Splenic injury was graded according to the different damage of surface area, Lac-capsular tear, intraparenchymal and involving trabecular vessels.
Now that abdominal ultrasound is the main choice of screening modalities to detect solid injuries in general. Take splenic fracture for example, we often found fluid inside abdominal space ( Morison’s pouch) as a truthful sign. According to AAST which is known as American Association for the Surgery of Trauma, there are 5 levels of splenic injury grading from I to V. However in practice, most surgeons tend to manage the patients symptomatically regardless of the grade.
Nonetheless, the Grades are as follows:
I- Hematoma – subcapsular <25% surface area, Lac-capsular tear, <1cm depth.
II-Hematoma- subcapsular 25-50% surface area, intraparenchymal 50% surface area. Intraparenchymal >10cm expanding. Lac- >3m involving trabecular vessels.
IV-Lac – involving segmental/hilar vessels with devascularization of >25%.
V- Lac- Shattered spleen. Vascular – Total splenic devascularization.
A young man who arrived at Thu Duc hospital because of blunt injury ( after fighting with another man). He was checked on abdominal ultrasound scan with hypoechoic fluid in his abdomen and splenic injury. On ct scan, he has same finding for splenic fracture with grades III because he has a laceration more than 30mm in depth.
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