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Rectus sheath hematoma mimicking acute splenic disease
The American Journal of Gastroenterology
|September 1, 1983
Summary
Left upper quadrant abdominal pain in patients with hematologic cancers and enlarged spleens often indicates splenic issues. This case highlights a rectus sheath hematoma mimicking splenic disease in a chronic myelogenous leukemia patient.
Area of Science:
- Internal Medicine
- Hematology
- Diagnostic Imaging
Background:
- Splenomegaly in hematological malignancies can present with acute left upper quadrant (LUQ) abdominal pain.
- Differential diagnoses for LUQ pain in this context include splenic hematoma, infarction, or rupture.
- Accurate diagnosis is crucial for appropriate management of abdominal emergencies in oncology patients.
Observation:
- A patient with chronic myelogenous leukemia and significant splenomegaly presented with acute LUQ abdominal pain.
- The clinical presentation strongly suggested acute splenic pathology, posing a diagnostic challenge.
- Initial symptoms mimicked splenic infarction or hematoma.
Findings:
- Diagnostic ultrasonography revealed a rectus sheath hematoma as the cause of the patient's LUQ pain.
- The rectus sheath hematoma was an unusual cause of LUQ pain in this clinical setting.
- This finding resolved the diagnostic dilemma, differentiating it from primary splenic disease.
Implications:
- Clinicians should consider rectus sheath hematoma in the differential diagnosis of LUQ pain in patients with splenomegaly and hematological malignancies.
- Ultrasonography is a valuable tool for diagnosing rectus sheath hematoma and differentiating it from intra-abdominal emergencies.
- Recognizing this unusual presentation can prevent misdiagnosis and guide timely, appropriate treatment.