The spleen is the most frequently injured organ in blunt abdominal trauma. Injuries can range from subcapsular hematoma to splenic fracture. On imaging studies a subcapsular hematoma will compress the lateral margin of the spleen. A laceration appears as a hypodense linear cleft through the splenic parenchyma. A fracture is a laceration that extends through the splenic hilum, isolating a fragment of splenic tissue.
The above CECT demonstrates a large subcapsular splenic hematoma causing compression and medial deviation of the spleen. A focus of high density within this hematoma represents active contrast extravasation. Angiogram of the splenic artery shows a blush of contrast near the inferior splenic pole which was successfully embolized with Gelfoam.
Roberts JL, Dalen K, Bosanko CM, et al. CT in abdominal and pelvic trauma. Radiographics 1993;13:735-52.