Upper left abdominal pain: the origin may be in the spleen

 Summary

A 65-year-old woman went to Medical Oncology with upper left abdominal pain and on the left shoulder. He had been suffering from this pain for about 6 months before a road accident, but had increased in the last month, without nausea or vomiting. Three years earlier she had a diagnosis of colon adenocarcinoma, but there were no data of recurrence in the last visit.

Diagnostic Process

The first action taken by her doctor was to order a left shoulder x-ray that was normal. The doctor in charge of the patient  thought to find some data related to the underlying disease, although it was difficult from any point of view, since  a local recurrence would have presented as a intestinal obstruction. A CT scan showed the presence of splenic vein thrombosis and extensive infarction in the spleen. At that time the doctor related the traffic accident with a trauma in the splenic area as the most probable etiology.

In the next table, specify, according to your criteria, the degree of difficulty  of each  item (there will also be a Twitter survey in @foro_osler), being  green-easy and red-difficult.

Comentary

When a patient is diagnosed of an important process such as a colon adenocarcinoma, the doctor always tries to relate the symptoms to the main disease. This is a safety option when the doctor is a superspecialist, but at the same time you can leave behind some important entities, so you should always follow the rule  of the ”worst-case scenario” , about entities that should not be forgotten. In this location the differential diagnosis should include basal pneumonia, retroperitoneal hematoma or diverticulitis.

In the next table, specify, according to your criteria, the degree of difficulty  of each  item (there will also be a twitter survey in @foro_osler), being  green-easy and red-difficult.