Think: Screen the Spleen

Author: Sophie Herbert, Faisal Faruqi / Editor: Thomas MacMahon / Codes: HCPS4i / Published: 31/10/2019

A 75-year-old female with no relevant past medical history presents with severe left upper quadrant pain which woke her from sleep. The sharp pain reached maximum intensity over a few minutes and was 9/10 in severity.

The pain was worse with movement and deep breathing. There were no other abdominal, urinary or respiratory symptoms nor history of
trauma.

On examination, her observations are all within normal ranges. The patient is holding her left side. Her abdomen is not distended. There is guarding in her mid to lower left zones and tenderness on light palpation, but no palpable organomegaly.

Bowel sounds are present and normal.

Bloods results include a lactate of 1.9, pH of 7.46, WCC of 8.5 and Hb of 12.9.

You order a CT abdomen/pelvis to investigate her concerning abdominal exam. It reveals wedge-shaped areas of hypo-enhancement within her spleen.

You arrange her admission under the surgical team.

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