الفهرس 
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Abstract
This study was conducted in Assuit University Hospital Trauma Unit and Radiology Department during the period from March 2019 to June 2019. The current study aim to evaluate the role of contrast enhanced MDCT in diagnosis of splenic injury in blunt abdominal trauma. Contrast enhanced CT is a non-invasive method allowing proper visualization of splenic artery, vein and enhanced parenchyma. It’s an audit study carried out in Radiology Department in Assuit University Hospital. Our study included 40 patients. As regard mode of trauma, motor car accident was the most common mode of trauma in our study. The study had 7 patients with grade I, 6 patients with grade II, 19 patients with grade III, 2 patients with grade IV and 6 patients with grade V according to CT based splenic injury scale system that was developed by the American Association for the Surgery of Trauma (AAST) . In our study conservative management was successful in 80% of cases while only 20% of patients had splenectomy. Splenectomy was done in grade IV and V splenic injury and there is significant association between operative management and higher grades of splenic injury. In this study splenic injury was associated with other organ injuries in 14 patients from 40 patients such as hepatic, renal and lung contusion while 26 patients had only splenic injury. There was no significant association between age and grade of splenic injury as well as type of trauma and grade of splenic injury. With the new advancement in multi detector CT the scan time has been significantly delayed reducing motion artefacts and providing good visualization of opacified vessels at angiographic phase with precise localization of the organ injuries with accurate grading of the injury, also it is not affected by obesity, bowel gaseous distension or surgical emphysema, so MDCT become the imaging modality of choice for evaluation of blunt splenic injuries and provide accurate diagnosis including injury grades, associated active bleeding and/or other visceral injury, which are helpful in determining the proper plan for successful management strategy and decreasing the rate of unnecessary exploratory laparotomy. Our results confirm the accuracy of CT in demonstrating splenic injury and the presence and quantity of intraperitoneal hemorrhage. Unfortunately, the capacity of CT to demonstrate and to enable grading of splenic injury can’t reliably help predict the success or failure of nonsurgical management of blunt splenic injury in adults. The potential for delayed progression of initial injury with clinical deterioration exists. In all patients with isolated blunt splenic injury demonstrated with preoperative CT, the decision for surgery should be based strongly on hemodynamic variables, laboratory studies, and serial bedside clinical assessments. Finally after evaluating the practice in our Diagnostic Radiology Department for blunt splenic injury, every patient referred with blunt trauma to the abdomen must do abdominal US (FAST), and for those patients with positive US finding, CECT is mandatory to evaluate the grade of splenic injury as explained by the following algorithm:.