Spontaneous spleen rupture mimicking non-specific thoracic pain: A rare case in physiotherapy practice

Sforza, Carla; Margelli, Michele; Mourad, Firas; Brindisino, Fabrizio; Heick, John; Maselli, Filippo

doi:10.1080/09593985.2021.2021578

Cited by 2 publications

(2 citation statements)

References 52 publications

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“…In the setting of hypotension of unclear cause, with an associated reduction in haemoglobin, surgical causes including ASR should be considered [ 19 ]. This may also present atypically with thoracic back pain and right upper quadrant pain presumably due to haemoperitoneum [ 20 ]. While there was no prior abdominal imaging in our patient to exclude preexisting splenic pathology, the normal histopathology at the operation makes this unlikely.…”

Section: Discussionmentioning

confidence: 99%

Atraumatic Splenic Rupture in Legionella pneumophila Pneumonia

Worku

2023

Case Reports in Infectious Diseases

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A previously fit 46-year-old male handyman presented to a rural hospital with a cough, fever, and epigastric pain without peritonism. The patient was admitted medically with symptoms and radiological appearances consistent with atypical community-acquired pneumonia. During the first 48 hours of admission, he suffered a significant haemodynamic deterioration and was transferred to the intensive care unit (ICU) for vasoactive support. Following stabilisation, urgent abdominal CT imaging demonstrated splenic rupture with haematoma in the absence of historical trauma. Emergency splenectomy was performed; the histopathological examination was unremarkable. Investigations for the presenting complaint confirmed Legionella pneumophila serotype 1 pneumonia by urinary antigen testing. The patient was extubated on postoperative day 2 and stepped down from ICU to complete a 14-day course of azithromycin. Atraumatic splenic rupture is a rarely described clinical entity. The process can be subdivided into pathological and nonpathological (spontaneous) cases. Pathological atraumatic splenic rupture may occur in the context of wide-ranging aetiologies, including bacterial pneumonia; however, the association with Legionella pneumophila serotype 1 is exceptional, with this representing the eighth case in the medical literature.

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Section: Discussionmentioning

confidence: 99%

Atraumatic Splenic Rupture in Legionella pneumophila Pneumonia

Worku

2023

Case Reports in Infectious Diseases

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“…Moreover, it could be necessary for health professionals to be trained in “inductive reasoning or pattern recognition”—which consists of formulating hypotheses after observing data and identifying some patterns attributable to specific pathological pictures and contributing factors [ 32 ]. Unfortunately, sometimes patients are referred to physiotherapists, but they are out of the physical therapy scope of practice [ 33 , 34 , 35 ]. For this reason, it is important for physiotherapists to perform a comprehensive anamnestic collection for each patient and to always screen for red flags, in order to understand if the patient must be treated, treated and referred, or referred [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Tumour Hidden behind Thoracic Spine Pain: A Rare Case of Neuroblastoma in a Young Mother—A Case Report

Passudetti

Leo

Maselli

et al. 2022

IJERPH

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Background: Neuroblastoma (NB) is the most common form of paediatric malignancy, responsible for up to 15% of cancer deaths in children, whereas in adults, its onset is a rarer event, despite being characterized by greater lethality. The purpose of this case report was to describe the clinical presentation, physical examination, and clinical decision-making process in a patient with Neuroblastoma mimicking thoracic spine pain of musculoskeletal origin. Methods: a thirty-two-year-old mother complained of thoracic spine pain on her left vertebral side and in her left periscapular muscles; her pain was constant, deep, and worse at night; she also experienced pain during physical exertion of her upper limbs; the patient also reported pain in her left breast. Results: the physiotherapist’s anamnesis and physical examination led him to suspect the need for an extra-expertise pathology and to refer his patient to another medical specialist; the subsequent investigations revealed a poorly differentiated Neuroblastoma ALK + (IIC) in the posterior mediastinum on the left; the patient underwent surgery excision after 4 months. Conclusions: differential screening should be a physiotherapist’s fundamental skill in their patients’ clinical management, especially in direct access cases; the physiotherapist has an ethical and moral duty to conduct differential screening, in order to rule out extra-expertise pathologies—both when patients self-refer for rehabilitation assessment, and when they are referred by other practitioners.

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Spontaneous spleen rupture mimicking non-specific thoracic pain: A rare case in physiotherapy practice

Cited by 2 publications

References 52 publications

Atraumatic Splenic Rupture in Legionella pneumophila Pneumonia

Atraumatic Splenic Rupture in Legionella pneumophila Pneumonia

Tumour Hidden behind Thoracic Spine Pain: A Rare Case of Neuroblastoma in a Young Mother—A Case Report

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