Imaging of Blunt Splenic Injuries

This chapter provides a comprehensive review of blunt splenic injury. Beginning with a discussion of the physiologic function of the spleen, historical trends in splenic injury management will then be discussed and then the clinical features of splenic injury. An in-depth discussion regarding the different types of splenic injury—lacerations, hematomas, and various vascular injuries—and how they are identified on CT, with associated imaging examples, will be presented. CT techniques are reviewed with a discussion of the various phases of contrast and how different pathologies may be viewed more clearly on certain phases. A review of the grading and management of the blunt splenic injury is provided. The American Association for the Surgery of Trauma (AAST) organ injury scale of splenic injury is used as a guideline in categorizing various splenic injuries and their subsequent management. A thorough discussion is provided of nonoperative management (NOM), surgical management, and selective angiographic embolization, with a brief discussion of potential complications. Finally, the chapter concludes with a discussion of various pitfalls which a radiologist may encounter with splenic injury imaging and ways to identify potential splenic injury mimickers.