Manuela Stoicescu,
University of Oradea, Romania.
Title: The surprise of diagnosis of a fluid collection around the spleen
Biography
Biography: Manuela Stoicescu,
Abstract
Objectives: The most important objective of this clinical case presentation is to found the real cause of a patient who came in the Emergency Department for a clinical picture of a left renal colic. Material and Methods: I present the clinical case of a man 42 years old, prisoner-convict who came in the Emergency Department together with a policeman who supervise him,
with sudden onset of left lumbar pain irradiate into the left flank and left iliac fosse(on the way of left ureter), polakiuria, dysuria and macroscopic hematuria. At the objective examination: BP=130/80mmHg, HR rhythmic=78 bates/min, normal vesicular sound, Giordano sign positive on left side, costo-vertebral and costo-muscle points sensible on left side, superior and middle ureteral points sensible. For this reasons the doctor from penitentiary sent the patient in emergency with the diagnosis: left renal colic, left kidney stone. The results of blood tests were in normal range, except the level of Hb=10g/dl, Ht=42%, red blood cells =3,7 million cells/mcL. The abdominal ultrasound image showed all the organs normal, the both kidneys normal as well but unexpected a free fluid collection around the spleen, in small quantity but the capsule of the spleen apparent intact and without free liquid collection in the Douglas cavity. An abdominal CT was performed and relieved the same image with fluid collection around the spleen and all the organs normal. The patient was referred to the Surgery Department with suspicion of possible spleen fine fissure unobservable at echo and CT scan, because of the free fluid collection around the spleen, indifferent that the patient didn’t recognize any trauma. After abdominal laparotomy, unexpected the spleen was normal, with intact capsule, without any fissure and fresh blood was around the spleen, but this came from a big hematoma localized in the posterior wall of the left kidney and migrate around the spleen and was solved with good evolution of the patient.