[Chronic, pseudocystically altered splenic hematoma as the cause of left-sided chest pain: successful therapy using...

A 26-year-old man was admitted urgently because of breathing-related pain in the left thorax. This pain had started 3 months before, but had at first improved spontaneously. He had lost 13 kg during those weeks and had no recollection of any injury. Physical examination was unremarkable except for slight pain on upper-abdominal pressure and a palpably enlarged spleen.

All laboratory tests were normal, including the Quick value (100%), partial thromboplastin time (38 sec) and hemoglobin (14.2 g/dl). Chest radiogram showed a high left diaphragm. Abdominal sonography revealed a 12 x 10 cm moderately echogenic tumour in the spleen, extending from the splenic hilus to the upper splenic pole. Contrast-enhanced computed tomography demonstrated a hypodense tumour from which 300 ml of old blood were removed by needle puncture. Biopsy of the wall of the haematoma revealed pseudocystic transformation.

The pseudocyst again filled with blood in a few days. A drain was inserted and remained for 32 days. Six installations of alcohol achieved complete obliteration of the cystic haematoma, which did not recur.

Splenic haematoma should be considered in the differential diagnosis of pain in the lower left thorax, even in the absence of a history of injury. Sonographically such a haematoma my imitate a solid tumor. Obliteration of the cavity by alcohol installation can be a successful alternative to surgical treatment.