Three patients were scanned in whom the sonographic diagnoses of per- isplenic fluid collections were made. Computed tomography scanning demonstrated that the appearances were not caused by perisplenic pathology but by lateral extent of normal left lobe of the liver. Methods to avoid this potential sonographic pitfall are suggested. Indexing Words: Perisplenic hematoma -Perisplenic abscess -Sonographic pitfall
In patients who present with left flank pain, splenic and left subphrenic pathology must be ruled out. Ultrasound and computed tomography (CT) scanning are the preferred diagnostic modalities because they can rapidly survey the pertinent organs and peritoneal cavity and are highly sensitive in identifying abnormal fluid collections. We re- cently surveyed three cases in which the ultrasound examination was misleading in suggesting a subphrenic or perisplenic fluid collection. The CT scanning did not demonstrate left upper quandrant fluid collections and revealed the etiology of the sonographic appearance.
CASE REPORTS
Case 1 K.R., a 36-year-old intravenous drug user, was admitted to the hospital with cough, fever, and left flank pain. On admission, laboratory data included leukocytosis with left shift and an elevated erythrocyte sedimentation rate. The chest radiograph was initially read as negative. The patient was begun on empiric intravenous antibiotic therapy and defervesced. An ultrasound examination was performed to evaluate the left flank pain. Coronal scanning in the left upper quadrant demonstrated a hypoechoic area adjacent to the spleen; the possibility of a subphrenic fluid collection, pos-From the