The spleen is one of the most common organs to be injured during trauma. The spleen receives a large amount of blood supply. Injury to the spleen can therefore be life threatening.
CT is used to assess the severity of injury to the spleen. Many injuries of the spleen can be treated conservatively without surgery in patients who are not actively bleeding.
Symptoms of spleen injury
Patients can experience pain in the left upper abdomen and left lower chest.
Patients who are experiencing blood loss from their injury may have distention of their abdomen, low blood pressure, and fast heart rate.
Some patients may develop peritonitis or an inflamed lining of the abdominal cavity.
The main concern with splenic injury is a splenic rupture. The spleen mainly stores and filters blood. A rupture of the spleen means that the lining of the spleen has torn. This can lead to life threatening bleeding.
How is spleen injury diagnosed?
Splenic injury may be suspected after trauma to the abdomen. An ultrasound is sometimes done looking at the spleen for injuries and for bleeding in the abdomen.
A CT scan is more definitive and can grade injury of the spleen on a scale of 1 to 5. CT can show tears of the spleen, injury to the blood vessels of the spleen, bleeding in or around the spleen and bleeding into the abdominal cavity.
What does spleen injury look like on imaging?
Ultrasound may show blood in the abdominal cavity in some cases of injury to the spleen. When combined with shock, urgent surgical intervention is indicated. We may also see areas of abnormality in spleen itself corresponding to injuries.
X-rays do not show us a splenic injury. We can not see bleeding on X-ray nor can we seen direct splenic injuries. We can see rib fractures in the left lower chest which can be associated with splenic injury.
CT can show us tears of the spleen. The depth of tears or lacerations increases the severity of the injury. The amount of bleeding into or around the spleen increases the severity of injury. CT can show us active bleeding and injury to the blood vessels. The most severe grade of injury is when there is active bleeding into the abdominal cavity.
What else can look like spleen injury in radiology?
There are few diagnostic possibilities when seeing tears or bleeds involving the spleen.
Splenic clefts are something you’re born with. They can mimic a laceration or tear but are smooth in appearance and not associated with bleeding.
Some splenic lesions or masses can mimic a bleed or injury to the spleen.
What causes spleen injury?
Penetrating trauma like a gun shot wound or stabbing injury can cause spleen injury.
Blunt trauma or direct blow to the abdomen can cause spleen injury.
Medical procedures like biopsies and colonoscopies can be associated with splenic injuries.
Is a spleen injury dangerous?
Yes, splenic injury can lead to life threatening bleeding in some cases.
What type of doctor treats spleen injury?
The management of spleen injury is often guided by a multidisciplinary team with surgery often being involved.
Spleen injury treatment
Many cases in which patients are hemodynamically stable or are not actively bleeding are treated conservatively.
Patients who are actively bleeding and develop low blood pressure and shock will be treated surgically.
Some higher grade injuries may be treated by interventional radiologists. Interventional radiology can do an embolization procedure which is non invasive to help stop the bleeding.
Spleen injury: summary
Injuries to the spleen are common in the setting of trauma. Spleen injuries can be life threatening because of blood loss. Often ultrasound and CT are used to diagnose splenic injuries and bleeding.
Treatment is conservative when patients are not actively bleeding. Embolization of the bleed by an interventional radiologists and surgery to remove the injured spleen are options for patients who have active bleeding.