Presentation
The patient visited the emergency department complaining of persistent left upper quadrant pain, after having fallen off his bed the other days.
Patient Data
There are multiple hypodense linear areas in the splenic parechyma, which correspond to parechymal lacerations, due to previous trauma.
There is also a hypodense curvilinear subcapsular fuild collection, due to chronic type haematoma.
A hyperdense capsular calcific line in the non constrast examination probably relates to chronic calcification, rather than in acute blood extravasation, because it is constant through out the whole set of examination.
An ectopic right subclavian artery is noted coursing behind the oesophagus and trachea.
An enhanced left lower lobe segmental atelectasis reveals itself better after the i.v. contrast administration.
Fluid collection can be seen in the left paracolic gutter, which can be tracked down to the douglas area with an isodense to mildly hyperdense appearance.
Case Discussion
Splenic trauma is a very serious emergency situation, which in many instances needs surgical intervention as soon as possible, because any huge blood loss can lead to patient death.
There is a grading system which was introduced in 2018 by the American Association for the Surgery of Trauma (AAST), which correlates to the severity of the trauma and the need for immediate surgical intervention or for conservative medical treatment.
The spleen has a very rich blood supply. Its parechyma is easily succeptible to rupture, because of its inherent fragile nature. This inherent potential danger is exacebrated when the spleen enlarges due to various reasons, such as chronic anaemia , leukaemia, lymphoma, paracitic infections, infectious mononucleosis, e.t.c.
In the presented case the spleen is of median size, but this is not a restricted factor, for a traumatic rupture with a minor trauma, such as falling off the bed. So, in any trauma situation, especially of the left hypochondrium and in a patient with symptomatology of acute blood loss, a possibility of splenic rupture has to be considered.
Unable to process the form. Check for errors and try again.