Presentation
Left upper quadrant abdominal pain. Recent flu like symptoms.
Patient Data
Small left pleural effusion. Splenomegaly. Large subcapsular splenic hematoma. No contrast extravasation on the arterial phase images to suggest active arterial hemorrhage. Free fluid in the peritoneal cavity, left para-colic gutter and pouch of Douglas. No pneumoperitoneum.
Splenomegaly (14.5 cm). Organized subcapsular splenic collection (203 cc, 173 x 34 x 71 mm) consistent with the known subsplenic hematoma. Left pleural effusion.
This study was used as a baseline for future comparison.
Case Discussion
The patient's EBV PCR was positive. In combination with her flu like symptoms the diagnosis of infectious mononucleosis was made. The associated splenomegaly and subcapsular splenic hematoma caused hemoperitoneum dropping the hemoglobin to 83. The patient was transfused 1 unit of packed red blood cells, due to concern of ongoing losses and tachycardia. This case was managed conservatively.
The treatment of splenic hematoma includes a conservative watch and wait approach, endovascular embolization and splenectomy.