Ruptured spleen: A radiological pitfall and a suggested modification

Abstract

The diagnosis of splenic injury may be obvious from the outset, or it may either be masked by other injuries or present much later in the phase of convalescence. Delayed rupture may occur as late as 1 month after injury, at which time it may be embarrassing for the doctor and dangerous for the patient. Any additional diagnostic measure is therefore considered appropriate in cases of abdominal trauma. Schorr and Danon (1967) described the value of a film taken in the left lateral decubitus position with barium in the stomach, and noted the significance of a distance of more than 3 cm. from the greater curvature of stomach to the lateral abdominal wall. A case is described in the present paper in which a false‐positive result was obtained with the method of Schorr and Danon (1967) owing to interposition of a heavy mobile omentum. A right lateral decubitus film had been taken while the patient had a gas‐filled stomach, and had revealed a distance of only 2.2 cm. between the greater curve and lateral abdominal wall. In this projection the mobile omentum had obviously fallen away, allowing the stomach to rise towards the left abdominal wall and thus demonstrating the absence of a fixed mass in this region. Although it would appear that this technique is more useful in cases of delayed rupture than in acute cases, it is suggested that routine use be made of the right lateral decubitus film with a gas‐filled stomach, prior to films being taken according to Schorr and Danon's (1967) method. This modification might also be useful in the diagnosis of diseases of the spleen, and in following the progress of patients after treatment.