I was consulted on a 41 year old man with severe anemia and what looked like bleeding into his abdomen on CT scan. He was a pretty healthy guy, he took no medications, and he had no prior surgeries.
The reason I was called is because 99% of the time intra-abdominal bleeding is due to trauma. I asked the man if he had been in a car accident recently - no. Had he been kicked or punched in the abdomen? Nope. Fallen on his side? No again.
Well, damn. I looked at his CT scan, and sure enough it looked to me like he had a ruptured spleen. I searched my brain for any other reason for him to have a ruptured spleen.
Bicycle accident? Any violent coughing or sneezing fits? Grizzly bear attack? ANYTHING? No, no, and no. I obviously wasn't asking the right question. Regardless, he was bleeding to death internally and needed surgery. I took him to the operating theatre and removed his spleen that looked like this:
I asked him if he'd been feeling very fatigued lately, and he said he had. I asked him if he had a terrible sore throat recently, and he said he had. Any fevers? Yes indeed. He started looking at me strangely. "What does my cold have to do with my spleen, Doc?"
This was no ordinary cold. His monospot test confirmed that he had infectious mononucleosis, also called "mono". Mono can cause the spleen to become quite enlarged, and his had enlarged so much that his little "bump" was enough to cause it to rupture.
His postoperative course was uneventful, and he went home a few days later. "How did you figure that out?" he asked me just before he left. I just smiled but didn't answer him - it just wasn't the right question.