Being and ER and Trauma radiologist by trade, I had to start with a trauma case. While we do not see a lot of higher-end trauma here, we still do see some and it’s always nice to review these cases as trauma is the leading cause of death in the US for patients under the age of 45. Conveniently, the spleen is the most commonly injured organ in blunt abdominal trauma, hence why I picked a splenic laceration as the first case.
This case demonstrates a grade III splenic laceration as the laceration was just over 3 cm in length. There are two flavors of injury to the spleen, either a laceration or subcapsular hematoma. A laceration will be an irregular, hypoattenuating linear structure in the splenic parenchyma, just like this:
This case demonstrates a grade III splenic laceration as the laceration was just over 3 cm in length. There are two flavors of injury to the spleen, either a laceration or subcapsular hematoma. A laceration will be an irregular, hypoattenuating linear structure in the splenic parenchyma, just like this:
Conversely, a subcapsular hematoma will be low-density, curvilinear fluid surrounding the splenic parenchyma, which is contained by the splenic capsule. You can have one, the other, or both. Evaluating the fluid for an irregular, blush of hyperdense contrast material is of utmost importance for both of these injuries, as that tells the ER physician/Trauma surgeon that there is active bleeding and they may need to call IR or take the patient to surgery. In this case, we did not have active bleeding. I'll have a case with active extravasation later in the year.
The American Association for the Surgery of Trauma (AAST) has a grading scale for traumatic injuries and, generally, a grade 2 or lower injury will be managed conservatively. A grade 3 or higher injury will oftentimes require surgical management. I try to always put in the relevant grading scales as it drives management. Don't try to memorize them; thankfully, these grading scales are online:
The American Association for the Surgery of Trauma (AAST) has a grading scale for traumatic injuries and, generally, a grade 2 or lower injury will be managed conservatively. A grade 3 or higher injury will oftentimes require surgical management. I try to always put in the relevant grading scales as it drives management. Don't try to memorize them; thankfully, these grading scales are online:
Additionally, here’s a great radiology article to get you started on MDCT of Blunt Abdominal Trauma.
Next Case is up.
