Monday, April 2, 2012

The Greek Heart

A passenger in a motor vehicle accident is brought into the emergency department by ambulance. On arrival, the only complaint she has is left shoulder pain, worse with inspiration. Exam shows a positive seat belt sign. Plain films of that extremity are negative; CXR notes rib fractures. The FAST exam and a CT scan are positive, and the patient goes to the operating room.

Challenge: Given the limited information presented here, what was the most likely injury? What is the sign described here?

Image shown under Fair Use.


Sarah said...

splenic injury!


Ruptured Spleen?
Seatbelt sign shows possible abdominal blunt trauma in an accident, approximately 65% of those with seatbelt sign have trauma to at least one organ, usually spleen or liver....

Craig Chen said...

The Greek Heart

The Greek root of spleen is the idiomatic equivalent of heart in English; to be good-spleened is to be good-hearted or compassionate. Kehr’s sign is referred pain to the left shoulder from irritation of the phrenic nerve from blood adjacent to the left hemidiaphragm. FAST exam often shows a hypoechoic rim of subcapsular fluid or intraperitoneal fluid around the spleen or in Morrison’s pouch (hepatorenal space).

Sources: UpToDate; Wikipedia.