Gambaran

By. Uca
Splenic Injury
 the minimal perisplenic
collection.
She was managed
conservatively with uneventful
recovery.
intraparenchymal
subcapsular haematoma involving
haematoma (arrow) less
30%–40% of splenic surface area
than 4 cm in diameter with
(arrow).
no capsular tear.
multiple intraparenchymal lacerations
with subcapsular haematoma (arrow).
Splenectomy was done with blood loss
of 300 mL.
a laceration at upper pole (arrow).
Intraoperative findings confirmed
a 6-cm laceration with
haemoperitoneum of about 1L.
Splenectomy was performed.
Grade Subcapsular Hematoma
III

• Crescent-shaped perisplenic
• Compresses the splenic parenchyma
Splenectomy was
performed for this patient
shattered spleen with large-volume
haemoperitoneum.
focal high attenuation --- due to
active hemorrhage.
Splenectomy was done for this
patient.
non-perfusion of the spleen on
this post contrast image.
Perisplenic hyperdensity --- due
to contrast extravasation.
also a left renal injury (long
arrow).
Liver

• The liver is the second most

commonly injured organ in abdominal
trauma.
• Between 70 and 90% of hepatic
injuries are minor
• Right lobe most commonly affected(4
times)
• Associated injuries:
2/3 have hemoperitoneum
45% have associated splenic injury
33% have rib fractures
Duodenal or pancreatic injury
Biliary injury: hematobilia, biloma, biliary
ascites, bile duct disruption
• Ultrasound sensitive for grade 3 or
greater
 Radiological overview of
liver
injury:
• Right lobe> left lobe; 3:1
• Posterior segment most common
(fixed by coronary ligament)
• CT imaging method of choice
Classification
(AAST) I-Subcapsular hematoma<1cm,
superficial laceration<1cm deep.
II-Parenchymal laceration 1-
3cm deep, subcapsular
hematoma1-3 cm thick.
III-Parenchymal laceration> 3cm deep
and subcapsular hematoma> 3cm
diameter.
 IV-Parenchymal/supcapsular
hematoma> 10cm in diameter, lobar
destruction, OR devascularisation
V-Global destruction or
devascularizatio
n of the liver.
VI-Hepatic avulsion
 Imaging of Renal Trauma

• Computed tomography (CT) is the

modality of choice in the evaluation of
blunt renal injury
• Injury to the kidney is seen in
approximately 8%– 10% of patients
with blunt or penetrating abdominal
injuries
 Renal criteria for
performing CTin
abdominal trauma
• Macroscopic hematuria
• Microscopic hematuria with shock
• Important renal ecchymosis or fracture of
the lumbar transverse process
• Open trauma involving the retroperitoneum
• Mechanism of deceleration (risk of pedicle
injury)
• In children all types of posttraumatic
hematuria
• CT cystography
– Perforation by bony spicules
– "Knuckle" of bladder: Trapped bladder by
displaced fracture of anterior pelvic arch
– Simple (type 4A): Extravasation is
confined to perivesical space
– Complex (type 4B): Extravasation extends
beyond perivesical space; thigh, scrotum,
penis, perineum, anterior abdominal wall,
retroperitoneum or hip joint
– "Molar tooth sign": Rounded cephalic
contour (due to vertical perivesicle
components of extraperitoneal fluid)
CTof extraperitoneal bladder
rupture

MOLAR TOOTH SIGN