Splenic hypoperfusion due to torsion
Severe left upper and lower quadrant pain for several days. Attended 3 emergency departments with no diagnosis made.
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Partial torsion of the spleen causes obstruction of the splenic vein. Hypoperfused spleen, perisplenic minimal fluid, no contrast in splenic vein nearest to the spleen and patent splenic artery is observed on contrast enhanced CT. There is no thrombus in splenic vein.
The cause of splenic torsion appears to be related to issues with the attaching ligaments such as weakening or malformation. Usually splenic torsion is seen in association with a wandering spleen (splenoptosis), however, in this case the spleen seems is in a normal location.