1. Jalal JalalShokouhi-M.D. jalaljalalshokouhi@hotmail.com Spleen trauma in adults

7. The spleen is the organ that is most frequently injured by blunt abdominal trauma. The extent of the injury can range from subcapsular hemorrhage and parenchymal contusion, to a parenchymal laceration (with or without capsular injury), or a complete splenic rupture. The detection of a subcapsular hemorrhage is important

8. because there is the potential of a lifethreatening hemorrhage in the event of a capsular rupture. Injury to the vascular pedicle leads to splenic infarcts of variable extent. CT has greater than 95%sensitivity in the detection of splenic injuries and is indicated whenever ultrasound findings are inconclusive.

9. A B C

10. Even if a parenchymal defect cannot be directly visualized, the detection of perisplenic blood clots (so called sentinel clots, patchy hyperattenuating structures with CT numbers > 60 HU as compared to 35-45 HU of a hemoperitoneum) provides an indirect sign of parenchymal injury.

11. Faint focal hyperenhancing regions in an otherwise homogenous splenic parenchyma may be an indicator of laceration and are as- 'sociated with an increased risk of delayed rupture. Strongly hyperenhancing regions suggest a traumatic false aneurysm. Splenic laceration may be mimicked by beam-hardening or streak artifacts due to ribs, an air-contrast interface in the stomach, nasogastric tubes, or monitor material.

12. The streaks usually extent beyond the splenic parenchyma. Fissures in a lobulated spleen should not be mistaken for a splenic laceration or rupture. An over-distended stomach compressing the medial border of the spleen may obscure a small laceration.

14. Splenic artery aneurysm

15. Splenic hemorrhage

16. Hemorrhage and laceration, fracture

17. Peri-splenic hematoma or fluid and tear

18. Laceration and intra peritoneal fluid or hemorrhage

19. Intera peritoneal fluid or blood,splenic fracture

20. MRI of spleen fracture

21. Tumor or fracture

22. Infarction, tumor, rupture

23. Splenic explosion

24. Splenic fracture

25. Splenomegaly, partial tear, fluid and plural effusion

26. Splenic hematoma

27. Splenic fracture Spleen

28. Pleural and pulmonary reactions during splenic rupture