Return to Contact Sports following Infectious Mononucleosis: The Role of Serial Ultrasonography

Abstract

Splenic rupture is a rare but potentially fatal complication of infectious mononucleosis. Athletes returning to contact sports following infectious mononucleosis are at potential risk of splenic rupture secondary to abdominal trauma. No clear consensus exists as to when it is safe to allow these athletes return to contact sports. Suggested periods of abstinence have ranged from 2 weeks to 6 months. We outline our experiences with the use of abdominal ultrasonography at 1 month aft er the diagnosis of infectious mononucleosis as a means of determining when athletes can safely return to contact sports. Our study group was made up of 19 such patients (mean age: 16.7 yr). We found that 16 of these patients (84%) had normal splenic dimensions on ultrasonography 1 month aft er diagnosis, and they were therefore allowed return to contact sports. While the remaining 3 patients had an enlarged spleen at 1 month, their splenic dimensions had all returned to normal when ultrasonographic examination was repeated at 2 months postdiagnosis. We conclude that serial abdominal ultrasonography allows for informed decision making in determining when athletes can safely return to contact sports following infectious mononucleosis.

Spleen Size Is Significantly Influenced by Body Height and Sex: Establishment of Normal Values for Spleen Size at US with a Cohort of 1200 Healthy Individuals

“…False-positive labeling of a patient as having splenomegaly can lead to medical tests that invariably will be negative, causing unnecessary anxiety to the patient as well as health care expenditure. Because of the potential risk of splenic rupture of an enlarged spleen, absence of splenomegaly has been mentioned as a requirement for peripheral blood stem cell donation (4,6,8,9) and as a requirement for participation in contact sports after infectious mononucleosis (5,10,11). The ability to recognize a spleen as abnormal inevitably requires generally accepted reference values.…”

Ultrasound in Athletes

“…A recent case series provided preliminary evidence of how serial ultrasound could prove useful in this manner (51). In that study, 84% of athletes had a return of splenic size to baseline at 1-month follow-up.…”

Ultrasonographic assessment of spleen, kidney and liver size in licensed football players

“…There are few studies in the literature on the visceral organ dimensions of athletes in various branches. [6,[9][10][11][12][13][14] Other studies mainly aimed to create reference values in healthy adults. [8,[15][16][17][18][19][20][21][22][23][24][25][26] To our knowledge, this is the first study that has evaluated spleen, kidney and liver dimensions in the football players.…”

“…[9,23] In addition, splenomegaly (longitudinal length ≥13 cm) may be a risk factor for splenic rupture. [13] False-positive labeling of a patient as having splenomegaly can lead to conducting unnecessary medical tests and anxiety for the athletes as well as delaying for participation in contact sports activity. [6,9] In various studies, the long axis length of the spleen was reported as 10.76±1.84 cm, [24] 11.1±0.9 cm [25] and the average as 10.9 cm [23] for healthy adults.…”