Splenic injuries Most common injured in blunt trauma Pathophysiology Direct compression of the organ in the left upper quadrant of the abdomen Deceleration mechanism that tears the splenic capsule or parenchyma, mainly areas fixed or tethered to the retroperitoneum Diagnosis Identification of splenic injuries may occur during laparotomy in unstable patients taken emergently to the operating room Unstable patients with intrabdominal fluid on FAST require exploration, with spleen commonly being the bleeding intra abdominal organ In stable patients, abdominal CT performed with IV contrast is the main stay for diagnosis & characterizing splenic injuries Images are typically obtained with the contrast in the poal venous phase to enhance the splenic parenchyma maximally while being able to visualize the vasculature Splenic injuries appear as disruptions in the normal splenic parenchyma, frequently with surrounding hematoma & free abdominal blood Occasionally, active extravasation of contrast, identified as a high-density blush, can be identified, contained within a pseudoaneurysm or bleeding into the peritoneal space Angiography has been used for injuries that demonstrate active extravasation by CT Angiography can identify specific sites of bleeding from splenic parenchyma & underlying segmental or trabecular vessels, however, it cannot characterize the splenic parenchymal injury but can be complementary to CT Advantage of angiography : Potential to obstruct sites of bleeding endovascularly using angioembolization Patients who are candidates for nonoperative management of their splenic injury but demonstrate a blush by CT, indicating active extravasation, may benefit from angiography with embolization to eliminate the splenic pseudoaneurysm Angiographic embolization is considered only in hemodynamically stable patients Ref: Sabiston 20th edition Pgno :435-437