RT Journal
A1 Tan T, Griffith RC, Vezeridis MP
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD January 1
VO 146
IS 1
SP 115
OP 115
DO 10.1001/archsurg.2010.296-a
UL http://dx.doi.org/10.1001/archsurg.2010.296-a
AB 
A 66-year-old man with a history of diabetes mellitus presented with 3 days of chills and nausea but with no abdominal or chest pain. On physical examination, he was afebrile with mild left upper-quadrant tenderness. His white blood cell count was 4200/μL, and his hemoglobin level was 12 g/dL at admission. A computed tomographic scan of the abdomen showed thickening of the splenic flexure and descending colon with an adjacent collection of air in the spleen (Figure 1). An electrocardiogram showed signs of a myocardial infarction with ST-segment changes, and his troponin I level on presentation was 1.6 ng/mL. (To convert white blood cell count to number of cells ×109/L, multiply by 0.001; hemoglobin to grams per liter, multiply by 10; and troponin to micrograms per liter, multiply by 1.)