrey RB Jr et al: Detection of active intraabdominal arterial hemorrhage: value of dynamic contrast-enhanced CT. AJR Am J Roentgenol. 156(4):725-9, 1991
                                                                          35. Jeffrey RB Jr: CT diagnosis of blunt hepatic and splenic injuries: a look to the future. Radiology. 171(1):17-8, 1989
                                                                          36. Orwig D et al: Localized clotted blood as evidence of visceral trauma on CT: the sentinel clot sign. AJR Am J Roentgenol. 153(4):747-9, 1989
                                                                          37. Federle MP et al: Splenic trauma: evaluation with CT. Radiology. 162(1 Pt 1):69-71, 1987