CASE
A 50-year-old male presented to the emergency department after meeting with a driver’s traffic accident. His mental status was alert, with all vital signs within normal ranges. The patient only complained of pain in the left lower chest wall.
The findings of the focused assessment for sonography in trauma were all negative, and chest X-ray did not reveal any thoracic injuries. An abdominal computed tomography (CT) scan was subsequently performed, and it revealed an intraparenchymal hematoma in the spleen (Fig. 1).
The patient was hospitalized and closely monitored. The organ perceived to be the spleen was then found to be hepatic tissue extended from the left liver. In addition, the intraparenchymal hematoma was mistaken as hemangioma (Fig. 2).
In conclusion, hepatic hemangioma was mistaken as intraparenchymal hematoma in the spleen because of its position and shape. An atrophied spleen was observed between the tissue of hepatic hemangiomas, but the exact underlying cause is unknown (Fig. 2). The patient recovered with pain management and was discharged a few days later.
DISCUSSION
A typical hepatic hemangioma is detected as a hypodense, well-defined lesion on a CT scan, which shows peripheral nodular enhancement with progressive centripetal homogeneous filling after contrast injection [1]. Conversely, the typical intraparenchymal hematoma in the spleen can be seen on a CT scan as a low-density fluid adjacent to the spleen that distorts the splenic architecture [2]. Therefore, these two diagnoses can be easily distinguished by performing contrast-enhanced abdominal CT.
However, the location of hepatic hemangioma, the atrophied spleen, and the symptoms in this case may lead to the hemangioma being mistaken as intraparenchymal hematoma in the spleen. Thus, imaging findings should be more carefully examined to prevent unnecessary additional tests and long-term hospitalization.
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