HISTORY: A 16 year-old junior high school football wide receiver presents to the training room with left flank and low back pain. During practice he was involved in a tackle where he sustained a blow to his left flank, just below his protective padding. He is unsure if he was hit by helmet or elbow. He had immediate sharp pain on his left but was able to stand and walk to the sidelines. He waited 10 minutes, and when the pain did not abate he went to the training room. He notes that he has increased pain with flexion and lateral bending away from and toward the affected side. Running and deep breathing do not increase his pain. He does not feel dizzy or nauseated. His pain is 5 out of 10 and he does not want to return to practice today. PHYSICAL EXAMINATION: Examination in the training room reveals an overall healthy adolescent male who is in moderate discomfort and holding his left side. Inspection of his left flank shows no bruising or swelling. He has diffuse, mild tenderness to the soft tissue overlying his posterior left flank. He has no point tenderness over his ribs. He has no tenderness over his vertebrae. He does have CVA tenderness on his left flank. His abdomen is benign with normal bowel sounds, and is non-tender without guarding or rebound. DIFFERENTIAL DIAGNOSIS: Renal contusion Rib fracture Soft tissue contusion Abdominal injury SECOND DAY EVALUATION: Patient was held out of practice. The following day he is evaluated and complains of ongoing left flank pain. He also has noted new onset left shoulder pain, worse with lying down, and some new pain in his left lower quadrant along. He denies any blood in his urine. Physical examination reveals an abdomen with tenderness in the left upper and lower quadrants. Bowel sounds are positive. No masses. No hepato-splenomegally are appreciated. No guarding or rebound is present. He continues to have CVA tenderness. TEST AND RESULTS: Abdominal CT scan: splenic laceration of 0.9 cm subcapsular hematoma of less than 10% of spleen surface area FINAL DIAGNOSIS: Splenic laceration - Grade I TREATMENT/OUTCOMES: Overnight inpatient observation Restricted from activity for 2 weeks Non-contact for 2 months Cleared for full play if CT scan shows resolution of laceration