Imaging quiz: A child with multiple trauma
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Splenic and renal infarctions are embolic conditions which usually occur secondary to cardiac problems, thromboembolic systemic diseases, and infectious conditions such as sepsis. Trauma is a relatively rare cause of visceral infarctions. Traumatic segmental renal infarction associated with total splenic infarction is extremely rare. For detecting these visceral infarctions, contrast-enhanced computed tomography is essential, and a very careful examination is required for detecting very small infarctions and excluding total visceral infarctions. In isolated splenic or renal infarctions secondary to trauma, the common contrast-enhanced computed tomography findings are wedge-shaped or segmental hypodense areas in kidneys or spleen and rarely total visceral infarctions. Usually, intraperitoneal or retroperitoneal fluid collection which corresponds to bleeding from kidney or spleen is not seen in such cases. Also, the lack of evidence of active extravasation from renal/splenic arteries and pseudoaneurysm or dissection is an important finding of isolated traumatic splenic or renal infarctions. Because total infarctions can be misinterpreted in some cases, differences in density between intra-abdominal organs allowed by computed tomography must be carefully examined. Intestinal infarctions, the other abdominal injuries, pulmonary injuries, and pelvic or thoracic bone fractures usually accompany traumatic renal or splenic infarctions. In this report, we present contrast-enhanced computed tomography findings of a multitrauma pediatric case of traumatic total splenic and bilateral segmental renal infarction by reviewing the literature.