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At least 379 records · Page 21Linked to original sources
PubMed2005

Splenic syndrome in patients at high altitude with unrecognized sickle cell trait: splenectomy is often unnecessary.

BACKGROUND: The health risks associated with sickle cell trait are minimal in this sizable sector of the world's population, and many of these patients have no information about their sickle cell status. Splenic syndrome at high altitude is well known to be associated with sickle cell trait, and unless this complication is kept in mind these patients may be subjected to unnecessary surgery when they present with altitude-induced acute abdomen. METHODS: Four patients were admitted to the surgical ward with a similar complaint of acute severe left upper abdominal pain after arrival to the mountainous resort city of Abha, Saudi Arabia. All were subjected to splenectomy because of lack of suspicion regarding sickle cell status. RESULTS: Histologic examination of the spleen showed all patients had sickle cells in the red pulp. On further assessment all were found to have sickle cell trait with splenic infarction. In a similar study of 6 patients with known sickle cell disease who had comparable problems when they travelled to the Colorado mountains, all made an uncomplicated recovery with conservative management. CONCLUSIONS: In ethnically vulnerable patients with splenic syndrome, sickle cell trait should be ruled out before considering splenectomy. These patients could respond well to supportive management, and splenectomy would be avoided.

Abdomen, Acute↗
PubMed2005

[Abdominal organ infarction encountered immediately after surgery of primary lung cancer].

Very rare cases of abdominal organ infarction after surgery of primary lung cancer were reported. Case 1: Patient 1 was a 70-year-old man who underwent left upper lobectomy and ND 2a in June 1999 based on the clinical diagnosis of stage IA lung cancer. On the 4th postoperative day, the patient developed fever and right flank pain. Abdominal computed tomography (CT) demonstrated a specific finding compatible with renal infarction. The etiology could not be determined. The patient was treated conservatively. However, severe atrophy of right kidney was demonstrated by following CT performed 3 years later. Case 2: Patient 2 was a 70-year-old woman who underwent left upper lobectomy and ND 2a in December 2002 based on the clinical diagnosis of stage IA lung cancer. On the 4th postoperative day, the patient developed abdominal pain in the left upper quadrant, nausea and vomiting which had lasted for 10 days. Abdominal CT demonstrated a wedge-shaped filling defect at spleen compatible with splenic infarction. The etiology could not be determined. The patient was treated conservatively with prophylactic antibiotic therapy and followed closely. Partial atrophy of spleen was demonstrated by following CT performed 4 months later.

Adenocarcinoma↗
PubMed1984

Morbidity of sickle cell trait at high altitude.

A Caucasian with sickle cell trait (54% A, 43% S hemoglobin) had symptoms and signs of chronic hemolytic anemia as well as splenic infarction while living at very high altitude (in excess of 2,800 m). Trips from sea level back to high altitude repeatedly precipitated pulmonary infarctions. All symptoms and evidence of hemolysis resolved at low altitude.

Adult↗
PubMedDate not supplied

The frequency, appearance, and significance of splenic perfusion defects in CT arterial portography.

BACKGROUND: The purpose of this study was to determine the frequency, appearance, and significance of splenic perfusion defects on computed tomographic arterial portography (CTAP). METHODS: CTAP was performed with dynamic scanning at 1-cm increments on 46 consecutive patients prior to laparotomy. Two readers retrospectively reviewed these studies in consensus and recorded the number, size, and shape of focal splenic perfusion defects. These defects were later correlated with surgical findings and at least one of the following imaging modalities: delayed CT 4-6 h after CTAP, intravenously enhanced CT, sonography, or magnetic resonance imaging (MRI). RESULTS: Splenic perfusion defects were present in 14 of 46 CTAP studies (30%), and in seven patients these defects were multiple. Most defects were wedge-shaped and peripherally located, although several round defects simulating metastases were also present. The spleen was normal at surgery in all patients, and comparison imaging revealed only a small splenic infarct in one patient on MRI. CONCLUSIONS: Splenic perfusion defects occur in about one-third of patients referred for CTAP, are usually wedge-shaped but may be round, and should not be interpreted as metastases without other evidence of a space-occupying mass.

Contrast Media↗
PubMed1989

Cholesterol embolism: experience with 22 histologically proven cases.

The records of 22 patients, aged 61 to 85 years, with histologically proven cholesterol embolism (CE) were reviewed. All had one or more risk factors. Twenty-one patients had preexisting symptomatic or recognized atherosclerotic disease. Twenty patients had one or more identifiable precipitating factors, including warfarin administration (4), angiography (15), angioplasty (2), intra-aortic balloon pump placement (2), vascular surgery (11), aortitis (2), and cardiopulmonary resuscitation (1). These preceded the onset of symptoms by as many as 3 months, but usually by less than 3 weeks. Eight patients had peripheral CE alone. Fourteen patients had visceral CE. All 14 had renal CE that was characterized by abrupt deterioration of renal function after a precipitating event (13), evidence of concurrent CE to the lower extremities or other organs (10), accelerated hypertension (9), gross hematuria (6), or flank and back pain (3). Unusual presentations included one case each of spinal cord infarction, penile gangrene, adrenal insufficiency, and symptomatic splenic infarct. If patients with visceral CE survived after initial hospitalization, they often required dialysis and later hospitalizations because of complications. Premortem diagnoses were made in 18 patients: nine from surgical specimens and nine from biopsies (one kidney, eight muscle and skin). Attempts at definitive vascular surgery were possible in only two patients and successful in one. The challenges encountered in managing these patients' conditions are reviewed.

Adult↗
PubMed2003

Torsion of a wandering spleen: acute abdominal presentation.

Torsion of a wandering spleen is a rare but fulminant condition and is part of the differential diagnosis in patients presenting with acute abdominal pain. It results due to absence or laxity of the various ligaments supporting the spleen. Patients may be asymptomatic or may present with acute abdominal pain. It may occur in people of all ages, with a predilection for male patients under 10 years of age and for female patients in older age groups, being most common in multiparous women. Early intervention is necessary to reduce the risk of splenic infarction and other complications. An awareness of the condition together with use of appropriate medical imaging can lead to the correct diagnosis.

Abdomen, Acute↗
PubMedDate not supplied

Acute abdomen due to wandering spleen infarction: a case report.

We report a rare clinical case of acute abdomen due to partial infarction of a wandering spleen in the pelvis in a 60-year-old woman. The patient was suffering from stabbing pain in the external lower quadrant of the abdomen, irradiating back to the lumbosacral area, together with an unremitting feverish state (38 degrees C), sickness and constipation. After carrying out serological examinations, which revealed an increase in CPK and leukocytosis, ultrasonography and CT examinations were performed, revealing a mass in the left iliac cavity, which in all probability was a wandering spleen with an abnormally long pedicle and a dyshomogeneous lower area bearing witness to a splenic infarction. The patient was therefore submitted to surgery consisting in splenectomy after lysis of the adherences, which were plainly inflammatory. A wandering spleen, especially when infarcted, is a very rare clinical condition that may be congenital or acquired. Its presence can be confirmed by serological, ultrasonographical and CT examinations and must be suspected when there is no clearly defined acute abdomen.

Abdomen, Acute↗
PubMed1994

A case of Trichosporon beigelii endocarditis 8 years after aortic valve replacement.

We report a case of Trichosporon beigelii endocarditis in a 77-year-old diabetic man who presented with an embolic stroke 8 years ago after a porcine aortic valve replacement. He was treated successfully with amphotericin, rifampin, and replacement of the original porcine valve; however, he died suddenly 8 months later from unknown causes. Blood cultures 2 months prior to death were negative. The first manifestation of the endocarditis was a left hemiparesis followed some days later by a splenic infarction. Transthoracic echocardiography failed to demonstrate the aortic vegetation, which was clearly visualized subsequently by transesophageal echocardiography. The literature on Trichosporon beigelii endocarditis is reviewed.

Aged↗
PubMed2004

Torted and ruptured wandering spleen presenting as a surgical emergency in pregnancy.

Wandering spleen (WS) is characterised by incomplete fixation of the spleen to its supporting linorenal and gastrosplenic ligaments. It can predispose to life-threatening complications due to torsion of its vascular pedicle, splenic infarction, portal hypertension, and haemorrhage. A 27-year-old, 36-week prima gravida underwent emergency caesarean section for tachycardia and hypotension. A healthy baby girl was delivered. However, she remained shocked despite aggressive fluid therapy and intraoperatively it was noted that there was significant intraperitoneal bleeding and the on-call surgical team was summoned. Midline laparotomy revealed a lacerated, infarcted, hypermobile spleen found with free intraperitoneal bleeding. The unsalvageable spleen was resected and the patient went on to make an excellent recovery. The aetiology of WS is contentious. With an increased frequency among multiparous females of reproductive age, some suggest the hormonal effects of pregnancy as contributing factors. Clinical presentations range from an asymptomatic abdominal mass to acute abdominal pain with hypovolaemic shock. WS poses a serious threat to life due to thrombosis, bleeding, or infarction. Ultrasound scan and CT scan are equally effective in the diagnosis. Patients with asymptomatic WS should be treated with elective splenopexy, however, in the acute presentation, splenectomy is the procedure of choice.

Adult↗
PubMed1995

[Splenic abscess after angiography. Considerations on a clinical case].

A case of splenic abscess in a diabetic, cardiopathic and arteriopathic 49-year-old man is reported. The abscess developed on a previous splenic infarction caused by an embolus coming from an intraventricular thrombus. The angiographic procedure was the source of bacterial contamination (Staphylococcus aureus). The patient was successfully treated with splenectomy.

Abscess↗
PubMedDate not supplied

Gastric angina secondary to acute thrombosis of celiac artery.

We report a 48-year-old woman with foregut ischemia with splenic infarct due to isolated celiac artery obstruction. The patient presented with acute-onset pain in the epigastrium 10-15 min after every meal. Investigations revealed obstruction of the celiac artery by artheromatous plaque. This patient had an acute thrombosis, which responded to anticoagulation.

Acute Disease↗
PubMed1990

Hypertension in sickle cell disease.

We report a young male with sickle cell trait who developed severe hypertension and splenic infarction soon after travel to a high altitude. Hypertension persisted for three days after a diagnostic laparotomy. His blood pressure then continued to be normal over the next one and a half years. Red cell sludging in the small vessels of the kidney possibly activated the renin angiotensin system.

Adult↗
PubMed2001

Thermophilic multidrug-resistant Campylobacter fetus infection with hypersplenism and histiocytic phagocytosis in a patient with acquired immunodeficiency syndrome.

We present a case report of a patient who had acquired immunodeficiency syndrome (AIDS) and Campylobacter fetus infection with a number of unusual clinical and microbiological features. The patient had prominent gastrointestinal symptoms, splenic infarction, splenomegaly with hypersplenism, and hemophagocytic histiocytosis in the spleen and lymph nodes; the organism displayed growth on Campy-selective blood agar, thermotolerance, and resistance to quinolones, piperacillin/tazobactam, ceftazidime, and erythromycin.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Computed tomography of the abdomen in the diagnosis of splenic emboli.

Abdominal computed tomographic scans were performed in 25 consecutive patients with bacterial endocarditis. Six patients had splenic infarcts, only two of whom had symptoms. Three of the six patients had no evidence of emboli to other organs. In patients with endocarditis who have had clinically apparent emboli or who are, for other reasons, being considered for valvular surgery, a computed tomographic scan of the abdomen may help in decision making.

Adult↗
PubMed1990

[The diagnostic importance of echography of the spleen, abdominal lymph nodes and vessels in chronic lympho- and myeloleukemias].

Echography of the spleen and abdominal vessels was performed in patients with chronic myeloleukemia (CML) and chronic lympholeukemia (CLL). The patients belonging to these groups manifested enlargement of the spleen, alterations of its echo structure and dilatation of the vessels even at the initial disease stage. Appreciable splenomegaly with a proportional increase of the diameter of the main vessels of the abdominal cavity and derangement of the splenic echo structure were ascertained in patients in the stage of pronounced clinicohematological manifestations. Moreover, provided those diseases run an atypical course, echography of the spleen, abdominal lymph nodes and vessels is of differential diagnostic importance. As compared to patients with CLL, the spleen of those with CML differed as regards the extent of enlargement and alterations in the organ structure in different stages of the tumorous process. There were differences in the diameter of the abdominal vessels. The patients with CML demonstrated splenic infarctions of different standing whereas patients with CLL conglomerates of the abdominal lymph nodes. In patients with CML, remarkable splenomegaly was observed more frequently. Echography of the spleen and vessels in patients with CML and CLL is a highly informative, noninvasive and safe method which is likely to be widely used in hematology.

Abdomen↗
PubMed2003

Real-time contrast-enhanced ultrasound of the spleen: examination technique and preliminary clinical experience.

PURPOSE: To report our preliminary experience in the evaluation of the spleen using a real-time contrast-specific ultrasound module in combination with a second-generation contrast agent. MATERIALS AND METHODS: In a 7-month period, 55 patients (34 males and 21 females, aged 5-77 years) with spleen disorders were evaluated by means of contrast-enhanced ultrasound. Two patients were studied because of baseline evidence of an accessory spleen and both underwent ultrasound follow-up. Twenty-five patients were studied for abdominal trauma and results were correlated with those of helical CT. Three patients were examined for suspected splenic infarction and for all CT correlation was obtained. Finally, twenty-five subjects were examined for focal diseases, such as lymphomas (17 cases) and focal lesions (8 cases); contrast-enhanced US results were correlated with those of CT (8 cases), MRI (2 cases), ultrasound follow-up (8 cases), biopsy (2 cases) or splenectomy (1 case). After an initial baseline study, the contrast-enhanced examinations were carried out using a dedicated unit equipped with a continuous contrast-specific module at low acoustic pressure. The examination started immediately after rapid contrast injection and lasted approximately 4 minutes. In the comparison between baseline and contrast-enhanced ultrasound, the following aspects were considered: detection rate of parenchymal changes, lesion extent (equal to CT, under- or overestimated), and lesion conspicuity (lesion-to-parenchyma gradient, from 0 = absent to 3 = high). RESULTS: In the 2 patients with accessory spleen, an enhancement very similar to that of the adjacent parenchyma was present and a small vascular pedicle was noted. Among the trauma patients, 18 had a direct splenic injury and one showed splenic contraction and hypoperfusion due to shock. In 74% of cases, a peritoneal effusion was demonstrated both with baseline and contrast-enhanced ultrasound; perisplenic blood collections (58% of cases) were identified in 42% of patients by both baseline and contrast-enhanced ultrasound; post-traumatic infarction was always revealed by contrast-enhanced ultrasound (11% of cases) but never by baseline ultrasound; parenchymal injuries were detected with a sensitivity of 63% by baseline ultrasound and a sensitivity of 89% by contrast-enhanced ultrasound. Moreover, contrast-enhanced ultrasound revealed findings undetectable on conventional ultrasound: global splenic hypoperfusion in 2 cases (due to shock in one and pedicle avulsion in the other), intraparenchymal contrast collections in 21% of positive cases (as confirmed by CT), extrasplenic contrast leakage in 1 of 2 cases demonstrated by CT. Of the 3 cases of splenic infarction, baseline sonography only only identified two, whereas the contrast-enhanced examination clearly identified three. Contrast-enhanced ultrasound revealed 35 of 39 focal lesions in patients studied for Hodgkin's disease and splenic focal lesions. Baseline ultrasound had a lower sensitivity (23 lesions). Lesion extension shown by contrast-enhanced sonography was equivalent to that provided by standard methods in 88% of cases (underestimated in 9% and overestimated in 3%); baseline US correctly estimated lesion size in 52% of cases, under- and overestimating them in 35% and 13% of cases, respectively. Lesion conspicuity was graded as 1 (low) in 16%, 2 (moderate) in 67%, and 3 (high) in 17% of the cases identified by enhanced sonography. Baseline ultrasound was less effective: conspicuity was graded as 1 in 42%, 2 in 39%, and 3 in 19% of cases. CONCLUSIONS: The spleen is the ideal organ to be studied with second-generation contrast media due to its superficial location, high vascularity, small size and homogeneous texture. Contrast-enhanced ultrasound is a simple, poorly-invasive and accurate tool for the evaluation of splenic disorders. If our data are confirmed, it will be possible to reduce the use of more complex technologies such as CT and MRI.

Adolescent↗
PubMedDate not supplied

[Streptococcus bovis meningitis. An infrequent cause of bacterial meningitis in the adult patient].

INTRODUCTION: Bacterial meningitis in adult patients, produced by streptococci other than Streptococcus pneumoniae, is not common. CASE REPORT: We report the case of a 74 year old male patient with meningitis and endocarditis due to Streptococcus bovis (group D, not enterococcus), sensitive to penicillin (CMI< 0.1 mg/L), with no characteristic clinical or analytical discoveries. A gastrointestinal exploration revealed only diverticles in the colon and two lesions compatible with splenic infarction, observed by using computerised axial tomography of the abdomen. The patient responded favourably to a four week course of antibiotics; he remained asymptomatic, afebrile and culture negative after the therapy was stopped. CONCLUSIONS: In many previously reported cases, there is an association with gastrointestinal illness, endocarditis or oral lesions. Gram staining of the cerebrospinal fluid is usually negative and the neurological signs are often subtle. In the case of bacteraemia, endocarditis or S. bovis meningitis, the presence of an underlying pathology of the colon due to the frequent association between these processes must be ruled out. Treatment with penicillin G is usually sufficient.

Aged↗