PMC5585582_01
CT scan showing a large subcapsular splenic hematoma (16.0 x 16.0 x 7.6 cm) with a large pancreatic pseudocyst (13.5 x 10.0 x 8.0 cm).
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The CT-Abdomen revealed a huge low-density mass (16.0 x 16.0 x 7.6 cm) with some separations and loss of normal pancreatic morphology in the body and tail, splenomegaly with subcapsular hematoma (13.5 x 10.0 x 8.0 cm) that possibly pressurizes the left kidney, multiple cysts seen in the liver, gallstones, abdominal and pelvic effusion, bilateral pleural effusion with lungs atelectasis, splenic vein dilation, and expansion of portal vein branches (Figures 1-3).
CT scan showing a large subcapsular splenic hematoma with a large pancreatic pseudocyst.
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fig2
The CT-Abdomen revealed a huge low-density mass (16.0 x 16.0 x 7.6 cm) with some separations and loss of normal pancreatic morphology in the body and tail, splenomegaly with subcapsular hematoma (13.5 x 10.0 x 8.0 cm) that possibly pressurizes the left kidney, multiple cysts seen in the liver, gallstones, abdominal and pelvic effusion, bilateral pleural effusion with lungs atelectasis, splenic vein dilation, and expansion of portal vein branches (Figures 1-3).
Vascular restructure with CT showing splenic vein dilation and expansion of portal vein branches.
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fig3
The CT-Abdomen revealed a huge low-density mass (16.0 x 16.0 x 7.6 cm) with some separations and loss of normal pancreatic morphology in the body and tail, splenomegaly with subcapsular hematoma (13.5 x 10.0 x 8.0 cm) that possibly pressurizes the left kidney, multiple cysts seen in the liver, gallstones, abdominal and pelvic effusion, bilateral pleural effusion with lungs atelectasis, splenic vein dilation, and expansion of portal vein branches (Figures 1-3).
CT showing the drainage tube was in place, but splenic subcapsular hematoma had no change.
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The following day CT-Abdomen showed no changes in the pancreatic pseudocyst and splenic subcapsular hematoma, while the NG tube was still in place (Figure 4).
Showing coil embolization of splenic artery.
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Splenic artery embolization (Figure 5) was done on the next day, with no significant changes on the follow-up CT-Abdomen result.
After US-guided percutaneous puncture drainage of pancreatic pseudocyst, X-ray showing drainage tube was in the right place.
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About 4 days later, ultrasound-guided percutaneous puncture drainage of pancreatic pseudocyst was done (Figure 6).
About 2 weeks after splenic artery embolization and ultrasound-guided percutaneous drainage of pancreatic pseudocyst, CT showing the disappearance of pancreatic pseudocyst, multiple areas of infarction on the spleen, and the significant reduction of splenic subcapsular hematoma.
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The follow-up CT-Abdomen (plain + contrast), about 2 weeks later, showed the disappearance of pancreatic pseudocyst and multiple areas of infarction on the spleen, while the splenic subcapsular hematoma had significantly reduced (Figure 7).
CT scan showing the volume of splenic subcapsular hematoma significantly reduced compared to all previous images.
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The patient was discharged after almost a month of his hospital admission with the drainage tube attached, and about 2 weeks later the drainage tube was removed upon CT scan confirmation of decrease in the volume of the subcapsular hematoma (Figure 8).