A 30-year-old man presented at the emergency department with a 2 h onset of intense left upper quadrant pain irradiating to his back. Physical examination showed tenderness in the left hypochondrium. Initial laboratory results were unremarkable. Abdominal computed tomography was performed revealing a wedge-shaped hypodense lesion compatible with splenic infarction (fig 1).
Figure 1. Abdominal computed tomography showing signs of splenic infarction.
Clinical manifestations of splenic infarction include left upper quadrant pain, fever, vomiting and pleuritic chest pain. One-third of cases are asymptomatic and may be found incidentally by radiological studies or autopsy.
In young people it is associated with diseases of haematological origin, including polycythaemia vera, leukaemia, lymphomas and hypercoagulable states.1 Embolic disorders such as infective endocarditis and atrial fibrillation are common in elderly patients. Other causes include autoimmune and collagen-related diseases, trauma, mononucleosis and malaria. Complications include abscess, haemorrhage and rupture, which may require surgery. Initial management is supportive with analgesia and fluid therapy.
All possible causes were ruled out and the patient recovered promptly.
Acknowledgments
This article has been adapted from Louis C Jean, Velilla N, Fernandez B, Beaumont C, Santiago I. Unexpected left upper quadrant abdominal pain in a 30-year-old man Emergency Medicine Journal 2008;25:423
Footnotes
Competing interests: None declared.
Informed consent was obtained for publication of the details in this report.
REFERENCE
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