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Congress: ECR25
Poster Number: C-15687
Type: Poster: EPOS Radiologist (educational)
DOI: 10.26044/ecr2025/C-15687
Authorblock: M. E. Oguzturk, I. B. Akin, C. Altay, N. D. Mentes, B. Kandemir, B. N. Yildirim; Izmir/TR
Disclosures:
Muhammed Enes Oguzturk: Nothing to disclose
Isil Başara Akin: Nothing to disclose
Canan Altay: Nothing to disclose
Nihal Deniz Mentes: Nothing to disclose
Bengisu Kandemir: Nothing to disclose
Bilge Nur Yildirim: Nothing to disclose
Keywords: Abdomen, Spleen, Trauma, CT, Staging, Trauma
Findings and procedure details

Splenic injury due to trauma can occur due to blunt, penetrating or iatrogenic causes. The spleen is the most injured organ in blunt abdominal trauma and accounts for a significant proportion of visceral organ injuries (2). Focused Assessment Sonography for Trauma (FAST) should be the imaging modality of first choice in hemodynamically unstable patients. On the other hand, in hemodynamically stable patients, dual-phase contrast-enhanced tomography should be the first choice (3). Several CT-based grading systems for the assessment of splenic injury have been developed to standardize reporting, plan appropriate management, and make comparisons between institutions and studies. However, none of the grading systems correlate well with the need for surgical intervention. Recently, a better correlation between a newly proposed CT grading system and surgical intervention was demonstrated when important CT findings such as active bleeding, pseudoaneurysm, arteriovenous fistula, and severity of hemoperitoneum were included in the grading system. Radiologists should be familiar with CT-based grading systems to facilitate research and communication with surgeons (2). The most used CT grading system for splenic injury in trauma patients is based on the American Association for the Surgery of Trauma (AAST) scale (Fig.1).

Arteriovenous fistula (AVF) of the splenic vessels is rare.

Fig 7: Axial and coronal contrast-enhanced arterial phase tomography shows an A-V fistula associated with the splenic artery in a patient with grade 3 injury.
It is most caused by spontaneous rupture of an existing splenic artery aneurysm into an adjacent vein or traumatic or iatrogenic pseudoaneurysm. Blunt abdominal trauma can sometimes cause vascular injury to the spleen leading to AVF formation (4).

 

AAST GRADING

  • Grade I
    • subcapsular hematoma <10% of surface area
      Fig 2: Shows subcapsular hematoma involving less than 10% of the splenic surface area (Grade 1 injury).
    • parenchymal laceration <1 cm depth
    • capsular tear
  • Grade II
    • subcapsular hematoma 10-50% of surface area
    • intraparenchymal hematoma <5 cm
    • parenchymal laceration 1-3 cm in depth
      Fig 3: Axial contrast-enhanced tomography demonstrates a 2 cm laceration line suggesting a grade 2 injury.
  • Grade III
    • subcapsular hematoma >50% of surface area
      Fig 4: Subcapsular hematoma extending more than 50% of the surface area on contrast-enhanced coronal view indicates grade 3 injury.
    • intraparenchymal hematoma ≥5 cm
    • parenchymal laceration >3 cm in depth
    • ruptured subcapsular or intraparenchymal hematoma
  • Grade IV
    • any injury in the presence of a splenic vascular injury* or active bleeding confined within splenic capsule
    • parenchymal laceration involving segmental or hilar vessels producing >25% devascularization
      Fig 5: Grade 4 injury with hilar vascular injury and more than 25% devascularization.
  • Grade V
    • shattered spleen
      Fig 6: Shows shattered spleen and pseudoaneurysm originating from a branch of the splenic artery in the lower pole of the spleen (Grade 5 Injury).
    • any injury in the presence of splenic vascular injury* with active bleeding extending beyond the spleen into the peritoneum
GALLERY