History :
This 34 years old gentleman had. Severe chest and abdominal pain since traffic accident 2 days ago.

Image finding :
CXR revealed left lower rib fracture,abdominal CT revealed Gr. III splenic laceration with fluid accumulation in peritoneal cavity.

Diagnosis :
1.Spleen laceration 2.Rib fracture

DISCUSSION :
SPLENIC TRAUMA
Most frequently injured intraperitoneal organ in blunt abdominal trauma

Associated with:
-other solid visceral / bowel injuries (29%); lower rib fractures in 44%, injury to left kidney in 10%, injury to left diaphragm in 2% Technique:
-scanning delay of 60-70 sec to avoid the phase of heterogeneous splenic enhancement

CT sensitivity:
->95% for splenic injury, but not reliable to determine need for surgical intervention
-Attenuation of active extravasation (80-370 HU) exceeds that of splenic parenchyma / clotted blood

Prognosis:
high PPV for surgery

1. Intrasplenic laceration linear parenchymal defect almost always associated with hemoperitoneum
2. Splenic fracture laceration traverses two capsular surfaces
3. Subcapsular hematoma crescentic lesion along splenic margin flattening / indenting the normally convex lateral margin
4. Perisplenic hematoma "sentinel clot" (= area of >60 HU adjacent to spleen) sensitive predictor of splenic injury
5. Delayed splenic rupture =hemorrhage >48 hours after trauma --Prevalence:0.3-20% of blunt splenic injuries
   --Time of onset:in 70% within 2 weeks of injury, in 90% within 4 weeks of injury

Rx:
52% surgery (splenectomy (8%), splenorrhaphy), 48% nonsurgical management