Woman with beaver tail liver and splenic injury

Abstract Objective This study aims to highlight the diagnostic challenges posed by beaver tail liver—a rare anatomical variant—during point‐of‐care ultrasonography (POCUS) in the assessment of splenic injury. This case demonstrates how beaver tail liver can closely resemble pathological conditions, such as splenic hematomas, potentially leading to misdiagnosis in emergency settings. Methods This case‐based study describes a 34‐year‐old woman who presented to the emergency department with abdominal pain after a 6‐meter fall. Initial evaluation with POCUS was performed at the bedside for rapid assessment. Due to inconclusive ultrasound findings, contrast‐enhanced computed tomography (CT) was subsequently conducted for further evaluation. Results POCUS revealed relatively hyperechoic hepatic tissue overlapping the hypoechoic splenic region, along with fluid accumulation at the lower pole of the spleen and a heterogeneous splenic lesion—findings suggestive of splenic laceration complicated by the presence of a beaver tail liver. Contrast‐enhanced CT confirmed both the splenic laceration and the anatomical variation of a beaver tail liver. Conclusion Although rare, beaver tail liver can significantly interfere with the interpretation of POCUS in cases of splenic trauma by mimicking subcapsular hematoma. Clinicians should be aware of this anatomical variant to avoid misdiagnosis during FAST (focused assessment with sonography in trauma) examinations. While CT remains essential for definitive diagnosis, recognizing the possibility of beaver tail liver on POCUS can help guiding appropriate diagnostic pathways and prevent unnecessary interventions.