Large post-traumatic splenic cyst diagnosed by radiology, isotope scintigraphy and ultrasound

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Abstract
A young woman presented with a large mass in the left upper quadrant of the abdomen at a routine post-natal examination before leaving hospital after the birth of her first child. A plain radiograph showed a large smooth soft tissue opacity. A liver and spleen scan showed a normal but vertically orientated liver and a massive rounded defect in a very large spleen. A combined barium meal and intravenous pyelogram showed that the stomach and liver were displaced to the right and the intestines and left kidney downwards. A combination of these methods of examination led to correct pre-operative diagnosis. Radiology showed the displaced organs, whilst the scintigram demonstrated that the mass lay within the spleen, but did not distinguish between a solid or cystic structure. This was readily carried out by ultrasound as cysts are trans-sonic and free from internal echoes, whereas reflections are obtained from within solid tumours. Measuring the diameter of the cyst allowed its volume of approximately 2,500 ml. to be calculated. Further questioning elicited the history of a previous automobile accident. A large haemorrhagic post-traumatic cyst was found in the spleen at splenectomy.

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