Ultrasound detection of blunt splenic injury

The purpose of this study was to determine the sensitivity of emergency ult rasound (US) for the detection of blunt splenic injury (BSI), and to descri be sonographic parenchymal patterns. Over 3 years, 2138 emergency US were p erformed, and 162 patients had BSI. CT was performed for 76 patients, and t here were 86 laparotomies. Seventy patients (43%) had concomitant intraabdo minal injuries. Ultrasound detected free fluid in 109 patients (67%), and p arenchymal injury in 31 patients (19%). There were 48 false negative US (30 %). Sonographic patterns included a diffuse heterogeneous appearance, hyper echoic and hypoechoic perisplenic crescents, and discrete hypoechoic or hyp erechoic areas within the spleen. Overall sensitivity of US for detection o f BSI was 69%, but was 86% for grade III or higher injuries. Ultrasound is most sensitive for the detection of grade III or higher BSI based on the pr esence of haemoperitoneum. Ultrasound may also identify BSI on the basis of parenchymal abnormality, with a diffuse heterogeneous pattern most commonl y encountered. Sonographic evaluation for both free fluid and parenchymal i njury improves sensitivity of US. (C) 2001 Elsevier Science Ltd. All rights reserved.