.Spleen laceration History : This 34 years old gentleman had. Severe chest and abdominal pain since traffic accident 2 days ago. Image finding : CXR revealed left lower rib fracture,abdominal CT revealed Gr. III splenic laceration with fluid accumulation in peritoneal cavity. Diagnosis : 1.Spleen laceration 2.Rib fracture DISCUSSION : SPLENIC TRAUMA Most frequently injured intraperitoneal organ in blunt abdominal trauma Associated with: -other solid visceral / bowel injuries (29%); lower rib fractures in 44%, injury to left kidney in 10%, injury to left diaphragm in 2% Technique: -scanning delay of 60-70 sec to avoid the phase of heterogeneous splenic enhancement CT sensitivity: ->95% for splenic injury, but not reliable to determine need for surgical intervention -Attenuation of active extravasation (80-370 HU) exceeds that of splenic parenchyma / clotted blood Prognosis: high PPV for surgery 1.Intrasplenic laceration linear parenchymal defect almost always associated with hemoperitoneum 2.Splenic fracture laceration traverses two capsular surfaces 3.Subcapsular hematoma crescentic lesion along splenic margin flattening / indenting the normally convex lateral margin 4.Perisplenic hematoma "sentinel clot" (= area of >60 HU adjacent to spleen) sensitive predictor of splenic injury 5.Delayed splenic rupture =hemorrhage >48 hours after trauma --Prevalence:0.3-20% of blunt splenic injuries --Time of onset:in 70% within 2 weeks of injury, in 90% within 4 weeks of injury Rx: 52% surgery (splenectomy (8%), splenorrhaphy), 48% nonsurgical management