All of the following are true regarding splenic rupture except : September 2009
Ans. C: Obliterated colonic gas shadow The most common finding associated with splenic injury is left lower rib fracture. Rib fractures signify that adequate force has been transmitted to cause splenic pathology. The classic triad indicative of acute splenic rupture (ie, left hemidiaphragm elevation, left lower lobe atelectasis, and pleural effusion) is not commonly present and should not be regarded as a reliable sign. However, any patient with apparent left hemidiaphragm elevation following blunt abdominal trauma should be considered to have splenic injury until proven otherwise. More reliable signs of Left Upper Quadrant (LUQ) injury are medial displacement of the gastric bubble and inferior displacement of the splenic flexure gas pattern. These findings are indicative of a LUQ mass and result from either suhcapsular or perisplenic hematoma. LUQ hematoma, if sufficiently large, can displace the shadow of the inferior splenic margin caudally, simulating splenomegaly. Subcapsular hematoma can produce a similar appearance, and the appreciated mass has distinct borders. Associated displacement of the left renal shadow also may be evident. The constitution of findings present when retroperitoneal hemorrhage or free intra-abdominal blood exists contrasts with those mentioned above. Little, if any, mass effect on LUQ organs is apparent. Splenic margins are obscured, but this finding is not specific. Retroperitoneal blood can obliterate the left renal outline and psoas muscle margin. Free blood pools exist dependently in the left paracolic gutter, displacing the descending colon gas pattern medially. Larger amounts of abdominal hemorrhage can obliterate the flank stripe. The small bowel gas pattern can be displaced out of the pelvis by collecting hemorrhage. A midpelvic opacity with sharp convex lateral borders may result. The bladder margin is enhanced and demarcated by a thin lucency outlining the dome and representing extra peritoneal fat.
Elevation of the left dome of diaphragm
Obliterated psoas shadow
Obliterated colonic gas shadow
Obliterated splenic outline