SHM Converge Scientific Abstract ePoster Gallery-Unplanned Spleen Break: Rare Rupture Strikes in Hodgkin Lymphoma

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This case describes a 45-year-old woman who presented with two weeks of fever after travel, along with three months of night sweats, weight loss, myalgias, diffuse lymphadenopathy, and splenomegaly. Labs showed inflammation and elevated EBV PCR. CT imaging revealed extensive abdominal and thoracic adenopathy plus multiple splenic lesions, raising concern for infection or hematologic malignancy.<br /><br />During hospitalization, she suddenly developed left upper quadrant pain radiating to the left shoulder, consistent with Kehr’s sign. Repeat CT showed a grade V splenic injury with active bleeding and hemoperitoneum. She rapidly progressed to hemorrhagic shock, requiring massive transfusion, ICU transfer, and emergent exploratory laparotomy with splenectomy. Pathology later confirmed EBV-positive classic Hodgkin lymphoma, and she began chemotherapy before discharge.<br /><br />The case highlights spontaneous, atraumatic splenic rupture as a rare but life-threatening complication of hematologic malignancy, including Hodgkin lymphoma. Malignant infiltration can enlarge and weaken the spleen, making rupture possible even without trauma. Typical presenting symptoms include abdominal pain, left shoulder pain, and, in severe cases, shock. CT with IV contrast is the diagnostic standard, though bedside ultrasound may quickly identify hemoperitoneum in emergencies.<br /><br />Key teaching points are that splenic rupture is a true surgical emergency requiring immediate recognition and intervention. While select stable patients may be managed nonoperatively or with splenic artery embolization, emergent splenectomy remains the cornerstone of treatment when rupture is severe or the patient is unstable.

Asset Subtitle

Morgan O. Orand

Meta Tag

Author List Morgan O. Orand, Tara K. Ward

Category Clinical Vignettes

Concept Spontaneous Splenic Rupture

Concept Hemodynamic Instability

Concept Surgical Emergency

Concept Splenectomy

Concept Abdominal Pain

Distinguished Non-Finalist

Presenter Organization University of Colorado Anschutz Hospital

Presenting Author Morgan O. Orand

Track Adult

Keywords

EBV-positive Hodgkin lymphoma

spontaneous splenic rupture

atraumatic splenic injury

hemorrhagic shock

splenomegaly

lymphadenopathy

hemoperitoneum

Kehr sign

emergent splenectomy

CT imaging

Spontaneous Splenic Rupture

Hemodynamic Instability

Surgical Emergency

Splenectomy

Abdominal Pain