A 44-year-old helmeted man was involved in a 50-mph motorcycle collision. The victim refused evaluation by emergency medical personnel at the scene. He arrived at the emergency department the next day complaining of left shoulder and flank pain, bloody urine, and dizziness. A primary survey was unremarkable and a secondary survey revealed left upper quadrant and shoulder tenderness. Diagnostic studies identified a left clavicular fracture, left scapular fracture, left lung contusion, 2 distinct grade 2 splenic lacerations without evidence of active bleeding, and a small amount of free fluid in the pelvis. The patient was admitted for observation and remained hemodynamically stable with hematocrits greater than 40%. He was discharged home 3 days later with a scheduled follow-up visit in 2 weeks. The patient did not return for his scheduled visit and was seen 7 weeks later complaining of significant abdominal pain radiating to the left shoulder. He was hemodynamically stable with a hematocrit of 40%. Computed tomography (CT) scan of the abdomen (Figure 1) and celiac arteriography (Figure 2) were performed.
Computed tomography of abdomen and pelvis.
Celiac artery angiogram.
A. Arteriovenous fistula of the splenic vessels.
B. Splenic artery pseudoaneurysm.
C. Splenic artery aneurysm.
D. Pancreatic pseudocyst.
Gave AA, Frangos SG, Frankel H, Rabinovici R. Image of the Month—Quiz Case. Arch Surg. 2006;141(11):1141. doi:10.1001/archsurg.141.11.1141