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August 14, 1972

Negative Aortogram Not Reliable for Diagnosis Of Splenic Hemorrhage

Author Affiliations

San Bernardino, Calif

JAMA. 1972;221(7):712. doi:10.1001/jama.1972.03200200058019

To the Editor.—  When patients are admitted to a hospital with suspicion of splenic hemorrhage, a normal abdominal aortogram is not entirely reliable, and selective splenic arteriography must be undertaken for definitive diagnosis. The following case illustrates this principle.

Report of a Case.—  A 32-year-old woman was admitted to the San Bernardino County General Hospital following an automobile accident, with fractures of the left lower leg and lower ribs, and a pneumothorax on the left side. The blood pressure initially was 84/60 mm Hg, becoming 110/70 mm Hg following infusion of plasma and the insertion of a chest tube. Hematocrit value was 33.3 on admission. Results of physical examination showed left-upper-quadrant tenderness, and abdominal paracentesis returned with a red blood cell count of 130,000/cu mm. The patient's vital signs and abdominal findings remained stable.Abdominal aortography gave normal findings (Fig 1), with particular attention directed to the splenic artery and