Review Question - QID 3029

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Visceral Blunt Trauma Spleen Injuries Introduction QID: 3029 (OBQ09.216)

QID 3029 (Type "3029" in App Search)

A 17-year-old football player presents to the emergency department with the acute onset of left upper quadrant abdominal pain, nausea, vomiting, and tachycardia after being tackled during a game. His medical history reveals he had mononucleosis 1 month ago. What is the most likely explanation for these findings?

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Fractured kidney

5/3632

Ruptured appendicitis

4/3632

Ruptured gallbladder

16/3632

Splenic rupture

99%

3596/3632

Pneumothorax

2/3632

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The presentation is most consistent with splenic rupture following infectious mononucleosis. Mono causes splenomegaly and an increased risk of traumatic rupture. The most common time for rupture is within the 4-21 days after infection.

Farley et al reviewed over 8,000 patients with infectious mononucleosis and found 9 cases of splenic rupture. Current recommendations are that the athlete should not return to contact sports until splenomegaly has resolved. Some even suggest radiographic surveillance, but this is up for debate.

The Committee on Sports Medicine and Fitness article reviews athletic activities that place an increased stress on the cardiovascular system, and discusses an approach for athletic participation in children with cardiovascular conditions.