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PubMed2002

[Multivisceral infarcts are complication of invasive aspergillosis].

Aspergillus fumigatus is one of the species of Aspergillus that causes aspergillosis. The clinical picture of invasive-disseminated aspergillosis is generally characterized by fever and respiratory distress that usually follows a fatal course. This form of intensive aspergillosis is suffered by severely immunossuppressed patients. There is another clinical form of severe aspergillosis, aortic aspergillosis, that appears after cardiac surgery. We present two cases of invasive aspergillosis complicated by multiple visceral infarcts involving the liver, spleen, kidneys, pancreas, thiroid and brain. Infarcts were confirmed in necropsy and appeared to be caused by an overwhelming amount of intravascular hiphae, which were observed in the infarcted areas acting forming septic embolus. We believe that multi-visceral infarcts are an underestimated complication of invasive aspergillosis. Given the progressive increase in the population of immunossuppressed patients, clinicians have to aware of all the possible presentations of invasive aspergillosis.

Aged↗
PubMed1980

Pulmonary and systemic embolism after deliberate intravenous fluorocarbon administration.

After intravenous injection of 0.1 ml Fluorocarbon (FC) into the caudal vein of rats clear droplets which are reminiscent of gas emboli appear in the pulmonary and cerebral arteries. These droplets cannot be stained with Azan, haematoxylin-eosin, Nile blue sulfate, Sudan black B, and Sudan III in Paraplast embedded or frozen sections. Gas chromatography of affected lung tissue reveals a high concentration of FC. The clear droplets are the histological correlates of FC emboli which lead to haemorrhagic lung infarction and ischaemic brain infarcts. After intralienal injection FC induces haemorrhagic infarcts of the spleen near the injection site and massive embolization of the intrahepatic portal veins with consequent liver cell necrosis. FC droplets are phagocytosed by hepatic sinusoidal lining cells. Due to the absence of a specific method for identifying FC embolization of renal vessels is difficult to assess.

Animals↗
PubMedDate not supplied

[Floating spleen with chronic torsion of the pedicle causing splenomegaly and secondary hypersplenism].

If the spleen is not fixed within the left subphrenic space, it gradually passes into the lower abdomen, where is much more exposed to trauma. Torsion of the splenic pedicle can also occur, causing the infarct necessitating an immediate surgery. Venous stasis causes splenomegaly and sometimes secondary hypersplenism. The authors present 16.5-year old girl with torsion of the splenic pedicle of floating spleen for 720 degrees: in spite of that, the patient had neither splenic infarct nor splenic vein thrombosis, possibly due to thrombocytopenia, but she had splenomegaly and secondary hypersplenism with pancytopenia causing bleeding, sideropenic anemia and mild jaundice. After treatment with iron, the patient underwent splenectomy which resulted in almost immediate rise of the number of all blood cells, and even thrombocytosis. The authors suggest early surgical treatment of the floating spleen, preferably splenopexy, before development of severe complications when splenectomy had to be performed in the majority of patients. Accessory spleens, if present, should be saved.

Adolescent↗
PubMed2005

Fibrocongestive splenomegaly in sickle cell disease: a distinct clinicopathological entity in the Eastern province of Saudi Arabia.

Sickle cell disease displays a unique progression in the Eastern province of Saudi Arabia, where splenomegaly with hypersplenism is noted with high frequency in the adolescent and adult patients. The late persistence of splenomegaly although likely reflects the milder progression of sickle cell disease in this region; nevertheless, it predisposes the patients to increased morbidity. The present study documents the characteristic clinicopathological features of splenomegaly associated with sickle cell disease in the Al-Hassa region of Eastern province Saudi Arabia. Forty-four cases of sickle cell disease patients in whom splenectomy was performed during 1999-2003 were studied. The hemoglobinopathy profiles of the patients (age range 5-42 years) comprised sickle cell anemia (8 cases), sickle cell anemia with high fetal hemoglobin (23 cases), and sickle cell-beta degrees thalassemia (13 cases). All patients had manifestations of hypersplenism and 39 patients experienced episodes of minor-type sequestration crisis. Splenectomy was effective in ameliorating the hematological abnormalities in all cases, without any major complications in the follow-up period. The splenectomy specimens showed moderate-to-marked enlargement in most cases, with histological features of fibrocongestive splenomegaly and prominent Gandy-gamma body formations. Micro-infarcts in 27 cases and gross infarctions in 9 cases were evident. The relationship of persistent splenomegaly with higher fetal hemoglobin levels and splenic hypofunction is examined along with the significance of splenectomy in these cases.

Adolescent↗
PubMed2000

Splenic abscess. An old disease with new interest.

BACKGROUND/AIMS: To study the demographics, signs and symptoms, causes, risk factors, imaging findings, bacteriologic profile, treatment and outcome of patients with splenic abscess. METHOD: The medical records of 17 patients with splenic abscess at two tertiary-care hospitals between 1989 and 1997 were retrospectively reviewed. The demographic data, physical and radiological findings, treatment, bacteriology reports and outcome of treatment were reviewed. RESULTS: The mean age of patients was 43 years (range 7-79 years). Fever and abdominal pain were the most prominent signs. Seven patients were immunocompromised, three had abscessed hydatic cysts, two were drug users and three suffered from splenic trauma, infarction, and endocarditis, respectively. No predisposing factor was identified in 2 patients. In all cases, CT demonstrated the splenic lesion(s). Staphylococcus species and Bacteriodes were the most common microbes, identified in the blood and abscess cultures. Thirteen patients underwent splenectomy, two medical therapy and two no therapy with respective survival rates of 92, 100 and 0%. CONCLUSION: Splenic abscess is a rare surgical entity encountered mostly in immunocompromised patients. CT scan is the gold standard for the definite diagnosis. Splenectomy is the treatment of choice, while medical therapy should be reserved for unusual pathogens provided that an effective antimicrobial agent is available.

Abdominal Abscess↗
PubMed1976

Fatal cerebral atheromatous embolization after cardiopulmonary bypass.

Cholesterol embolization to the abdominal viscera is common. Fatal cholesterol embolization to the central nervous system is rare. This report describes a 55-year-old woman with severe atherosclerotic disease who underwent cardiac surgery during which she suffered a fatal cerebrovascular accident. Postmortem examination revealed multiple infarcts in the brain, eye, and spleen due to emboli of cholesterol crystals and other atheromatous debris from a ruptured atherosclerotic plaque in the ascending aorta at the site of an aortotomy for cardiopulmonary bypass. In patients known to have severe atherosclerotic disease, atheromatous embolization to the central nervous system should be regarded as a potential complication of surgical manipulation and incision of the aorta for cardiopulmonary bypass. Ophthalmoscopic examination may be of diagnostic value in such cases.

Arteriosclerosis↗