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PubMed1987

[Focal changes in the spleen. Ultrasonic morphological characteristics and their clinical significance].

Focal changes in the spleen were rare findings in a large clinical material (less than 1% of cases). In a prospective study, which included 580 patients, lesions in the spleen were found in 40. Four focal lesions were due to infiltrates from non-Hodgkin's lymphoma. Twenty-one lesions with low echoes consisted of twelve infiltrates from Hodgkin's disease (six patients) or non-Hodgkin's lymphoma (six patients), five were due to fresh splenic infarcts and one each to an abscess, a metastasis from a carcinoma of the stomach, sarcoid and a haemorrhage. In only three of ten highly echogenic foci was a diagnosis possible (one leukaemic infiltrate and two scars following splenic infarcts). The significance of the sonographic demonstration of focal splenic lesions for diagnosis and treatment is discussed. The advantages of a sector scanner for evaluation of the spleen and splenic size are mentioned.

Hodgkin Disease↗
PubMed2003

Wandering spleen: a rare cause of abdominal pain.

Torsion of a wandering spleen is a rare cause of abdominal pain in children. The most common presentation is acute abdominal pain, although signs and symptoms vary widely. Due to the risk of splenic infarction, rapid and accurate diagnosis is essential. Wandering spleen and splenic torsion can be diagnosed by Doppler ultrasound and CT scan. Treatment options include splenopexy or splenectomy. This case describes a 9-year-old girl with torsion of a wandering spleen, complicated by splenic infarction and managed by splenectomy.

Abdominal Pain↗
PubMedDate not supplied

Spontaneous nontraumatic intrasplenic pseudoaneurysm: causes, sonographic diagnosis, and prognosis.

PURPOSE: The aim of this study was to describe the incidence, causes, sonographic features, therapy, and prognosis of nontraumatic intrasplenic pseudoaneurysms (NTISPs), a rare complication of splenic infarction or infiltration by malignant systemic disorders or infectious diseases. METHODS: We retrospectively reviewed the medical and sonographic records of all patients seen at our clinic from July 1985 through December 2000 to identify patients with a sonographic diagnosis of spontaneous nontraumatic splenic rupture. We then examined the features of the resulting cases to identify patients in whom NTISPs were revealed by color Doppler sonography. RESULTS: In total, 41 patients were identified. Among those patients, 5 (12%) had NTISPs. Three of those 5 patients had an underlying malignant disorder (1 case of non-Hodgkin's lymphoma and 2 cases of chronic myelogenous leukemia), and the other 2 had an inflammatory disease (1 case of endocarditis and 1 case of pancreatitis). Three of the patients also had splenic infarctions. Three patients underwent splenectomy; in 2 of them, secondary delayed splenic rupture occurred before or during splenectomy. In 2 other patients, spontaneous thrombosis of the aneurysms occurred (after 16 hours in 1 and 15 days in the other). CONCLUSIONS: NTISPs may occur in about 12% of patients with sonographically detected nontraumatic spontaneous splenic rupture. NTISPs appear to be associated with an increased risk of secondary delayed splenic rupture, although spontaneous thrombosis may occur. Short-term follow-up sonographic examinations, particularly with color Doppler imaging, are recommended for early recognition of progression of NTISPs, which can guide treatment decisions.

Aneurysm, False↗
PubMed1989

[2 cases of acute sickle cell crisis in subjects with sickle cell trait following high altitude exposure].

We present two patients with sickle cell trait (HbAS) who developed acute sickle cell crisis after passive exposure to high altitude on the Jungfraujoch (3454 meters, 11,333 ft). Both suffered splenic infarction and the first patient also presented with acute renal failure. Splenic infarction is known to be a complication of altitude exposure in carriers of the trait, whereas acute renal failure due to altitude exposure alone has as far as we know never been described in the literature. These forms of high altitude complications are totally unusual in Switzerland.

Adult↗
PubMedDate not supplied

Splenic lesions: sonographic patterns, follow-up, differential diagnosis.

This report concerns 172 patients with sonographically diagnosed benign and malignant splenic lesions. A variety of echopatterns was observed, but a differential diagnosis was often impossible without contributory clinical data. Thirteen patients underwent ultrasound-guided fine-needle biopsy for histological confirmation or therapy. In 14 cases splenectomy was performed for treatment or final diagnosis. Twenty-three patients had malignant space-occupying lesions of the spleen. 26 cases presented with normal splenic size, 47 showed splenomegaly of different extent. Lymphoma was the main basic illness in 60 patients. Thirteen cases presented with splenic metastases from other neoplasms. 71 malignant splenic lesions were hypoechoic when compared with normal splenic echotexture. Only two patients exhibited hyperechoic metastases. In three cases a 'halo' sign was seen. In 99 patients benign focal lesions of the spleen were diagnosed. These included splenic infarction (n = 36), dysontogenetic cysts (n = 23), splenic abscesses (n = 7), splenic calcification (n = 13), and hyperechoic lesions (n = 17) most probably representing splenic hemangioma.

Abscess↗
PubMed1997

Acute splenic complications in children with sickle cell-hemoglobin C disease.

OBJECTIVE: To determine the frequency and severity of acute splenic complications in children and adolescents with sickle cell (SC) hemoglobin C disease. METHODS: The medical records of 271 patients with SC disease seen at our center were reviewed to evaluate the incidence and severity of acute complications involving the spleen. RESULTS: Sixteen (6%) children had acute splenic complications. Thirteen (5%) had 16 episodes of acute splenic sequestration (ASSC), with the initial event occurring at a mean age of 8.9 years (range, 2 to 17 years). Splenomegaly had been noted before the initial event in 6 (46%) of the 13 cases, and 3 (23%) had a history of painful splenic infarction. Two young children (aged 4 and 6 years) had a hemoglobin value less than 2 gm/dl, one without history of splenic enlargement. Three (23%) children had a second episode of ASSC. Three additional patients had a history of acute painful splenic infarction, two of whom also had splenic hemorrhage. Eight (3%) of the 271 children required splenectomy (1 after the initial episode of ASSC, 3 after a second episode of ASSC, 2 as a result of pain accompanying chronic infarction and ASSC, and 2 because of splenic hemorrhage). No deaths resulted from ASSC. CONCLUSIONS: We conclude that (1) acute splenic complications in children and adolescents with SC disease are relatively uncommon, (2) most episodes of ASSC occur in preadolescents, (3) ASSC can be life threatening, even in younger children, and (4) prior splenomegaly is not a good predictor of ASSC. Thus it is vital that the parents of all children with SC disease be instructed to palpate their child's spleen regularly.

Adolescent↗
PubMed1995

Tc-99m leukocyte scintigraphy in infective endocarditis.

A 56-year-old man with Staphylococcal aureus septicemia and clinically suspected infective endocarditis was imaged using Tc-99m HMPAO leukocytes. Although abnormal uptake was seen at 3 hours after injection, 24-hour images demonstrated marked concentration of radiolabeled leukocytes in a myocardial abscess and large posterior parietal infarct. In addition, multiple splenic infarcts were shown. The Tc-99m labeled leukocyte scan proved to be an excellent whole body screening procedure for diagnosing sites of infection and infarction in this patient.

Bacteremia↗
PubMed1989

Pediatric wandering spleen--the case for splenopexy: review of 35 reported cases in the literature.

Wandering spleen is an uncommon diagnosis and has been rarely described in children. A review of the English literature yielded 35 reported cases in children less than 10 years of age. Eighteen (51%) presented as acute surgical emergencies, only eight of which had the correct diagnosis of pedicle torsion with splenic infarction established preoperatively. Thirteen patients underwent an elective laparotomy, either for chronic symptoms related to their wandering spleen or for an abdominal mass. Of the 13 patients electively managed, nine underwent a splenectomy while five were treated successfully with splenopexy. The remaining four patients were managed conservatively without surgical intervention. In only one third of the patients presenting as acute surgical emergencies was there any history of intermittent abdominal pain or of a previous abdominal mass. No deaths were reported. Males represented 63% of the patients. The occurrence was most common in patients less than 1 year of age, with a 6:1 male predominance in this age category. All acute cases of wandering spleen in which splenic infarction has occurred require splenectomy. However, in patients with chronic symptoms or in whom the diagnosis is made prior to splenic infarction, splenopexy should be the treatment of choice. Past recommendations of splenectomy or conservative nonsurgical management are not indicated. Literature on pediatric wandering spleen is reviewed herein, and a technique for splenopexy using Dexon mesh is described.

Child↗
PubMed2006

An unusual cause of acute abdominal pain - a case presentation.

BACKGROUND: In 1983, Graham Hughes described a condition of Antiphospholipid Syndrome in which there was a danger of thrombosis. The condition is readily detectable by blood tests and, once diagnosed; the risk of further thrombosis can be significantly reduced by anticoagulation treatments. Affected groups of patients can be distinguished by a specific blood test - the detection of antiphospholipid antibody (Ref-1). Patients with Hughes syndrome have hypercoaguable state with a markedly increased risk of both arterial and venous thrombosis and there is temporal persistence of antibody positivity. CASE PRESENTATION: A 44-year-old woman was admitted under the acute surgical "take" with left sided abdominal pain radiating to her back. She had a history of borderline thyrotoxicosis in the early 1990s. She was on etonogestrel-releasing implants for contraception and there was no history of previous deep venous thrombosis. She was very tender, locally, over the left side of the abdomen. Investigations showed haemoglobin of 13.2 g/dl, white cell count of 19.9 10*9/L, and platelets 214 10*9/L with neutrophilia. Amylase and renal function tests were found to be normal. Liver function tests were deranged with Gamma GT 244 u/l (twice normal). An abdominal Ultrasound Scan suggested a possible splenic infarction, which was confirmed by a CT scan of her abdomen. Tests were carried out to investigate the possibility of a post thrombotic state. Coagulation risk factors for thrombosis were within the normal limits; Protein S 67 %(60-140), Protein C 103 % (72-146), Antithrombin 3 110 %(80-120) and Activated P C Resistance was 1.9(2.0-4.3). The Hams test was negative but the Anticardiolipin antibody test was positive. IgM level was 52 (normal is up to 10) and IgG was 18.8 (normal is up to 10). She also had border line APC Sensitivity 1.9 (2 to 4.3). Kaolin time 49 sec (70-120) Ktmix 64 sec (70-120), thyroid function test revealed TSH 0.32 micro/L, fT4 20.2 pmol/L (10-25). Subsequent determination of Anticardiolipin antibody was negative. Her symptoms were settled with the use of simple analgesia and she was discharged home with long-term anticoagulation medication. The INR target for long-term anticoagulation was aimed at >3. CONCLUSION: This case presented to us as an acute abdominal pain. Subsequent investigations revealed the presence of splenic infarction. Coagulation risk factors for thrombosis proved negative. Haematological investigations revealed the presence of anticardiolipin antibodies at the first instance but subsequent determinations were negative. Hence, it mimicked Hughes syndrome initially but the criteria for temporal persistence of anticardiolipin antibody was not fulfilled. Unusual surgical presentation of a thrombotic abnormality as abdominal pain due to splenic infarction.

Journal Article↗
PubMed2007

Wandering spleen with torsion of the pedicle.

Wandering spleen is a rare medical entity. It usually occurs at 20-40 years of age, and most cases are seen in women. Clinical diagnosis is difficult due to lack of symptoms, unless splenic torsion has occurred and clinical symptomatology of acute abdomen develops. The diagnosis can be confirmed by imaging techniques. Treatment is operative due to complications of splenic infarction. Splenopexy is the usual treatment, except for cases of splenic infarction. Splenectomy should be carried out when there is no evidence of splenic blood flow after detorsion of the spleen and in cases of excessive splenomegaly.

Adolescent↗
PubMed1989

Sickle cell trait revisited.

Variability in the clinical severity of sickle cell diseases is often genetically determined. Coexistent alpha-thalassemia decreases some, but not all, associated morbid complications. Polymorphisms within the beta-globin-like gene cluster influence disease severity by varying gamma-gene expression and the amount of Hb F within the cells. Few persons with the sickle cell trait experience adverse consequences attributable to the beta s gene. Is this also due to genetic factors? A literature search failed to answer this question. It is intriguing, however, that reported associations of sickle cell trait and splenic infarction have occurred exclusively in males and mostly in whites. Plausible but scanty data suggest that splenic infarction, hematuria, and reduced renal concentrating ability may be associated with higher amounts of Hb S. Therefore, alpha-thalassemia may be protective. No evidence was found that the amount of Hb S influenced the incidence of sudden death after exertion or that increased amounts of Hb F accounted for protection against any complications. More detailed reporting of biochemical and genetic evaluations of persons with sickle cell trait who experience related clinical events may lead to a better understanding of risks in subpopulations of persons carrying a single beta s gene.

Altitude↗
PubMed1991

Sonographic investigation in the diagnosis of intrasplenic fluid collections.

The authors report about the diagnosis of 55 patients for whom cyst-like lesion sites or predominantly anechoic lesions were diagnosed by means of sonography of the spleen. Sonographic analysis included interventional sonography with fluid aspiration in accordance with diagnostic and therapeutic guidelines (n = 19), catheter drainage (n = 3), B-mode pulsed Doppler-Ultrasound, and short-term follow-up examinations. The final diagnoses were splenic cysts (n = 25), splenic ruptures (n = 10), splenic infarctions (n = 12), splenic abscesses (n = 7) and splenic metastasis (n = 1). Because of the ultrasound findings in diagnosis and during the follow-up observations, 15 patients underwent splenectomy. Special attention is drawn to the clinical relevance of these procedures for diagnosis of splenic liquid masses.

Abscess↗
PubMed1989

Technetium-99m sulfur colloid spleen imaging following partial pancreatectomy and splenic artery and vein resection.

We retrospectively studied the records and [99mTc]sulfur colloid (TSC) spleen studies of 38 patients who underwent distal pancreatectomy with splenic artery and vein resection for donation to HLA-compatible relatives. The spleens in immediate postoperative TSC studies were normal in 11% of cases, showed no uptake in 16%, showed diffusely decreased uptake in 50%, and showed focal defects in 26%. Twenty of the patients, all with abnormal initial TSC studies, had repeat studies 2 wk to 3 yr later; 15% showed no change, 35% showed some improvement, and 45% became normal. One of six patients with no TSC uptake required splenectomy 2 days after pancreatectomy for splenic infarction. These data suggest that the spleen usually survives splenic artery and vein resection. Absent splenic TSC uptake raises the possibility of splenic infarction.

Adult↗
PubMed2006

The exceptionally rare (sic) Common Scoter.

A 1-month-old infant with congenital heart disease underwent initial cardiac surgery (Mee Shunt) at day 20 but was later readmitted because of poor shunt flow and hypoxemia. Despite therapy, the infant deteriorated and suffered a cardiopulmonary arrest. After 40 minutes of resuscitation, spontaneous cardiac output was reestablished, and subsequently, the child was placed on extracorporeal circulation membrane oxygen (ECMO) support. The infant deteriorated further over the next 3 days with persistent acidosis, marked abdominal distension associated with significant nasogastric aspirates, and the passage of small amounts of bloodstained stool. The presumed diagnosis was necrotizing enterocolitis, and despite the grave prognostic indicators, the decision was taken to undertake laparotomy. At surgery, there was 350 mL of unclotted venous blood in the peritoneal cavity. The bowel was grossly normal. A ruptured, infarcted, hemorrhagic spleen was discovered to be the cause of the bleeding. A splenectomy was performed, and the child made rapid recovery, sufficiently well to undergo redo Mee shunt 2 days later. A splenic infarct was confirmed at pathological examination. The cause of the splenic infarct and rupture is uncertain in this baby but may have been related to either cardiopulmonary resuscitation and/or ECMO. The importance of this case is the similarity in presentation in a baby with congenital heart disease between necrotizing enterocolitis (which is relatively common) and hemoperitoneum secondary to splenic rupture (which is very rare). Medical practice contains many useful maxims such as, "What walks like a duck, talks like a duck, is often a duck." This case demonstrates that not all ducks are the common Mallard (Anas platyrhynchos) but occasionally the exceptionally rare (sic) Common Scoter (Melanitta nigra). The management of neonatal cardiac patients on ECMO therapy continues to be a challenge, and particular diagnostic rigor should be applied in their care.

Cardiac Surgical Procedures↗
PubMed1986

Acute splenic sequestration crises in adults with sickle cell disease.

Reports of acute splenic sequestration crises in adults with sickle cell hemoglobin C disease or sickle cell thalassemia are rare, although an enlarged and distensible spleen persists in half of these patients. Seven episodes of acute splenic sequestration crises in four adults, two with sickle C disease and two with sickle thalassemia, are described. The crises were life-threatening and recurrent in all, but there were no fatalities. One patient had mild steady-state thrombocytopenia suggesting hypersplenism. Technetium 99m/sulfur colloid scanning of the spleen during the acute splenic sequestration crises in three patients showed almost total lack of splenic uptake or decreased uptake with intrasplenic filling defects thought to be splenic infarcts or hematomas on follow-up computed tomographic scanning. The scanning abnormalities resolved following recovery from the crises. Acute splenic sequestration crises probably are common in adults with sickle C disease and sickle thalassemia but may be underdiagnosed or misdiagnosed as splenic infarctions. The hematologic and splenic findings during acute splenic sequestration crises resemble those following splenic vein ligation in animals.

Acute Disease↗
PubMed1994

Case report: bowel infarction with splenic air embolism: computed tomography findings.

Computed tomography (CT) is used increasingly as an early radiological examination in patients with suspected bowel infarction because it provides information about the intestinal wall, mesenteric circulation and peritoneal cavity [1, 2]. Other disorders that present with similar symptoms such as intraabdominal abscess, pancreatitis and ulcerative colitis can be excluded [3]. CT can demonstrate small amounts of air within the bowel wall, in the spleno-mesenteric-portal venous system and in the peritoneal cavity, making it possible to differentiate portal venous gas from pneumobilia. The authors describe a patient in whom a specific diagnosis of bowel infarction was made on the characteristic CT findings. Furthermore, air embolism was observed in the splenic parenchyma. This finding has not been previously reported in bowel infarction or in any other abdominal disorder.

Embolism, Air↗
PubMed2001

Early and long-term results of surgical treatment of splenic artery aneurysms.

BACKGROUND: This retrospective study was conducted to describe the presentation, surgical treatment, and follow-up of patients with splenic artery aneurysms. METHODS: From 1982 to 2000, 1,952 patients with abdominal aneurysms were referred to our department; 15 had splenic artery aneurysms. None had ruptured. All were operated on. RESULTS: Fourteen complete and 1 partial aneurysmectomies were carried out. Arterial continuity was restored in 10, by end-to-end anastomosis, and 4 had splenectomies. In 1 patient the spleen was preserved without arterial reconstruction. There were no deaths. Morbidity was restricted to 1 patient with a limited, asymptomatic splenic infarction. Eleven patients were followed up for a mean 19.7 months. No deaths or major complications were recorded. Reconstructed splenic arteries were patent in all cases without atrophy or new cases of splenic infarction. CONCLUSIONS: Elective surgery for splenic artery aneurysms is safe. Arterial reconstruction allows good early and long-term results. In some cases splenectomy may be unavoidable.

Aneurysm↗
PubMed1984

The sickle cell trait in relation to the training and assignment of duties in the armed forces: II. Aseptic splenic necrosis.

Well-documented information gleaned from the world's literature reveals that in vivo sickling of erythrocytes and vascular occlusive lesions involving the spleen have occurred in individuals with the sickle cell trait (SCT) while flying in unpressurized airplanes or when exposed to hypoxic environments in mountains at intermediate altitudes. The clinical and anatomical manifestations of splenic infarcts are described. Individuals without the trait do not develop splenic infarcts during or following exposure to ambient hypoxia.

Abdomen↗