Learning objectives
To describe the CT imaging features of each splenic trauma injury grade using cases and illustrative diagrams as per the updated 2018 organ injury update.
Background
Splenic injury is a major cause of morbidity and mortality in the setting of blunt trauma, and may require emergent surgery or angioembolization, particularly in high-grade injuries, with the secondary intent to preserve splenic tissue given its immunological function (1,2). Initially published in 1989 (3), ongoing research in regards to organ injuries have lead to an updated splenic, liver, and renal injury scales in 2018 (4).
In particular, the criterion and terminology for CT diagnosed splenic vascular injury has been revised in the recent update,...
Imaging findings OR Procedure details
The updated splenic injury scale as per the 2018 revision is as follows (4):
Grade I:
subcapsular hematoma (surface are: 25% devascularisation)
Grade V:
any injury in the presence of splenic vascular injury with active bleeding (extending beyond the spleen into the peritoneum)
shattered spleen
*Each additional injury denotes an increase in grade, up to grade III.
Vascular injury is now classified as either pseudoaneurysm or arteriovenous fistula. The presence of active bleeding extending into the peritoneum now differentiates grade V from IV (confined active...
Conclusion
Prompt diagnosis and risk grading of splenic injury remains a crucial service provided as a radiologist in the trauma setting. With new updates to vascular injuries in the 2018 organ injury revision, timely interventions and improved patient outcomes may be better facilitated with further familiarity of the imaging features.
References
1. Hildebrand DR, Ben-Sassi A, Ross NP, Macvicar R, Frizelle FA, Watson AJM. Modern management of splenic trauma. BMJ. 2014;348.
2. Zarzaur BL, Dunn JA, Leininger B, Lauerman M, Shanmuganathan K, Kaups K, Zamary K, Hartwell JL, Bhakta A, Myers J, et al. Natural history of splenic vascular abnormalities after blunt injury: a Wester Trauma Association Multicenter trial. Journal of Trauma and Acute Care Surgery. 2017;83(6):999-1005.
3. Moore EE, Shackford SR, Pachter HL, McAninsch JW, Browner BD, Champion HR, Flint LM, Gennarelli TA, Malangoni MA,...