PATTERNS OF FLUID ACCUMULATION IN SPLENIC TRAUMA - DEMONSTRATION BY CT

Detection of hemoperitoneum in splenic trauma is as important as detec tion of the visceral injury itself. Observation of a consistent spectr um of fluid accumulation in patients with splenic trauma prompted us t o investigate the patterns in more detail. Twenty-three computed tomog raphic (CT) scans in 20 patients were evaluated with respect to presen ce of fluid collections in various peritoneal and retroperitoneal comp artments. These were correlated with severity of injury and operative and pathologic findings. Hemoperitoneum was detected in the pelvis (65 %), paracolic gutters (52%), left subphrenic space (48%), perihepatic space (48%), Morison's pouch (17%) and in the lesser sac (9%). In addi tion to free fluid, pleural fluid (39%) and retroperitoneal hematoma i n the left anterior pararenal space (13%) were also encountered. These ancillary findings may help to substantiate the diagnosis of splenic trauma in equivocal cases, particularly when the spleen itself is obsc ured by artifacts. Early detection may reduce mortality and morbidity associated with splenic trauma.