title: Unusual presentation of spontaneous splenic rupture.
abstract: We report a case of a 47-year-old man who presented with hypotension after 2 weeks of fatigue and upper respiratory infection symptoms, and rapidly deteriorated in the emergency department. A bedside ultrasound revealed free intraperitoneal fluid, a subsequent diagnostic peritoneal lavage showed hemoperitoneum, and a laparotomy confirmed a splenic rupture. Pathology results revealed a relatively rare form of leukemia, known as hairy cell leukemia, leading to this presentation. We discuss the differential diagnosis of spontaneous (or without antecedent trauma) splenic rupture with a review of hairy cell leukemia, and stress the importance of keeping a high index of suspicion for medical diseases that affect the spleen.
authors.affiliation: Department of Emergency Medicine at Christiana Care Health System in Newark, Del, USA.
authors.forename: Preeti
authors.initials: P
authors.lastname: Dalawari
authors.forename: John C
authors.initials: JC
authors.lastname: Vandover
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenbaum
mesh_terms: D003937:Diagnosis, Differential; D005221:Fatigue; D006801:Humans; D007022:Hypotension; D007943:Leukemia, Hairy Cell / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage; D013161:Splenic Rupture / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D013997:Time Factors; D014463:Ultrasonography