How would you manage this patient's left-sided flank pain?

Each month, Dr. Maria Flynn issues a Radiology Challenge, presenting images from one of a variety of imaging modalities and a case report. Can you diagnose the condition? Follow the link to find out whether your answer was correct, what was really wrong with the patient, and how the patient was treated. Then, come back next month to test your radiographic reading skills on a new case!

Maria Flynn, MD

GU Imaging Chief

Radiology Intern Program Director

Department of Radiology

Naval Medical Center Portsmouth

Portsmouth, VA

Stephen L. Foster, MD

Chief Resident

Department of Radiology

Naval Medical Center

Portsmouth

Portsmouth, VA

Dr. Maria Flynn is Chief of Genitourinary Imaging and Radiology Intern Program Director at the Naval Medical Center Portsmouth, as well as a Lieutenant Commander in the US Navy Medical Corps. She received her medical degree from Tulane Medical School in 1994 and completed her radiology residency at the National Capital Consortium in 2003. She is certified by the American Board of Radiology and has been appointed Adjunct Assistant Professor of Radiology and Radiological Sciences at the F. Edward Hébert School of Medicine.

Case report

A 16-year-old boy presented to the emergency department 30 minutes after a BMX biking competition. His chief symptom was left-sided flank pain. He had fallen twice during the competition, directly impacting his handlebars on the second fall. He had no significant medical history and had undergone no previous surgeries.

His pulse was 90 beats per minute and he had a blood pressure of 105/65 mm Hg. Physical examination demonstrated clear lungs on auscultation and diffuse abdominal tenderness to palpation, which was most pronounced in the left upper quadrant. The patient’s hemoglobin and hematocrit were 14.6 g/dL and 41.5%, respectively. The surgery department was consulted and contrast-enhanced computed tomography (CT) scans of the abdomen and pelvis were obtained (Figures).

Challenge: What is your best diagnosis?

a) Ruptured bowel, surgical management

b) Undifferentiated pleomorphic sarcoma

c) Splenic hematoma, observe

d) High-grade splenic laceration, surgical management