Blunt liver and spleen injuries: CT grading versus intra-operative findings

Case contribution: Dr Radhiana Hassan


  • A 33 years old man
  • Alleged MVA, car versus lorry
  • Complaint of abdominal pain
  • Clinically guarded abdomen, not distended
  • BP=100/60mmHg, PR=110 bpm, Hb=11.6 gm/dL
  • Bedside ultrasound shows fluid surrounding the spleen
Contrast-enhanced CT scan of abdomen and pelvis in axial plane soft tissue window
CT scan of abdomen and pelvis in axial planes; bone window (upper row) and lung window (lower row)

CT scan findings:

  • There is intraparenchymal laceration in Segment VII of liver (yellow arrows) about 4 cm in length. No extension to liver capsule. This is consistent with Grade II liver injury.
  • Multiple intraparenchymal hematomas in spleen (red arrows), the largest one measures about 3×2 cm. There is associated minimal perisplenic collection. Superficial lacerations are also seen. This is consistent with Grade II spleen injury.
  • Fracture of transverse process of right L2/L3 (white arrows)
  • Presence of right hydropneumothorax (blue arrows)
  • Subcutaneous emphysema bilaterally (orange arrows)

Intra-operative findings:

  • Ruptured spleen Grade V, bleeding from pedicle
  • Liver, no obvious injury
  • Pancreas, kidneys and bowels are normal
  • No mesenteric hematoma
  • Splenectomy done

Diagnosis: Blunt abdominal trauma with liver and spleen injuries.


  • Discrepancies between CT injury grading with intra-operative findings is well documented in previous studies. The discrepancy can be as high as 85%.
  • CT findings generally underestimates the severity of injury.
  • Thus, clinical correlation is still an important in managing patient with blunt abdominal trauma in deciding whether operative management is required.


Author: radhianahassan