IMAGES IN EMERGENCY MEDICINE
Unexpected left upper quadrant abdominal pain in a 30-year-old man
1 Department of Emergency Medicine, Hospital of Navarra, Pamplona, Navarra, Spain
2 Department Internal Medicine, Hospital of Navarra, Pamplona, Navarra, Spain
Correspondence to:
Dr C Jean Louis, Avenida Pamplona N° 6, 5B IZQ, 31010 Barañain, Navarra, Spain; jlclint@gmail.com
Accepted 3 November 2007
| The first 150 words of the full text of this article appear below. |
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.
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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
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