This paper is based on the crash and casualty experience compiled by the National Highway Traffic Safety Administration's (NHTSA) National Accident Sampling System, Crashworthiness Data (NASS/CDS 1988-1992), and by the William Lehman Injury Research Center (University of Miami/Jackson Memorial Hospital/Ryder Trauma Center) crash data files. The NASS/CDS files provide data on injuries to occupants in all types of tow-away crashes. The William Lehman Injury Research Center files provide detailed crash analysis and injury documentation of more than 100 restrained occupants with injuries from frontal crashes. These files provide a basis for recognizing injury patterns among restrained occupants and postulating their causes.The purpose of this paper is to report on an observed pattern of liver and spleen injuries suffered by drivers wearing shoulder belts without the lap belt fastened. To place the pattern in context, an analysis of chest/abdominal injuries among belted drivers in the (NASS/CDS) for the years' 1988-1992 shows that liver and spleen injuries are relatively rare events. However, when these injuries occur, they may be unexpected during the initial scene evaluation of the patient. If untreated, the consequences can be fatal.Observations from the crash scene may be useful in raising the suspicion of occult (not obvious) injuries to the chest/abdominal region. Based on eight cases observed in the William Lehman Injury Research Center data, several scene indicators are suggested. These include: (1) failure to wear available lap belt, (2) deformed steering wheel/column, (3) presence of unrestrained rear seat occupants and (4) severe damage to the right front of the car for injured drivers, or the left front of the car for injured passengers.