A 46 y.o. woman presents 5 days after an assault in which she sustained rib fractures of the 9th and 10th rib on the left
She continues to complain of L flank pain. What do you see on CT?
Our patient had splenic artery pseudoaneurysms. Pseudoaneurysms have a similar appearance to active hemorrhage but they are contained and do not increase in sized on delayed phases . They are similar to AVMs on CT. Pseudoaneursyms and delayed hemorrhage can occur five days or more after injury and a repeat CT is recommended after injury to the spleen.
splenic artery pseudoaneursyms five days after injury
Splenic rupture is the most frequent serious abdominal injury following blunt abdominal trauma. It is most common in a diseased spleen but also occurs in normal spleens. The classic triad for splenic rupture is elevation of the L hemidiaphragm, LLL atelectasis and L pleural effusion however this is rarely present. The CT scan has vastly improved the diagnosis of splenic injury with ultrasound only useful when the splenic injury is grade III or worse . The mortality of acute rupture of the spleen is 1% but if there is delayed rupture of the spleen as in our patient; the mortality increases to 15%. Delayed rupture is defined as rupture more than 48 hours after injury. Cases have been reported with delayed rupture and a normal initial CT.
A 49 y.o. with normal spleen post MVC and C2 fracture
this is the same 49 y.o. pt three days later showing a splenic rupture
The mechanism of delayed rupture is felt to be either increased capsular pressure secondary to clot lysis and increase in oncotic pressure causing rupture of the capsule or development of traumatic pseudoaneursyms which then rupture.
Our patient underwent splenectomy and recovered without complications.
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