Abdominal Wall Contusion, Hematoma of the Abdominal Wall vs. Rupture of the Spleen
Left picture: In spite of the local findings no indications of a lesion of a parenchymatous organ of the abdomen have been found, neither in the ultrasound and CT, nor in the blood and urine; no lesion of spleen, kidney, pancreas or diaphragm is present. But, an abdominal wall contusion with hematoma of the rectus muscle was finally diagnosed. Notice the swelling of the left abdominal rectus muscle in the picture in addition to the abrasion. Right picture: Here, a spleen rupture was found with interruption of the continuity of the involved organ in the middle of the ultrasound picture at the top, the extension and type of which can be better seen in the CT with contrast application than in the ultrasound. The picture in the middle of the right side shows a continuous rupture of the spleen, a huge perisplenic hematoma at the lateral abdominal wall, and in front an intact upper pole of the left kidney (= type III lesion of the spleen). In the picture at the bottom on the right side the operative findings of a similar case of trauma to the spleen are visible. The blunt abdominal trauma is an important differential diagnosis of a surgical abdomen, and not always considered first on account of an insufficient history and missing local findings, such as abdominal abrasion or contusional mark.
Left picture: Schoolchild following a fall with the bicycle, with abrasion on the left side of the navel. What kind of additional examinations are you arranging to be performed? Right picture: Schoolchild following a road accident and a palpable local finding in the left upper belly. The ultrasound shows an organ with a rather homogeneous structure in the left upper abdomen. What happened to the child?