Presentation
Nonspecific upper abdominal pain. Lactate elevated on blood tests.
Patient Data
![](https://prod-images-static.radiopaedia.org/images/22280484/5133dfabfe985653e28ea656baf370_thumb.jpeg)
![](https://prod-images-static.radiopaedia.org/images/22280492/964579c0afb92be01cfdbe33af4168_thumb.jpeg)
![](https://prod-images-static.radiopaedia.org/images/22280484/5133dfabfe985653e28ea656baf370_big_gallery.jpeg)
On these portal vein images, the spleen shows to be heterogeneously hypoperfused.
![](https://prod-images-static.radiopaedia.org/images/22280452/c02de970b1a7bafc14afe5a8791294_thumb.jpeg)
![](https://prod-images-static.radiopaedia.org/images/22280460/cf16cb8cc049bf3d540897487af31c_thumb.jpeg)
![](https://prod-images-static.radiopaedia.org/images/22280461/b6245576de455f01531a5ed0303edd_thumb.jpeg)
![](https://prod-images-static.radiopaedia.org/images/22280475/fec3a7255196261ef348061d5632c1_thumb.jpeg)
![](https://prod-images-static.radiopaedia.org/images/22280452/c02de970b1a7bafc14afe5a8791294_big_gallery.jpeg)
The spleen has heterogeneous echogenicity with an irregular contour in its upper posterolateral aspect with anechoic fluid in between these irregularities and the left diaphragm. A small pleural effusion is also noted on the left. Free fluid within the abdomen.
Case Discussion
This patient had CPK and LDH elevated. CT raised the suspicion for a perfusional disturbance involving the spleen, ultrasound 4 days later demonstrated heterogeneous echogenicity and irregular margins associated with subphrenic fluid. Features that are in keeping with splenic infarct with liquefaction.