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A 51 year old woman was admitted with an 11 hour history of retrosternal and epigastric pain. She was known to have multiple neurofibromatosis and a large neurofibroma had been removed from the left sacral plexus in 1984. ECG showed changes of acute inferolateral myocardial infarction. There were no obvious contraindications to thrombolytic treatment and she received 1.5 MU of streptokinase over the following hour. She was given oral aspirin and subcutaneous heparin (she was obese and relatively immobile).
Over the next few days she complained of being generally unwell and developed a left sided pleuritic chest pain. Chest radiography and ventilation–perfusion scan were normal. Abdominal ultrasound revealed a moderate sized haematoma within the spleen with no evidence of free fluid in the abdomen and these findings were confirmed by computed tomography (CT). She was managed conservatively and repeat CT showed no progression of the haematoma. She was eventually discharged feeling well.
Splenic haematoma is a rare but a well recognised complication of thrombolytic treatment; this patient presented with left pleuritic chest pain mimicking pulmonary embolus.