Spleen injury

44 yo M, s/p assault by unknown assailant. Left upper quadrant pain.

Routine CT shows splenic injury. On spectral analysis, the large area of devascularized spleen is much better appreciated. Note active extravasation from the lower pole.

Aditional intrasplenic focal enhancement on early images, barely perceptible on delayed conventional images. On 40 keV delayed image, this is much better seen, and is consistent with intrasplenic pseudo aneurysm.

Failure to appreciate post traumatic intrasplenic pseudoaneurysm is a common cause of failure of conservative management.

Early image with intrasplenic focal enhancement

Delayed image conventional

Delayed image 40 keV

Angiogram confirms splenic pseudoaneurysm