What The Heck?

Here’s an interesting one for you to solve!

A 20ish year old male was involved in a motor vehicle crash, sustaining a Grade IV spleen injury. He fails nonoperative management early in his hospital course, undergoing a splenectomy 6 hours later.

He has an uneventful recovery and is ready for discharge after 5 days. His platelet count has plateaued at 600K. He presents to your ED 2 weeks later complaining of abdominal pain. On exam, he is diffusely but mildly tender. His subjective complaints appear to be a bit out of proportion to his exam.

Here is one slice from his CT scan. I’ve put a nice fat arrow on it to help out. But it won’t.


  • What does the scan show?
  • Why is it there?
  • What other key piece of information do you want to know?
  • Any other studies?
  • Then what?

Some hints tomorrow! Tweet your answers or leave comments below! Let’s see if anyone can figure this one out!

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