title: Splenic artery pseudoaneurysm due to seatbelt injury in a glucose-6-phosphate dehydrogenase-deficient adult.
abstract: A 23-year-old man presented with abdominal pain after suffering blunt trauma caused by a seatbelt injury. His low platelet count of 137 × 10(9)/L was initially attributed to trauma and his underlying hypersplenism due to glucose-6-phosphate dehydrogenase (G6PD) deficiency. Despite conservative management, his platelet count remained persistently reduced even after his haemoglobin and clotting abnormalities were stabilised. After a week, follow-up imaging revealed an incidental finding of a pseudoaneurysm (measuring 9 mm × 8 mm × 10 mm) adjacent to a splenic laceration. The pseudoaneurysm was successfully closed via transcatheter glue embolisation; 20% of the spleen was also embolised. A week later, the platelet count normalised, and the patient was subsequently discharged. This case highlights the pitfalls in the detection of a delayed occurrence of splenic artery pseudoaneurysm after blunt injury via routine delayed phase computed tomography. While splenomegaly in G6PD may be a predisposing factor for injury, a low platelet count should arouse suspicion of internal haemorrhage rather than hypersplenism.
authors.affiliation: Cardiac Heart Health Centre, Suite 1303, Central Building, 3 Pedder Street, Central, Hong Kong, China. cplau@hkucc.hku.hk.
authors.forename: Yu Zhen
authors.initials: YZ
authors.lastname: Lau
authors.forename: Yuk Fai
authors.initials: YF
authors.lastname: Lau
authors.forename: Kang Yiu
authors.initials: KY
authors.lastname: Lai
authors.forename: Chu Pak
authors.initials: CP
authors.lastname: Lau
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000063:Accidents, Traffic; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods; D005500:Follow-Up Studies; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D035583:Rare Diseases; D018570:Risk Assessment; D012622:Seat Belts / Q000009:adverse effects*; D013157:Splenic Artery / Q000293:injuries*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult