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Elongated left lobe of the liver mimicking a subcapsular hematoma of the spleen on the focused assessment with sonography for trauma exam

Published:January 06, 2014DOI:https://doi.org/10.1016/j.ajem.2013.12.050
      The focused assessment with sonography for trauma examination has assumed the role of initial screening examination for the presence or absence of hemoperitoneum in the patient with blunt abdominal trauma. Sonographic pitfalls associated with the examination have primarily been related to mistaking contained fluid collections with hemoperitoneum. We present a case in which an elongated left lobe of the liver was misdiagnosed as a splenic subcapsular hematoma. It is imperative that emergency physicians and trauma surgeons be familiar with this normal variant of the liver and its associated sonographic appearance on the perisplenic window in order to prevent nontherapeutic laparotomies or embolizations.
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      References

        • Melniker L.A.
        • et al.
        Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial.
        Ann Emerg Med. 2006; 48: 227-235
      1. Nagdev A, J Racht, The “gastric fluid” sign: an unrecognized false-positive finding during focused assessment for trauma examinations. Am J Emerg Med, 2008;26(5): 630 e5-7.

        • Cholankeril J.V.
        • Zamora B.O.
        • Ketyer S.
        Left lobe of the liver draping around the spleen: a pitfall in computed tomography diagnosis of perisplenic hematoma.
        J Comput Tomogr. 1984; 8: 261-267
        • Li D.K.
        • et al.
        Pseudo perisplenic “fluid collections”: a clue to normal liver and spleen echogenic texture.
        J Ultrasound Med. 1986; 5: 397-400
        • Crivello M.S.
        • Peterson I.M.
        • Austin R.M.
        Left lobe of the liver mimicking perisplenic collections.
        J Clin Ultrasound. 1986; 14: 697-701
        • Richards J.R.
        • et al.
        Ultrasound detection of blunt splenic injury.
        Injury. 2001; 32: 95-103