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Thu Jun 7 03:02:44 BST 2007

An impressive hit. I would love to see an above and below cut of the 2nd 
image you sent. It appears as there might be a blush. If that is true or 
you think its true then i would angio with possible embolization. If not 
i would just continue to observe for another2 days(WAG). Then no f/u CT 
until about 3 mths then i would repeat just to confirm healing and let 
the kid get back to his sports.
Ron Simon, MD
Bellevue Hospital
NYC

caesar ursic wrote:
> Actual current case of mine:
>
> 15 yo male 'accidentally' tackled during spring football training (it was
> supposed to be a 'no-contact' practice session, but...oh well.. )  He 
> said
> the blow 'knocked the wind out of me and hurt pretty bad."  He went home
> that afternoon feeling a bit 'weak' and tried to eat but could not.  
> Slept
> poorly due to pain in left upper abdomen/lower chest.  Next morning in 
> more
> pain, so mom takes him to our ER.  He tells me his left upped belly 
> hurts.
> He's not hungry even though he skipped dinner and breakfast.
>
> His vital signs on arrival:  BP 136/81   HR: 90   RR: 16   TEMP: 36.5
>
> Exam: He looks pretty good, albeit worried.
> Skin: warm, well perfused,  No scleral icterus
> Lungs: Equal breath sounds.
> Chest: minimal tenderness over left lower anterior ribs
> Heart: Normal heart tones.
> Abdomen:  non-distended, no bruises,  bowel sounds present and normal.
> Tender in LUQ with some voluntary guarding; other areas of abdomen are
> NON-tender and soft.
> Back and spine are normal.
> Genitourinary exam: normal
> Rectal exam: normal
>
> Hb: 13.9 g/dL (prior to any intravenous fluids).  WBC 17,000.  Serum 
> amylase
> and lipase are normal.  T. Bili: 2.1.  ALT and AST: normal
>
> urinalysis: grossly clear (i.e. no gross hematuria), microscopy shows 
> 5-10
> RBCs per high-power-field.
>
> CT scan of abdomen:  selected cuts
> here<http://trauma.homestead.com/spleen_ct.html>(
> http://trauma.homestead.com/spleen_ct.html). Remainder of abdominal CT 
> shows
> NO pneumoperitoneum, NO liver/kidney/pancreatic injury, NO oral contrast
> extravasation, NO periduodenal fluid or thickened loops of intestine.  
> there
> is some fluid in the pelvis and around the lower liver.
>
> Remember, this injury is now approx 18 hours old.  His BP on repeated
> determinations remains normal, and he is NOT tachycardic.
>
> How would you manage this patient?  Next step(s)??
>
> C. Ursic, MD
> Santa Fe
> USA
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