Left lobe of the liver draping around the spleen: a pitfall in computed tomography diagnosis of perisplenic hematoma

Abstract

Computed tomography scanning has become one of the prime modalities in the diagnosis of trauma to the spleen (1-6). We present three cases of potential pitfall in computed tomography scan diagnosis. In the first case, computed tomography scan showed a high-attenuation perisplenic density in the superio-lateral region of the spleen compatible with a perisplenic hematoma. Exploratory surgery showed a left lobe of the liver draping around the spleen. The second case showed similar computed tomography findings as in the first case, but the perisplenic density showed enhancement after contrast infusion. Also, on careful evaluation, the perisplenic density was traced as part of the left lobe of the liver. The third case, an alcoholic without any history of trauma, showed a perisplenic density of lower attenuation. On careful screening, this was traced as part of the left lobe of the liver. The lower attenuation value of the liver was due to fatty infiltration. The importance of performing computed tomography with and without contrast infusion in these cases is discussed.