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RADIOLOGY: SPLEEN: Case# 32819: ASYMPTOMATIC SPLENIC LACERATION P MVA. This is a 32-year-old male who was involved in an MVA. The patient has a decreasing hematocrit from 32 to 27. Noncontrast examination reveals multiple mixed low and high attenuation regions within the spleen consistent with splenic injury. There are multiple splenic fractures extending through the capsule with multiple areas of mixed high and low attenuation.The liver, gallbladder, pancreas, biliary ductal system, major abdominal vasculature, genitourinary tract, and gastrointestinal tract are unremarkable. There is diffuse intraperitoneal hemorrhage extending around the liver into the pelvis and Morrisons pouch. The spleen is the most commonly injured intra-abdominal organ following blunt trauma. Splenic laceration may occur with or without subcapsular hematoma formtation. CT findings include splenomegaly, an irregular cleft or defect in the splenic border, irregular low density fracture lines, and the presence of blood in the peritoneal cavity. The hematoma may have a multilayered appearance. Conservative management of splenic trauma is becoming more prevalent since there is an increased risk of infection in patients who have undergone splenectomy. Some surgeons are performing splenorrhaphy, suturing the spleen without removal. CT may be helpful in the postoperative evaluation of these patients.

Peter Anderson
radiology, spleen