IS Case 83: Splenic Laceration Embolization

Scott Cassar, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-20

History

Patient is a 30-year-old male status post motor vehicle collision.

Findings

Posteroinferior splenic laceration with active extravasation of contrast.

Diagnosis

Splenic Laceration Embolization

Discussion

The spleen is the solid organ most often injured in blunt abdominal trauma. Surgery was the treatment of choice but now is reserved for hemodynamically unstable patients. Stable patients are managed with bed rest, observation, and splenic artery embolization if there is arterial injury. Embolization is usually performed with microcoils as distally as possible in the segment of extravasation to preserve perfusion to the remaining uninjured splenic parenchyma. Also, branches of the splenic artery supply the pancreas body and tail and these branches should be visualized prior to their unintentional embolization.

In the above case, multiple small areas of vascular blush were visualized in the contused inferior spleen. Instead of using multiple microcoils in extremely distal branches, gelfoam was used with excellent result in the superselected artery which supplied the area of contusion.

References

1. 1. Madoff DC, Denys A, Wallace MJ, et al. Splenic arterial interventions: anatomy, indications, technical considerations, and potential complications. Radiographics. 2005 Oct;25 Suppl 1:S191-211. [PMID: 16227491]