Splenic torsion presenting as splenic vein thrombosis

We present the case of a 13-year old female presenting with abdominal pain and splenomegaly. CT scan revealed splenic vein thrombosis but no whirl sign to indicate torsion. Her pain persisted, hypercoagulability workup was negative, and she underwent laparoscopic splenectomy. Intraoperatively she was found to have splenic torsion with absent ligamentous attachments. Further review of CT images revealed the spleen anterior to the hilum on sagittal views, a sign not previously described as characteristic of splenic torsion.