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?
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3 comments:
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....
yes!
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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.
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