spleen

Grades of Splenic Injury – Image based Question

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Q) 45 year old male with road side accident and fracture of 3 ribs on left side. CT scan of the abdomen is shown below. Out of the five grades of splenic injury What is the grade  in him ?

Splenic Injury grades

 

 

 

 

 

a) Grade II

b) Grade III

c) Grade IV

d) Grade V 

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Ans b Grade III

Grade 1
Subcapsular haematoma <10% of surface area
Parenchymal laceration <1 cm depth Capsular tear
Grade 2
Subcapsular haematoma 10–50% of surface area; Intraparenchymal haematoma <5 cm
Parenchymal laceration 1–3 cm
Grade 3
Subcapsular haematoma >50% surface area; ruptured subcapsular or intraparenchymal haematoma ≥5 cm Parenchymal laceration >3 cm depth
Grade 4
Any injury in the presence of a splenic vascular
injury or active bleeding confned within the splenic
capsule
Parenchymal laceration involving segmental or hilar
vessels producing >25% devascularisation
Grade 5
Any injury in the presence of splenic vascular injurya
with active bleeding extending beyond the spleen
into the peritoneum – shattered spleen
Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging.
Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that
increases in size or attenuation in the delayed phase

Splenic cyst

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Q) A 35 year old asymptomatic male   undergoes a routine USG which reveals a 3 cm Splenic cyst. There is a prior history of trauma 2 months back. CT Shows smooth, unilocular, thick walled lesion. What should be further management

a) Conservative

b) Partial Splenectomy

c) Total Splenectomy

d) Percutaneous Aspiration

OPSI

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Q) True about OPSI is 

a) OPSI is over estimated and not seen 2 years after splenectomy

b) Focus of infection is always in the lung or abdomen

c)  Despite antibiotics and intensive care, the mortality rate is between 50% and 70% for full blown OPSI

d) H. influenza is the most common organism

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Splenectomy

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Q) Which of the following is not an indication for splenectomy in Non Hodgkin Lymphoma?
 
a)  Massive splenomegaly
b) Signs of hypersplenism
c) Diagnosing and staging of isolated splenic disease

d) All are indications for splenectomy

The correct answer is: d) All are indications for splenectomy

Explanation:

In Non-Hodgkin Lymphoma (NHL), splenectomy may be considered in the following scenarios:

  • Massive splenomegaly causing symptoms or complications like infarction, pain, or risk of rupture.

  • Hypersplenism, which leads to cytopenias (low counts of blood cells) that are not responsive to medical therapy.

  • Diagnostic and staging purposes, especially in isolated splenic disease where biopsy is inconclusive or not feasible.

 

Accessory spleen

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Q  Most common  site of accessory spleen ( # CET 2017 ) 
A. Hilum
B. Gastrosplenic ligament
C. Mesentery
D. Retroperitoneal