The AAST (American Association for the Surgery of Trauma) Grade IV splenic injury on CT scan is characterized by which finding?

• A Subcapsular hematoma >50% surface area or expanding; parenchymal laceration >3 cm depth
• B Laceration involving segmental or hilar vessels producing >25% devascularization ✓
• C Shattered spleen or hilar vascular injury with total devascularization
• D Subcapsular hematoma <10% surface area; parenchymal laceration <1 cm depth

Explanation

AAST splenic injury scale: Grade I = subcapsular hematoma <10% surface area or parenchymal laceration <1 cm; Grade II = subcapsular hematoma 10-50%, laceration 1-3 cm; Grade III = subcapsular hematoma >50% or expanding/ruptured, laceration >3 cm; Grade IV = laceration involving segmental or hilar vessels producing ≥25% splenic devascularization; Grade V = shattered spleen or hilar injury with complete devascularization. Grade IV requires angioembolization consideration; Grade V typically requires splenectomy. Option A describes Grade III; Option C describes Grade V; Option D describes Grade I.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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