Presentation
Unclear history of abdominal trauma.
Patient Data
The spleen is enlarged measuring 14 cm in craniocaudal length. There is a low-density lesion within the superior aspect of the spleen, affecting approximately one-third of the parenchyma likely consistent with a splenic infarct.
The interpolar region of the right kidney demonstrates some loss of volume with calcification likely consistent with chronic scarring.
The renal pelvis on the right may be partially extrarenal. The left kidney is unremarkable.
The liver demonstrates homogeneous enhancement with no focal liver lesion.
Geographic region of low-density adjacent to the falciform ligament likely to represent focal fatty infiltration.
Incidental phrygian cap within the gallbladder noted.
The adrenal glands and pancreas are unremarkable.
Likely origin of the right hepatic artery directly from the aorta noted.
No intra-abdominal or pelvic lymphadenopathy.
There is no free fluid seen within the pelvis.
Review of the bowel demonstrates a possible polyp in a loop of distal small bowel within the right lower quadrant measuring approximately 1.5 cm.
The prostate is enlarged through peri-prostate soft tissues are unremarkable. No abscess in the prostate.
Likely fat containing direct inguinal hernia within the left groin noted.
Left basal atelectasis. Small left pleural effusion.
The bones are unremarkable.
Case Discussion
The appearances are in keeping with a segmental splenic infarction: a wedge-shaped low-attenuation/non-contrasting area. The images are unequivocal about the diagnosis, although the main differentials to consider are a splenic laceration, particular in the setting of trauma, and, heterogeneous arterial phase enhancement of spleen.
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