Presentation
Recent diagnosis with multiple myeloma. 24 hour history of profuse watery diarrhoea and vomiting, abdominal distension, epigastric tenderness. Hypotensive 63/50 and tachycardic 120 bpm.
Patient Data
Large volume of heterogeneous fluid within the abdomen, with layering of different attenuation. This is denser than simple fluid and consistent with blood. This is centred on the spleen, with a small linear region of low attenuation within the medial aspect of the spleen, concerning for rupture/laceration. Anteriorly, the margin of the spleen is also ill-defined and potentially disrupted. Adjacent to the lateral aspect of the spleen, there is a linear region of higher attenuation, concerning for active contrast extravasation. Small splenunculus.
Case Discussion
This is an interesting case of spontaneous splenic rupture in a patient with a recent diagnosis of myeloma. There was no history of trauma and no other obvious cause for presentation. Patient had been started on anticoagulation recently and this may have therefore contributed.
The examination was carried out as a single portal venous scan as the clinical history was not particularly suggestive of haemorrhage - this was however sufficient to make the diagnosis.
Patient went for emergency splenectomy, where splenic rupture was confirmed. They recovered well post-operatively.