Atraumatic splenic rupture secondary to metastatic non-small-cell lung cancer
A 61-year-old male presented with a 2-week history of worsening posterior neck and bilateral shoulder pain, and a several hour history of severe, left-sided abdominal tenderness. The patient reported no recent history of trauma. The patient had been diagnosed with poorly differentiated, left lung adenocarcinoma 5 months prior; he was status-post left upper lobectomy. PET scan, at that time (Fig. ), showed no evidence of metastatic disease and the pathologic staging was determined to be T2aN0M0 (Stage 1B).\nIn the emergency department on current presentation, the patient was hypotensive with a blood pressure of 76/40. Physical examination revealed a soft, distended abdomen that was tender in the left upper quadrant. The patient demonstrated no rebound tenderness or guarding. CT scan of the chest, abdomen and pelvis revealed hemoperitoneum and a possible splenic laceration (Fig. ). Laboratory work showed hemoglobin of 10.9 g/dl and a hematocrit of 30.4%. The patient was optimized for emergent exploratory laparotomy.\nSurgery revealed gross, metastatic lesions in the spleen and mesentery. A splenectomy with en bloc resection of the involved mesentery was preformed. The resected specimens all revealed metastatic, poorly differentiated non-small-cell carcinoma; consistent on immunoperoxide staining with the previously known primary lung cancer diagnosed and treated 4 months prior.\nFurther workup on this patient revealed a final diagnosis of stage IV non-small-cell lung cancer with metastases to the liver, mesentery, spleen and cervical spine. The patient was started on radiation therapy, but eventually refused more treatment due to the pain he was experiencing. The patient died <1 month later.