SPLENIC RUPTURE - SOCCER 1526

Abstract

HISTORY - While at an away game a 21 year old white male soccer player sustained a full-speed collision with a goaltender. The goalie's knee hit the athlete in the left flank. The athlete had immediate pain and shortness of breath. His pain was located in the left upper abdomen and left flank. He had no dizziness and did not feel faint. There was no shoulder or neck pain. There was no loss of consciousness. He had been complaining of mild sore throat and fatigue over the last seven days. PHYSICAL EXAMINATION - Upon initial contact, the patient was in severe pain and unable to ambulate. He was hyperventilating and diaphoretic. His shortness of breath resolved after approximately five minutes. The blood pressure was 98/60 and the heart rate was 88. The lung fields were clear with good air exchange in all quadrants. Bowel sounds were positive. He had severe left upper quadrant and flank tenderness. There were no peritoneal signs. There were no palpable abdominal masses. The spine was nontender. Pulses were palpable and strong in the upper and lower extremities. The patient was transferred to the emergency room where he was managed by the emergency physician on call. DIFFERENTIAL DIAGNOSIS: Splenic rupture or laceration Renal laceration or contusion Rib fracture Muscle contusion TESTS AND RESULTS Emergency Room Work-up Hemoglobin: 15.4gm Hematocrit: 45.3 WBC: 13.1 × 103 with 11.1% monocytes Urinalysis: 90-100 RBCs/hpf Monospot test: positive Liver function tests were mildly elevated. PT, PTT, and INR were normal Chest PA and lateral radiograph: No infiltrate or pneumothorax. Normal cardiac shadow. No rib or spine fractures seen. CT scan with intravenous contrast: A laceration with associated hemorrhage was seen at the inferior pole on the spleen. The capsule appeared intact. Kidney and liver were normal in their appearance. FINAL/WORKING DIAGNOSIS: Splenic laceration due to mononucleosis Hematuria TREATMENT: The patient was admitted to the ICU for observation with serial hemoglobins and urine dipstick for heme. His hemoglobin remained stable throughout his admission and his hematuria cleared within 24 hours. He was transferred to the general medical floor after four days and discharged five days later. He is presently stable two weeks after the injury, but has not been cleared to returned to contact sports yet. I will give a series of short case scenarios to present the current thoughts on the management of mononucleosis, and splenic rupture, as well as issues on return to play.