He reported no previous trauma, fever, headache, fatigue, myalgia, arthralgia, skin alterations, or comorbidities. [semanticscholar.org]

On day-18, he had fever and subcostal pain. Clinically, he had mild left subcostal tenderness with no masses. [ijcasereportsandimages.com]

Only rarely ruptures spontaneously (associated with acute splenitis, amyloidosis [rare], infectious mononucleosis, inflammatory disorders, leukemia / lymphoma, malaria, other tumors, peliosis lienis, pregnancy, subacute bacterial endocarditis, typhoid fever [pathologyoutlines.com]

Splenomegaly is defined as cranio-caudal length greater than 13 cm by ultrasound [ 7 ]. [omicsonline.org]

Diseases Causing Splenomegaly Separated Into 3 Categories Mild Splenomegaly (Organ Weight Moderate Splenomegaly (Organ Weight 500–800 g) Severe Splenomegaly (Organ Weight 800 g) Bacterial infection Portal hypertension Chronic myeloproliferative diseases [onlinelibrary.wiley.com]

Abdominal examination revealed tender palpable splenomegaly, without guarding. [em-consulte.com]

However, patients with splenomegaly due to anemia like the one discussed above are more vulnerable to splenic trauma. [e-ultrasonography.org]

In the tropics, the most common causes of massive splenomegaly include malaria (hyper-reactive malaria), schistosomiasis, and visceral leishmaniasis [ 14 ]. [omicsonline.org]

Fordice J, Katras T, Jackson RE, et al: Massive splenomegaly in sarcoidosis. South Med J 1992;85:775–778. Webb AK, Mitchell DN, Bradstreet CM, et al: Splenomegaly and splenectomy in sarcoidosis. J Clin Pathol 1979;32:1050–1053. [karger.com]

On day 5, she began reporting severe left chest-wall pain... [readbyqxmd.com]

Three days later, he was admitted because of persistent abdominal pain [jamanetwork.com]

Two days later he started to complain of acute abdominal pain, and laboratory findings showed a low hemoglobin level. [readbyqxmd.com]

A 23-year-old male patient presented with a 36-h history of intense, sudden, progressive abdominal pain, predominantly in the left hypochondrium, irradiating to the ipsilateral infrascapular region. [semanticscholar.org]

Patients with pancreatitis presenting with a mass in the left upper quadrant, pain radiating to the left shoulder, and a fall in haemoglobin should be suspected to have a hemorrhagic complication and urgently admitted. [tropicalgastro.com]

She was admitted with epigastric and left upper quadrant pain of two days duration. She had an attack of mild acute pancreatitis of unknown aetiology three months previously. [pancreas.imedpub.com]

Case of the Week: November 14-November 21, 2013 13 year old with ground level fall with left upper quadrant pain (Click for a larger image.) [pedsradiology.com]

He had recently been recumbent due to chronic abdominal pain. On arrival he was unwell. Baseline observations revealed an oxygen saturation of 87% on room air, pulse 115 bpm and blood pressure 86/57 mm Hg. [read.qxmd.com]

The clinical picture was marked by spontaneously painful epigastric mass, evolved over the past 48 hours. [readbyqxmd.com]

However, on the sixth day, the patient complained of a sudden onset of severe left flank pain not relieved by analgesics, and the hemoglobin levels were decreased (9.7 g/dL). However, there was no hypotension. [synapse.koreamed.org]

shoulder pain Physical exam Note: Negative exam does not preclude injury Unreliable Perform serial exams External inspection Count number of entrance/exit wounds Odd number may indicate retained bullet LUQ injury: high likelihood spleen is involved Vitals [fprmed.com]

[…] pt complaining of left shoulder pain after abdominal trauma pt with noted rib fractures (it takes a lot of force to fracture those compliant pediatric ribs) pt with multi-trauma Unfortunately, a contained rupture may have few initial symptoms. [pedemmorsels.com]

However, suddenly after defecation (72 h after the injury), he started complaining of severe abdominal pain and left shoulder pain. His blood pressure dropped to 70/35 mmHg, and he started to lose consciousness. [surgicalcasereports.springeropen.com]

Shoulder Pain Fever Unreliable abdominal examination (e.g. [fpnotebook.com]

(see differential diagnoses below) References: [3] Diagnostics Laboratory tests : low Hb, leukocytosis, and thrombocytosis ; crossmatch for blood transfusion if needed In hemodynamically unstable patients First ultrasound : focused assessment with sonography [amboss.com]

Although very little good data exist, many surgeons treat persistent thrombocytosis with a daily baby aspirin. [emedicine.medscape.com]

Altered Level of Consciousness ) Consider at 24-48 hours if high grade Splenic Injury (Grade 3 or higher) Indications for surgical intervention Continued Hemoglobin decrease or need for repeated Blood Transfusion Hemodynamic instability (e.g. [fpnotebook.com]

Enlargement of the spleen (for example, due to Epstein-Barr virus causing infectious mononucleosis ) makes the spleen more susceptible to injury. When the spleen is injured, blood may be released into the abdomen. [merckmanuals.com]

On the second day, US demonstrated an enlarged spleen with a longitudinal diameter of 17.7 cm and a rounded accessory spleen with a diameter of 1.4 cm situated near the splenic hilum. [e-ultrasonography.org]

Plain abdominal radiographs can show enlargement of the spleen with medial displacement of the gastric bubble and elevation of the left hemidiaphragm with impaired motion. 8 Angiographic findings include extravasation of contrast, a “mottled” parenchymal [abdominalsurg.org]

Sonogram of an enlarged spleen (D1 indicates 34 cm length) secondary to chronic lymphatic leukemia. D2 indicates width. Case of splenomegaly in which the upper pole of the spleen touches the left lobe of the liver (arrow). [onlinelibrary.wiley.com]

Intraparenchymal hematoma is a broader, more irregular, hypoattenuating area with mass effect and enlargement of the spleen. [emedicine.medscape.com]