Imaging description

The fetal spleen is characterized by numerous lobulations that may persist into adulthood [1]. Persistent splenic lobulations are most common along the medial border [1]. A separation between adjacent lobulations is known as a cleft, and may be mistaken for a laceration. Differentiating a cleft from a laceration on contrast-enhanced CT is facilitated by recognition of its characteristic appearance along with additional findings. Splenic clefts typically have smooth rounded margins and are not associated with perisplenic or subcapsular hematoma (Figures 56.1 and 56.2). A cleft may be quite large, measuring up to 3 cm in length. Larger clefts will usually contain fat. Typical imaging appearance with lack of surrounding perisplenic fluid or hematoma favors a cleft.

Importance

Splenic clefts are normal anatomic variants and have no clinical significance. When seen on contrast-enhanced CT, they may be mistaken for lacerations in abdominal trauma patients. Misdiagnosis may lead to unnecessary admission, observation, or further diagnostic workup, but is unlikely to lead to laparotomy now that conservative management of splenic lacerations is so strongly favored.