Use of Point-of-Care Ultrasound to Diagnose a Ruptured Splenic Hemangioma

TL;DR

A case where point-of-care ultrasound helped diagnose a rare ruptured splenic hemangioma in a patient with unexplained hypotension.

Contribution

Demonstrates the effectiveness of POCUS in identifying a rare cause of nontraumatic shock.

Findings

POCUS identified free fluid and a splenic lesion in a hypotensive patient.

CT confirmed a ruptured splenic hemangioma, leading to emergency surgery.

The case underscores the value of RUSH protocol in undifferentiated shock.

Abstract

An 89-year-old female presented to the emergency department (ED) with hypotension and altered mental status. The patient had no external signs of trauma or hemorrhage and no abdominal tenderness on examination. The patient remained hypotensive after initial fluid resuscitation, and laboratory testing revealed a significant anemia. Point-of-care ultrasound (POCUS) was used to perform a rapid ultrasound in shock (RUSH) exam in an attempt to uncover the etiology of undifferentiated hypotension. The exam displayed free fluid in the right upper quadrant and the left upper quadrant exam demonstrated a large splenic lesion with mixed echogenicity. Subsequent computed tomography (CT) of the abdomen and pelvis with intravenous contrast suggested a ruptured hemorrhagic splenic cyst, and the patient underwent an emergent splenectomy for hemorrhage control. Operative pathologic examination revealed the cystic lesion to be a splenic hemangioma. This case report highlights the utility of the Rapid Ultrasound for Shock and Hypotension (RUSH) protocol when evaluating patients with undifferentiated nontraumatic shock, and a rare cause of spontaneous intra-abdominal hemorrhage.

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