Splenic trauma: false-negative CT diagnosis in cases of delayed rupture

Pappas, Dennis G.; Mirvis, SE; Crepps, J. Thomas

doi:10.2214/ajr.149.4.727

Cited by 31 publications

(7 citation statements)

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“…9 When delayed splenic rupture does occur the mortality rate is high. 10 Almost invariably the patient will present with symptoms and/or signs of acute intraperitoneal haemorrhage. 3 Thankfully, in this case, at the time of representation to A&E the patient remained pain free and without clinical signs of abdominal haemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Occult splenic injury: delayed presentation manifesting as jaundice

Simpson

Ajuwon²

2001

Emergency Medicine Journal

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Delayed splenic rupture, though uncommon, is a recognised clinical condition and is associated with a significant mortality rate. In the vast majority of cases the patient re-presents with abdominal symptoms and/or signs of acute intraperitoneal haemorrhage. A case is presented of delayed splenic rupture presenting with jaundice attributable to intra-abdominal clot lysis. (Emerg Med J 2001;18:504-505) Keywords: splenic rupture Case report A 44 year old man presented to accident and emergency (A&E) after a riding accident. He had fallen oV the horse over a three feet high jump after which the horse had rolled on to him.The primary survey revealed a respiratory rate of 20 breaths per minute with normal symmetrical chest expansion, percussion and auscultation. Oxygen saturations were 100% and his tachypnoea settled with simple analgesia. His pulse rate was 80 beats per minute, blood pressure 175/105 and capillary refill time was two seconds. He scored 15/15 on the Glasgow Coma Scale. Secondary survey revealed slight tenderness over the left posterior chest wall in the infra-scapular region, with no surface bruising. The abdomen was noted to be soft and non-tender. He denied any abdominal pain. A chest radiograph, taken at the time of the primary survey was thought to be, and subsequently reported as normal. Routine blood tests were normal (haemoglobin, 16.8 g/dl). After a period of stable observation in the department he was discharged home with simple oral analgesia and appropriate advice.Seven days later the patient re-presented because that day he had become jaundiced and had noticed his urine had become dark brown in colour. Over the preceeding three days he had also noticed a considerable reduction in his exercise tolerance and had been more tired than usual. On close questioning he described a mild left upper quadrant discomfort worsened by deep inspiration. On examination he was comfortable, his abdomen was soft and non-tender, bowel sounds were normal and no masses were palpable. He was haemodynamically stable, and was noted to be clinically jaundiced. Routine blood investigations revealed an haemoglobin of 10.5 g/dl, and an isolated rise in bilirubin of 35 µmol/l.Computed tomography of the abdomen and pelvis revealed a splenic laceration and haematoma within the spleen. There was a large extra-splenic, sub-diaphragmatic haematoma and free fluid within the abdomen and pelvis. The liver was undamaged. A diagnosis of splenic rupture was made and he was admitted under the duty surgical team. He was managed non-operatively. During the course of his stay he developed a persistant fever. Repeated blood cultures were normal and his fever eventually settled with symptomatic management only. Day 6 after admission he developed a sudden onset of left upper quadrant pain and left shoulder tip pain. Clinical examination revealed tenderness and guarding in the left hypochondrium but the patient remained haemodynamically stable. Full blood count revealed an Hb of (9.9 g/dl). Again he was managed expectantly. T...

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Section: Discussionmentioning

confidence: 99%

Occult splenic injury: delayed presentation manifesting as jaundice

Simpson

Ajuwon²

2001

Emergency Medicine Journal

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“…I). It has been speculated that such a finding probably indicates only streak artifacts from the adjacent ribs, or a nonhomogeneous enhancement reflecting the variable speed and rate of blood flow within the contused splenic parenchyma (4,9).…”

Section: Discussionmentioning

confidence: 99%

Emergency CT in Blunt Abdominal Trauma of Multiple Injury Patients

Kinnunen¹,

Kivioja²,

Poussa³

et al. 1994

Acta Radiol

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“…It is important to note that delayed splenic rupture (> 48 hours after injury) has been reported in patients despite an initial normal CT scan [28]. This is likely from an injury with little initial bleeding.…”

Section: Computed Tomographymentioning

confidence: 96%

Radiographic Evaluation of the Patient with Sport-related Abdominal Trauma

Walter

2007

Current Sports Medicine Reports

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Abdominal injuries are rare in sports, but they can be very serious, even life threatening when they occur. With the increasing popularity of snowboarding and extreme skiing, the rate of abdominal injuries is beginning to rise slightly. It is imperative that physicians be able to recognize signs of injury to the liver, spleen, kidney, and hollow abdominal viscera and order appropriate diagnostic tests to investigate these injuries. This article focuses on the imaging modalities physicians can use to assist in diagnosis of sport-related abdominal trauma. Although the sports medicine physician will likely not provide definitive care and treatment of these injuries, because a team approach works best, it is important to know how to diagnose them through the proper studies.

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Splenic trauma: false-negative CT diagnosis in cases of delayed rupture

Cited by 31 publications

References 0 publications

Occult splenic injury: delayed presentation manifesting as jaundice

Occult splenic injury: delayed presentation manifesting as jaundice

Emergency CT in Blunt Abdominal Trauma of Multiple Injury Patients

Radiographic Evaluation of the Patient with Sport-related Abdominal Trauma

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