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PubMed2005

Complications arising from splenic embolization after blunt splenic trauma.

BACKGROUND: Nonoperative management (NOM) of splenic trauma is now the standard in stable trauma patients. Splenic artery embolization (SAE) is an increasingly used adjunct to NOM. We examined complications arising from SAE. METHODS: Patients admitted to a level I trauma center with splenic trauma over a 26-month period were identified. Management method, operative or nonoperative, was noted. SAE patients were analyzed in detail. RESULTS: There were 284 splenic trauma admissions. Ninety-three patients underwent operative management, and 191 received NOM. Fifteen patients (7.8%) underwent SAE. Embolization was proximal in 10, distal in 1, and combined in 4 patients. No NOM failures occurred. Major complications (27%) included splenic bleeding, splenic infarction, splenic abscess, and contrast-induced renal insufficiency. Minor complications of fever, pleural effusions, and coil migration occurred in 53% of patients. No relationship between SAE location and the presence of complications was noted. CONCLUSIONS: SAE is an effective and safe procedure. Both major and minor complications can arise after SAE.

Adolescent↗
PubMed1994

Late-onset Bochdalek hernia with a rare postoperative complication: case report.

We report a case of a 7-year-old-girl with a late-presenting Bochdalek hernia. The postoperative course was complicated by splenic torsion and subsequent total splenic infarction. Total splenic infarction due to splenic torsion has been reported in children with "wandering spleen" and in incarcerated Bochdalek hernias, but to our knowledge, not as a postoperative complication of Bochdalek hernia repair.

Child↗
PubMed2000

[Splenic thrombosis and celiac disease: a fortuitous association?].

BACKGROUND: Rare cases of venous thrombosis associated with celiac disease have been reported. CASE REPORT: We report a case of 40-year-old woman with splenic infarction and splenic venous thrombosis associated with celiac disease. This patient was homozygous for the C677T mutation of the methyltetrahydrofolate reductase (MTHFR) gene and had moderately elevated homocysteinemia. DISCUSSION: We discuss the link between celiac disease and thrombosis as well as the interest and appropriate duration of anticoagulation and hypothesize a mechanism of thrombotic disease in this setting with hyperhomocyseinemia.

Abdominal Pain↗
PubMed1994

Splenic sepsis in sickle cell disease.

We describe two patients with sickle cell disease (SCD) who developed infections situated in the spleen. One patient had a splenic abscess and there was strong clinical evidence for an infected splenic infarct in the second patient. SCD predisposes to splenic infection because of functional hyposplenism, defective phagocyte function and splenic infarction. Splenic infections can occur in patients who might be considered to have an absent spleen and the diagnosis of splenic abscess should be considered in individuals with SCD who present with fever and abdominal pain.

Abscess↗
PubMed2002

[Vascular complications of infective endocarditis: a retrospective analysis of 18 cases].

OBJECTIVES: Among 82 patients hospitalized for infective endocarditis between June 1995 and June 2001 at the cardiology B unit of the Rabat University Hospital Morocco, 18 (22%) had one or more vascular complications. We present here a retrospective analysis. PATIENTS AND METHODS: The cohort included 12 men and 6 women, mean age 22 years. Infective endocarditis had grafted on a pre-existing cardiopathy among 17 patients: rheumatic heart disease (n=14), mechanical prosthetic valve (n=2), congenital heart disease (n=1). RESULTS: For 12 patients, vascular disease was the only complication, 1 had two complications and 4 three complications. This gave 26 lesions: 11 neurological complications, 10 arterial diseases involving the limbs including 5 mycotic aneurysms, 2 acute myocardial infarcts, 2 splenic infarcts, and 1 recurrent septic pulmonary embolism. Vascular disease was the inaugural manifestation in 9 patients and 54% of the complications occurred before the end of the second week of antibiotic treatment. Blood cultures were positive in 7 patients (40%). Oral streptococcus was isolated in 5 cases, Gram-negative bacillus in 1 case and Staphylococcus aureus in 1. Echography revealed valvular vegetations in the 16 cases of infective endocarditis on native valves: mitral (n=9), aortic (n=5), mitroaortic (n=1), tricuspid (n=1). Short term outcome was marked by 4 deaths including 3 directly related to the vascular complication. DISCUSSION: We emphasize the variable and diverse features of vascular complications of infective endocarditis. Prevention and early diagnosis are essential to institute optimal management of infective endocarditis.

Adolescent↗
PubMed1995

Widespread embolism in a patient with infective endocarditis--a case report.

A 28-year-old man with a history of rheumatic heart disease, alcoholism and amphetamine abuse presented with severe left upper quadrant abdominal pain and persistent fever. He stayed at home for the previous two months due to intermittent dull lower abdominal pain, chills, fever and tarry stools without seeking medical help. A diagnosis of infective endocarditis with splenic infarcts and a renal infarct was made based on the echocardiographic and abdominal computer tomography scan findings. His clinical course was complicated by an acute inferior wall myocardial infarction and cerebral hemorrhage. Despite aggressive medical treatment, his condition deteriorated. One month later, his condition became more critical with pneumonia and intractable shock, and his family requested his discharge. He died soon after leaving the hospital.

Adult↗
PubMed1994

Color Doppler imaging of focal splenic masses.

UNLABELLED: We report the sonographic findings in 43 patients with focal splenic masses. A differential diagnosis of splenic tumors was attempted on the basis of echotexture, size, vascularity and patterns of blood flow within and around tumors on color Doppler sonography. Using the surrounding splenic tissue as an in vivo reference, markedly hypervascular (n = 3), hypervascular (n = 2), isovascular (n = 4), hypovascular (n = 3), and avascular (n = 31) tumors could be differentiated. The final diagnoses were splenic infarction (n = 13), splenic rupture (n = 9), splenic metastasis (n = 7), splenic lymphoma (n = 3), splenic abscess (n = 4), hemangioma (n = 3), splenic cyst (n = 3) and splenoma (n = 1). In 17 cases (40%) color Doppler provides no further information for diagnosis, color Doppler was helpful in 21 patients (49%) and in four (9%) cases, Doppler sonography detects unexpected flow phenomena and was necessary for final diagnosis and treatment. In one patient (2%) sonographic diagnosis was incorrect. CONCLUSION: Characteristic patterns of blood flow were seen in different splenic tumors and can, therefore, aid in the differential diagnosis of focal splenic lesions, and identify patients at risk for serious complications.

Abscess↗
PubMedDate not supplied

Real-time, contrast-enhanced sonographic imaging in emergency radiology.

PURPOSE: To report our pilot experience in the evaluation of traumatic and nontraumatic emergencies with contrast-specific, continuous-mode sonography (US) and a second-generation contrast medium. MATERIALS AND METHODS: Between January 2002 and December 2003 we evaluated 126 acute patients by using real-time contrast-specific US: blunt abdominal trauma (76 cases), penetrating abdominal trauma (3), blunt scrotal trauma (1), right upper abdominal pain (10), left upper abdominal pain (9), epigastric pain (2), flank pain (5), right lower abdominal pain (2), scrotal pain (7), postoperative abdominal sepsis (1), post-biopsy haemorrhage (1), ruptured abdominal aortic aneurysm (8), postsurgical aortic bleeding (1). In all cases the radiologist performed a complete baseline US survey and then decided whether or not to add a contrast-enhanced examination. RESULTS: All contrast-enhanced sonographic studies were completed proving to be adequate for diagnostic purposes and without adverse reactions to contrast medium. There were 40 true negatives. The final diagnosis, obtained in 85 positive cases out of 86, was: splenic injury (28 cases), hepatic injury (3), renal injury (3), multiple injuries (3), pancreatic and portal vein injury (1), colonic-mesocolic injury (1), testicular trauma (1), hepatic abscess (9), hepatic ischaemia (1), gangrenous cholecystitis (1), splenic infarction (8), splenic haematoma abscess (1), renal infection (4), renal infarction (1), necrotizing pancreatitis (1), post-biopsy haemorrhage (1), appendicitis (2), peritoneal abscesses (1), testicular torsion (6), orchiepididymitis (1), iliac artery dissection (1), ruptured abdominal aortic aneurysm (6), aortic periprosthetic hemorrhage (1). Out of 85 positive cases, agreement between baseline US and contrast-specific US was absent in 8% of cases, low in 26%, intermediate in 42%, and high in 24%. Baseline US had 3 false positives. Relevance of contrast-specific US was absent in 17% of cases, low (additional data not relevant for patient management) in 26%, intermediate (relevant additional data not modifying patient management) in 34%, and high (additional data modifying patient management) in 23%. Agreement between contrast-specific US and the gold standards was absent in 0% of cases, low in 6%, intermediate in 38%, and high in 56%. Contrast-specific US had 2 false positive results. CONCLUSIONS: Real-time contrast-specific US is an effective technique in emergency imaging. Its role should not be considered as a replacement of CT (though in some instances it can be considered a valuable alternative) but as a useful integration of conventional US. By always having the opportunity to add contrast-enhanced imaging, in case of interpretation doubts or diagnostic difficulties, the radiologist can assess the emergency patient with improved confidence and skill.

Abdomen↗
PubMed1984

Splenic complications of a pancreatic pseudocyst.

Six patients with pancreatic pseudocyst involving the spleen have been presented. The complications reported included massive hemorrhage into the pseudocyst, sepsis with splenic infarction, and splenic vein thrombosis. The diagnosis of intrasplenic pseudocyst based on clinical findings alone is difficult to arrive at but should be suggested by the presence of a mass in the left upper quadrant. Sonography and computerized axial tomography may be particularly helpful in confirming splenic involvement. Selective celiac arteriography should be performed whenever splenic involvement is suggested in order to confirm the diagnosis and to search for pseudoaneurysm formation. Urgent surgical intervention is usually warranted in view of the high incidence of serious complications and the propensity toward rapid clinical deterioration. Resection of the pseudocyst by splenectomy and distal pancreatectomy is the treatment of choice.

Adult↗
PubMedDate not supplied

Autopsy findings in patients on postcardiotomy centrifugal ventricular assist.

Reported experience with ventricular assist devices (VAD) routinely includes the rate of thromboembolic events, which is commonly calculated from clinically evident findings. Fifty-four patients have had postcardiotomy circulatory support with the Sarns centrifugal device at our institution. We have reviewed 43 patients who failed to survive VAD support to compare the thromboembolism rate diagnosed clinically to that determined at autopsy. In the 35 patients who had no autopsy, there was one clinically apparent thromboembolic event (2.3%). In eight similar patients who had autopsy, there was no clinically apparent thromboembolism. Five of these eight patients (63%) had acute thromboembolic infarcts determined at autopsy. Three had evidence of pulmonary thromboembolism, two cerebrovascular infarction, two liver infarcts, two splenic infarcts, two kidney infarcts, and one each gastric, pancreatic, prostate, adrenal, cervical, and ileal infarcts. All had left and/or right ventricular infarctions. It is concluded that patients dying following VAD have commonly suffered perioperative myocardial infarction. When evaluating complications associated with VAD, one should consider that the true incidence of thromboembolic events is underestimated by clinical findings.

Adolescent↗
PubMed2002

Spontaneous (pathological) splenic rupture in a blastic variant of mantle cell lymphoma: a case report and literature review.

Spontaneous (pathological) splenic rupture (SPSR) in hematological malignancies is rare. This report describes a 71-year-old male diagnosed with mantle cell lymphoma-blastic variant (MCL-BV) who experienced an SPSR a few days before the initial diagnosis. The patient underwent a splenectomy and recovered without incident. Partial remission was seen following several cycles of CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone). However, relapse was rapid, with leukemic meningitis occurring several months later. It was successfully treated by intrathecal methotrexate and cranial spinal radiation. A progressive lymphocytosis developed, which responded to rituximab. Lymphadenopathy and skin involvement ensued, followed by pneumonia and death. The literature on SPSR in patients with MCL-BV and other lymphoproliferative disorders showed similar clinical and postoperative findings. Clinical presentation included Kehr's sign and acute abdominal pain. Postoperative findings included blood in the peritoneal cavity, multiple splenic hematomas, splenic infarcts, and splenic necrosis. Most strikingly, the majority of the patients reviewed appeared to have undergone some type of blastic transformation. One or any combination of these findings that has been noted above in addition to a bleeding diathesis could be the foundation to SPSR. We recommend consideration of splenic rupture in patients with a lymphoproliferative disorder coupled with rapid progression of marked or massive splenomegaly.

Adult↗
PubMed2000

[An autopsy case of catastrophic antiphospholipid syndrome presenting with recurrent multiple cerebral infarction associated with lung cancer].

We reported an autopsy case of cerebral infarction with primary lung cancer. The patient was a 50-year-old man. Despite having been treated with warfarin potassium and ticlopidine hydrochloride, he relapsed cerebral infarction. His laboratory data on admission showed that lupus anticoagulant was positive, together with a high value of beta-thromboglobulin, thrombin-antithrombin III complex, markers of platelet and coagulation activation, CEA and CA 19-9. The autopsy finding revealed a primary papillary adenocarcinoma in the right lower lung, multiple cerebral infarction, renal infarction, pulmonary infarction and splenic infarction. The atherosclerotic changes were mild in the whole tissues and findings of vasculitis were not observed. Recurrence of cerebral infarction was effectively suppressed with the addition of steroid therapy to antithrombotic therapy. This case was considered as catastrophic antiphospholipid syndrome. It is necessary to differentiate antiphospholipid syndrome in case of the abnormal coagulation and fibrinolytic factors with recurrent cerebral infarction. Moreover, systemic examinations are important, because malignant tumor may exist on the background of the case.

Adenocarcinoma, Papillary↗
PubMed1990

Splenic septic emboli in endocarditis.

The significance of septic emboli to the spleen is inferred by the frequency of septic emboli in general seen in patients with left-sided infective endocarditis who are referred for valve replacement. To determine the proper management of splenic infarcts and abscess due to septic emboli, we retrospectively reviewed the records of 108 patients with left-sided endocarditis who underwent valvular surgery at the University of Illinois Hospital from 1980 through 1988. Intravenous drug abuse was the etiology in 68% (n = 73). The incidence of splenic infarcts and abscess was 19% (n = 20), but an incidental finding of splenic infarcts was found in 38% (n = 11) of 29 asymptomatic patients who had computed tomograms. Streptococci and staphylococci were the causative organisms in 85% (n = 17). Localized findings were absent in 90% of splenic infarcts and abscesses. Abdominal computed tomograms were diagnostic of the sequelae of splenic septic emboli in 100%. No patient had intra-abdominal bleeding complications associated with cardiopulmonary bypass. Splenectomy was performed in 50% (n = 10) of patients 3-24 days (mean, 11.2 days) after valve replacement. Indications for splenectomy included persistent sepsis in 60% (n = 6), large (greater than 2 cm) and peripheral lesions in 30% (n = 3), and splenic rupture in 10% (n = 1). Perioperative mortality of patients who underwent splenectomy was 30% (n = 3). The following conclusions can be drawn: 1) Splenic septic embolus is common in endocarditis. 2) Abdominal computed tomography should be performed for all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMedDate not supplied

[Four original cases of splenic venous infarction during pancreatic disease (author's transl)].

The authors report 4 cases of splenic complications occurring during chronic pancreatic disease and emphasize the vascular origin of the lesions observed in the spleen whether rupture, pseudo-cysts, hematic cysts, infarction or necrosis. The symptoms in each case seemed identical in their pathogenesis and linked to trunkular or radicular splenic venous thrombosis.

Chronic Disease↗
PubMed1987

[Value of leukocyte and gallium scintigraphy in the differential diagnosis of splenic abscess/-infarct].

The authors describe the limited role of non-invasive imaging procedures in the differential diagnosis of splenic abscess versus infarction. Sonography and computed tomography often do not offer any characteristic findings in these splenic disorders. A case is reported as an example. By means of 111 In-labelled leukocyte and gallium-67-scintigraphy exclusion of acute inflammatory processes can be performed with great certainty, and unnecessary surgical interventions can thus be avoided.

Abscess↗
PubMed2006

Asymptomatic splenic artery occlusion in a child: incidental detection with Doppler ultrasonography.

Splenic arterial occlusion is a rare condition usually presenting with signs that are due to splenic infarction. To the best of our knowledge, splenic artery occlusion without splenic infarction has not been reported in the literature. The case presented here was asymptomatic, except for hypertension. The splenic artery occlusion was detected incidentally during the color Doppler examination of renal arteries that was performed to rule out stenosis as a cause. The striking Doppler finding that led to the final diagnosis was peri-pancreatic multiple tubular structures consistent with collateral flow.

Child↗
PubMed2004

Association of splenic and renal infarctions in acute abdominal emergencies.

INTRODUCTION: Splenic and renal infarctions are usually related to vascular disease or haematologic abnormalities. Their association is infrequent and rarely observed in trauma. In this study, we analyze our data to look at the occurrence of renal and splenic infarctions based on CT findings in a period of 4 years. MATERIALS AND METHODS: We retrospectively reviewed the imaging findings of 84 patients admitted to our Department of Diagnostic Imaging from June 1998 to December 2002, who underwent emergency abdominal spiral CT examination and in whom there was evidence of splenic and/or renal infarction. RESULTS: We found 40 cases of splenic infarction and 54 cases of renal infarction, associated in 10 patients. In 26 patients, there was also evidence of intestinal infarction. A traumatic origin was found in 19 cases; non-traumatic causes were found in 65 patients. Association between renal and splenic infarction in the same patient was related to trauma in two cases. CONCLUSIONS: Although renal and splenic infarctions are a common manifestation of cardiac thromboembolism, other systemic pathologies, infections or trauma may lead to this occurrence. Renal infarction may be clinically and/or surgically managed with success in most cases. There are potential complications in splenic infarction, such as development of pseudocysts, abscesses, hemorrhage, subcapsular haematoma or splenic rupture; splenectomy in these cases may be necessary. Some patients with splenic and/or renal infarction may be clinically asymptomatic. The high accuracy of CT examination is needed to allow a correct evaluation of infarcted organs.

Abdomen, Acute↗
PubMedDate not supplied

Splenic and renal infarctions complicating atrial fibrillation.

Splenic and renal infarctions are common manifestations of cardiac thromboembolism. Usually they remain clinically silent and are not likely to be diagnosed antemortem. Two elderly female patients, in whom nonrheumatic chronic atrial fibrillation was noted, received low-dose aspirin. Both complained of the onset of acute abdominal pain and were found to have splenic and renal infarctions on abdominal computerized tomography. An enlarged left atrium was seen on echocardiogram in both cases. Treatment consisted of hydration, analgesics, and anticoagulation. In one case, liquefactive necrosis of the splenic infarct was observed on subsequent computer tomography studies. Both patients did well and remained free of new embolic events in the following 6 and 10 months, respectively. Clinicians should readily recognize the clinical manifestations of splenic and renal infarctions in patients with atrial fibrillation. Abdominal computerized tomography can confirm the diagnosis.

Aged↗