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Abdominal CT, soft tissue window

Abdominal CT, ST window

There is a marked quantity of abdominal free fluid consistent with the hemoabdomen reported in the history. On the precontrast images and on all of the post-contrast vascular-phase images, at the level of the splenic hilus, there is an amorphous, non-enhancing, hypoattenuating area in the spleen measuring 2 cm in size. This area passes vertically through the splenic parenchyma from the visceral capsular surface to the parietal capsular surface. At this level, the splenic capsule is depressed. On the dorsal oblique MPR images, one of the intraparenchymal branches of the splenic vein is localized in this hypoattenuating area and it is focally markedly decreased in size.

Abdominal blunt trauma with splenic rupture involving an intraparenchymal branch of the splenic vein. Conservative treatment with blood transfusion and aggressive fluid therapy was successful. Splenectomy was not performed.

CT is widely used as the initial diagnostic workup in human patients affected by abdominal blunt trauma. Specific CT criteria (grading system) have been established to distinguish surgical from non-surgical patients with liver and spleen rupture (2). Increasing scores are awarded according to the severity of parenchymal trauma, and presence of fluid from localized to distant from the spleen. Following the grading system proposed by Resciniti et al. (2) this dog had a total score of 4 which indicated that delayed celiotomy may be necessary. Conservative treatment was elected because in humans not all patients with a total score greater than or equal to 2.5 need surgery. Noncontrast abdominal ultrasound has low sensitivity for splenic rupture, but contrast-enhanced ultrasound has been recently evaluated (especially for radioprotection issues in pediatric patients) with promising results.

References

  1. C. D. Becker, G. Mentha and F. Terrier. Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Eur Radiol, 1998; 8: 553-562.
  2. A Resciniti, MP Fink, V Raptopoulos, Davidoff, WE Silva. Nonoperative treatment of adult splenic trauma: devel- 46. opment of a computed tomographic scoring system that detects appropriate candidates for expectant management. J Trauma 1998; 28: 828-831.
  3. John P. McGahan, Stephanie Horton Eugenio, O. Gerscovich, Marijo Gillen, John R. Richards, Michael S. Cronan, John M. Brock, Felix Battistella, David H. WisnerJames and F. Holmes Appearance of solid organ injury with contrast-enhanced sonography in blunt abdominal trauma : preliminary experience. AJR 2006; 187: 658-666.