Visual Diagnosis in Emergency Medicine| Volume 43, ISSUE 4, P710-711, October 2012

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Incidental Finding of Splenic Artery Aneurysm on Lumbosacral Spine Radiograph

      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 thumbnail gr1
      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.
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      Figure 2Lateral view of the lumbar spine radiograph demonstrates calcified circular lesion adjacent to the vertebral column related to calcified splenic artery aneurysm.
      Figure thumbnail gr3
      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.
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