Diagnosis of splenic torsion : a combined radiographic approach

Torsion of the spleen about its pedicle is a rare condition in North America and Europe, comprising only 0.2% of splenectomies performed at the Mayo Clinic between 1904 and 1945 (Pugh, 1946). In underdeveloped nations the rate of occurrence is probably slightly higher due to the increased presence of splenomegaly secondary to malnutrition and malaria (Cross, 1974; Carswell, 1974). Although this event is seldom suspected preoperatively, a thorough radiographic evaluation may be useful. This report will describe an approach to the correct diagnosis employing barium studies, diagnostic ultrasound, nuclear medicine and angiography. By utilizing all of these procedures, a specific diagnosis may be possible. A 26-year-old white female was hospitalized for evaluation of severe left upper abdominal pain of one week's duration. The patient had a three-year history of mild intermittent abdominal pain, exacerbated by blunt trauma.