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A 55-year-old woman with a past medical history of hypertension presented to the Emergency
Department after suffering a fall. She reported falling from a standing position while
attempting to hoist a garbage bag into a dumpster; she landed on her buttocks. After
the fall she reported immediately being able to ambulate without assistance, however
with considerable pain in her lumbosacral area. She denied loss of consciousness,
head injury, dizziness, abdominal pain, vomiting, or other injuries. Vitals signs
at triage were: blood pressure 171/84 mm Hg, heart rate 98 beats/min, temperature
36.8°C (98.3°F) oral, respirations 18 breaths/min, and oxygen saturation 99% on room
air. On physical examination, no abdominal tenderness was noted. Distal sensation,
motor function, reflexes, and pulses were intact in bilateral lower extremities, and
without signs of trauma. There was significant tenderness with palpation of the sacrum
and coccyx in the midline without step-offs. There was no midline lumbar spine tenderness.
An anterior, posterior, and lateral view radiograph of the lumbosacral spine was performed
to rule out fracture (Figure 1, Figure 2). Subsequently, computed tomography angiography (Figure 3) was performed to evaluate the finding of a possible splenic artery aneurysm on plain
films.
Figure 1Anterior/posterior view of the lumbar spine radiograph demonstrates calcified circular
lesion in the left upper abdomen likely related to calcified splenic artery aneurysm.
Figure 2Lateral view of the lumbar spine radiograph demonstrates calcified circular lesion
adjacent to the vertebral column related to calcified splenic artery aneurysm.
Figure 3Computed tomography angiography scan of aorta, with administration of intravenous
contrast demonstrating a clearly visible thoracic and abdominal aorta without evidence
of dissection or aneurysmal dilatation. There is a 2.5-cm diameter splenic artery
aneurysm without apparent contrast extravasation.
