Related Experiment Video
Updated: May 21, 2026
Focused Assessment with Sonography for Trauma (FAST) Exam: Image Acquisition
Published on: September 22, 2023
Identification of splenic infarction by emergency department ultrasound
David C Mackenzie1, Otto Liebmann
1Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
Background:
Splenic rupture or infarction can occur secondary to acute infectious mononucleosis. Patients with abdominal pain and known or suspected infectious mononucleosis mandate evaluation for these complications, which can have significant morbidity or mortality.
Case Report:
An 18-year old man presented to the emergency department (ED) with a 2-day history of left upper quadrant abdominal pain. He had been diagnosed with mononucleosis 4 days before his ED presentation. Physical examination was notable for focal left upper quadrant tenderness. The treating physician's principal diagnostic considerations were splenic rupture or infarction secondary to mononucleosis. Point-of-care ultrasound was performed by the emergency physician, demonstrating multiple hypoechoic areas in the splenic parenchyma with absent Doppler flow, consistent with multiple splenic infarcts. The patient was admitted for observation, managed conservatively, and had an uneventful course.
Conclusion:
Emergency ultrasound of the spleen can allow rapid diagnosis of splenic infarction and exclusion of splenic rupture in a patient at risk for splenic pathology.
Insights
Infectious mononucleosis can cause splenic infarction. Emergency ultrasound rapidly diagnosed splenic infarcts in a patient with abdominal pain, aiding in prompt management.
Area of Science:
- Emergency Medicine
- Radiology
- Infectious Diseases
Background:
- Acute infectious mononucleosis poses a risk for splenic complications such as rupture or infarction.
- Patients presenting with abdominal pain and suspected mononucleosis require thorough evaluation for these potentially life-threatening conditions.
Observation:
- An 18-year-old male presented with left upper quadrant abdominal pain and a history of recent mononucleosis diagnosis.
- Physical examination revealed focal tenderness in the left upper quadrant.
- Point-of-care ultrasound was performed by the emergency physician.
Findings:
- Ultrasound demonstrated multiple hypoechoic splenic areas with absent Doppler flow, indicative of splenic infarction.
- The findings were consistent with splenic infarction secondary to infectious mononucleosis.
- Splenic rupture was effectively excluded.
Implications:
- Emergency ultrasound of the spleen enables swift diagnosis of splenic infarction in at-risk patients.
- This diagnostic capability aids in excluding splenic rupture, guiding conservative management.
- Rapid ultrasound assessment is crucial for managing splenic pathology in infectious mononucleosis.
Related Concept Videos
01:25Ultrasound II: Endoscopic Ultrasound and FibroScan
Endoscopic Ultrasound (EUS):
01:17Ultrasonography
During an ultrasonography procedure, a handheld device called a...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:24Imaging Studies II: Ultrasonography
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for diagnosing...