Splenic Rupture Due to Infectious Mononucleosis: Normal Selective Arteriogram and Peritoneal Lavage

INFECTIOUS mononucleosis generally is regarded as a benign disease with an estimated mortality of less than 0.1%. 1 Splenic rupture is a common cause of mortality 2 and usually occurs in the second or third week of the illness when the spleen may be maximally enlarged and there is weakness of the capsule, trabeculae, and vascular wall. 1 Rupture can occur spontaneously or with minimal trauma. The most common symptom is abdominal pain. Abdominal tenderness frequently is associated with signs of peritoneal irritation and often is accompanied by anemia. Findings from peritoneal lavage can be expected to be abnormal in a high percentage of cases. Reportedly, a selective splenic arteriogram is highly reliable in the detection of rupture. Our report demonstrates that many of the clinical and roentgenographic studies employed in diagnosing splenic rupture can be misleading. Report of a Case A 23-year-old man was hospitalized because of severe left