EUROPEAN JOURNAL

OF

ELSEVIER European Journal of Ultrasound 2 (1995) 289-292

Clinical report
Splenic hematoma diagnosed with Colour Doppler Energy:
Case report

Anders Nilsson* a, A ke Lasson b, Tomas Lindhagen b, Ingemar Lo&n”, Paul Nilsson”

aDepartment of Radiology. MalmS General Hospital, S-214 01 Malmii, Sweden
bDepartment of Surgery. Malmii General Hospital, S-214 01 Malmii. Sweden

Received 10 December 1994; revision received 12 May 1995; accepted 19 May 1995

Abstract

The method of choice in the work-up of a patient with blunt abdominal trauma is contrast enhanced computed to-
mography (CT) as B-mode ultrasound alone is insensitive to intraparenchymal changes in the early stages. We describe
a case where ultrasound together with Colour Doppler Energy (CDE) correctly diagnosed a splenic rup-
ture/haematoma by demonstrating lack of perfusion in the upper pole of the spleen.

Keywordr: Spleen; Trauma; Ultrasound; Colour Doppler Energy imaging

1. case then there where no neurological symptoms, ex-

A Cyear-old boy was admitted to the emergency
unit having sustained blunt traumata to his head
and the abdominal left upper quadrant. On admis-
sion he was not fully conscious and complained of
abdominal pain.
A clinical examination revealed tenderness in
the left upper abdomen and he was referred for a
cranial and an abdominal CT to exclude a haemor-
rhage in both these locations. This, however, could
not be done without general anaesthesia and as by
* Corresponding author.
pectant treatment was decided on. An ultrasound
scan was performed instead, using an Acuson 128
XP (Mountainview, Ca, USA) with CDE (Tessler
and Rifkin 1994) software installed. Small
amounts of free fluid were found in the abdomen
on a B-mode scan with minute collections both
under the liver and adjacent to the spleen. When
supplemented with CDE, perfusion could be seen
in all parts of the liver, both kidneys and the
caudal two thirds of the spleen (Fig. 1). The upper
pole of the spleen, however, showed a near total
lack of perfusion as judged by the amount of
colour presented on the screen in CDE mode,

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290 A. Nilsson et al. /European Journal of Ultrasound 2 (1995) 289-292

Fig. I. Normal blood flow in the lower pole of the spleen. The colour box also includes part of the left kidney.

Fig. 2. No flow signals in the upper pole of the spleen (arrows).

 A. NiLEsonet al. /European Journal of Ultrasound 2 (1995) 289-292
Fig. 3. Contrast enhanced CT scan showing haematoma and
laceration of the upper pole of the spleen (arrows).
despite the same image quality and machine set-
ting (Fig. 2). The finding was interpreted as either
a splenic laceration with disruption of the blood
supply or a large isoechogenic haematoma and the
Fig. 4. Isoechogenic area without flow signals. Well demarcated on follow-up after 3 days.
291
patient transferred to the intensive care unit for
supervision. The day after, the ultrasound finding
was confirmed by a contrast-enhanced CT that
demonstrated laceration of the cranial part of the
spleen with a haematoma in and around the
damaged area (Fig. 3). On follow-up ultrasound
three days after the initial admission B-mode was
still inconclusive but a 3 x 3 cm large, well demar-
cated area was seen without perfusion detectable
with CDE (Fig. 4). The patient recovered unevent-
fully and was released from hospital three days
later.
2. Discussion
It is generally accepted that in the initial exami-
nation of a patient with blunt abdominal trauma,
CT is the method of choice (Jeffrey 1989). With
contrast enhanced scans, it has the ability to show
haemorrhages, parenchymal tears and lack of per-
fusion in all or part of an organ like liver, spleen
or kidney. The role of ultrasound has been limited
to searching for free abdominal fluid, as B-mode
292 A. Nilsson et al. /European Journal of Ultrasound 2 (1995) 289-292
usually lacks the sensitivity to pick up more subtle
intraparenchymal changes during the early stages.
Colour Doppler Energy (CDE) is a new
Doppler-based flow detecting ultrasound modality
where, compared to conventional colour Doppler,
the amount of colour on the screen is dependent
on the amount of moving reflectors rather than
their velocity. Information on velocity of flow is
traded for sensitivity and, at least in children,
where imaging conditions are nearly always opti-
mal, that would give CDE the potential to assess
perfusion, or lack of, in parenchymal organs like
the spleen. It could possibly also show an other-
wise isoechogenic haematoma as a circumscribed
area without flow signals. Conventional colour
Doppler lacks the sensitivity to produce the colour
‘blush’ in the parenchyma that makes this infor-
mation readily available.
In the above presented case ultrasound with
CDE provided such information and a subse-
quently CT-confirmed splenic rupture/haematoma
could be detected.
In conclusion, further research is warranted as
CDE may offer an alternative when CT is un-
suitable or difficult to perform as in our case with
a small child that would have needed general
anaesthesia.
References
[l] Tessler F, Ri!kin M. Color Doppler Energy imaging. Adm
Radio1 1994; 17-20.
[2] Jeffrey RB Jr. CT and Sonography of the Acute Ab-
domen. Raven Press, New York 1989; l-9, 77-90:
149-159.