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PubMedDate not supplied

Graft-versus-host disease after liver transplantation complicated by systemic aspergillosis with pancarditis.

Graft-versus-host disease after liver transplantation complicated by systemic aspergillosis with pancarditis. Can J Gastroenterol 2000;14(7):637-640. Acute graft-versus-host disease (GVHD) is a common complication after bone marrow transplantation, with characteristic rash and diarrhea being the most common features. After liver transplantation, however, this phenomenon is very rare. Most transplant patients are on a variety of medications, including immunosuppressants; therefore, the differential diagnosis of skin rash or diarrhea is broad. A 37-year-old man who underwent liver transplantation for primary biliary cirrhosis, and developed a rash and watery diarrhea, is presented. Skin and colonic biopsies confirmed acute GVHD. A pulse of intravenous steroids was given. The skin rash improved, but he developed pancytopenia. His course was complicated by central line infection, jugular and subclavian vein thrombosis, pseudomembranous colitis, recurrent bacteremia, cholestasis on total parenteral nutrition and cytomegalovirus infection. After the onset of pleuritic chest pain and clinical sepsis, spiral computed tomography scan of his chest and abdomen revealed septic infarcts in multiple organs. Despite empirical treatment with amphotericin B, he died of multiorgan dysfunction syndrome within 72 h. Autopsy revealed systemic aspergillosis with pancarditis, endocardial vegetations, and septic pulmonary, splenic, hepatic and renal infarcts. The pathogenesis and experience with this rare, but often fatal, complication of liver transplantation are reviewed. In contrast to GVHD after bone marrow transplantation, pancytopenia is common and liver dysfunction is rare. One should have a high level of suspicion in the liver transplant recipient presenting with rash and/or diarrhea.

Adult↗
PubMed1996

Delayed rupture of the spleen and streptokinase therapy.

Delayed rupture of the spleen is a rare but serious complication of blunt abdominal trauma. A 47-year-old woman with a history of fractured pelvis from a motor vehicle accident 6 months earlier presented with evidence of a myocardial infarction. Subsequent streptokinase administration was complicated by splenic rupture, which was managed by evacuation of the clotted blood and splenectomy. The patient made a complete recovery. The risk of splenic rupture and bleeding complications resulting from thrombolytic therapy for myocardial infarction is discussed, as are the controversy over whether delayed splenic rupture is a true diagnosis, the mechanism of rupture and the clues to impending rupture.

Abdominal Injuries↗
PubMed1983

Rectus sheath hematoma mimicking acute splenic disease.

In patients with hematological malignancies and splenomegaly, acute abdominal pain in the left upper quadrant is highly suspicious of splenic disease (i.e., hematoma, infarction, or rupture). We report the case of a patient with chronic myelogenous leukemia and splenomegaly who presented an unusual abdominal condition causing pain in the left upper quadrant, with a clinical presentation mimicking acute splenic disease. The diagnostic dilemma was resolved by ultrasonography, demonstrating a rectus sheath hematoma.

Abdominal Muscles↗
PubMed1976

Diffuse cavernous hemangioma of the spleen.

Diffuse hemangioma of the spleen occurred in a 59-year-old man. The presenting features were a dull ache and heaviness in the left upper quadrant for 3 weeks, severe left-sided pain and fever immediately before hospitalization, and a tender mass in the left upper quadrant. The condition was diagnosed at laparotomy; splenectomy was performed. In this case intrahemangiomatous hemorrhage had occurred, but not rupture of the spleen, which is a potentially lethal complication. Other complications of diffuse splenic hemangioma are thrombosis, infarction, infection with abscess formation, and partial calcification of the vascular spaces. The condition is rare; only 56 cases have been reported.

Hemangioma, Cavernous↗
PubMed1990

Splenic hemorrhage: a complication of tissue plasminogen activator treatment.

Thrombolytic therapy with tissue plasminogen activator (tPA) for acute myocardial infarction may result in major bleeding complications such as gastrointestinal or intracranial bleeding. A case is described of severe splenic hemorrhage and rupture which developed 3 h after completion of tPA infusion for suspected acute myocardial infarction. The patient developed hypovolemic shock with abdominal pain and distension and further evidence of myocardial necrosis. A computed tomography scan of the abdomen was helpful in elucidating the diagnosis, and surgical splenectomy resulted in a good patient outcome, though the period of hypotension had increased the extent of myocardial necrosis.

Aged↗
PubMedDate not supplied

The hilar perivenous hyperechoic triangle as a sign of acute splenic torsion in dogs.

Diagnosis of acute primary splenic torsion is challenging. The ultrasonographic appearance of this condition has been described, but other splenic diseases, such as diffuse infarction because of thrombosis, can appear very similar. We describe an additional ultrasonographic sign of acute splenic torsion; a triangular hyperechoic area at the hilus between the veins and the splenic parenchyma that is continuous with the hyperechoic mesentery. In a group of animals where acute splenic torsion was part of the ultrasound report differential diagnosis, we compared findings in dogs with torsion with findings in dogs with other splenic conditions. The presence of a hilar hyperechoic perivenous triangle was significantly associated with splenic torsion (P = 0.005). We speculate that this sign is associated with torsion because of the secondary severe, diffuse splenic enlargement. Although not pathognomonic, this sign could be used to more accurately diagnose splenic torsion in light of other findings consistent with this condition.

Animals↗
PubMed1989

Giant iatrogenic splenic pseudocyst.

Partial splenic arterial embolization was used to treat hypersplenism in a 10-year-old boy with portal hypertension secondary to congenital hepatic fibrosis. After embolization the spleen remained enlarged, but the boy's platelet count increased and his variceal bleeding ceased. One month later, he returned with vomiting and an abdominal mass. Computed tomography showed a large cyst of the spleen with a small rim of residual splenic tissue. Percutaneous drainage with ultrasound guidance yielded 2,800 mL of brown fluid. Wedge-shaped infarctions are described early after splenic embolization, and these areas eventually fibrose and contract. In this case, the embolization resulted in splenic necrosis and liquefaction with pseudocyst formation. This unusual complication was effectively treated without surgery.

Child↗
PubMed1982

Experimental transcatheter splenectomy using absolute ethanol.

Since ethanol is known to be effective for transcatheter infarction of the kidney, the authors evaluated it as an agent for splenic ablation in swine and dogs. Infarction was successful in 7 of 9 pigs and 4 of 5 dogs. Controlled segmental infarction using flow-directed balloon catheters was attempted and was successful in 3 pigs and 2 dogs. The maximum blood ethanol level was 78 mg/100 ml, and by 15 minutes after injection it was less than or equal to 20 mg/100 ml. There was no evidence of pancreatic or hepatic injury at autopsy. The authors conclude that with careful catheter positioning, controlled total or partial infarction of the spleen can be safely performed with absolute ethanol without risk of abscess formation, pneumonia, or significant damage to other organs.

Animals↗
PubMed1995

Foregut revascularization via retrograde splenic artery perfusion after resection of a juxtaceliac mycotic aneurysm: complicated by pancreatic infarction because of cholesterol emboli.

A 66-year-old woman had development of a rapidly enlarging juxtaceliac mycotic aneurysm after therapy for lumbar osteomyelitis and a psoas abscess. The aneurysm was repaired through a thoracoabdominal approach with a Dacron aortic graft sewn end to end to the thoracic aorta and end to side to the infrarenal aorta. Perfusion was restored after oversewing the abdominal aorta above the superior mesenteric artery and oversewing the celiac trunk. After reperfusion the foregut remained critically ischemic despite a patent superior mesenteric artery. Foregut reperfusion was achieved by removing the spleen and anastomosing the distal splenic artery to the aortic graft. Recovery was complicated by infarction of the body of the pancreas because of cholesterol emboli, resulting in a large pleural effusion. After undergoing a subtotal pancreatectomy that preserved the splenic artery, the patient recovered without additional complications. During 8 years of follow-up, the patient has normoglycemia and has had no further infections complications. The distal splenic artery offers an excellent inflow for foregut revascularization; however, the pancreas is intolerant of atheromatous emboli.

Aged↗
PubMed2001

Carcinoid tumor of the spleen: report of a case.

Carcinoid tumors are uncommon tumors of the neuroendocrine system. They grow slowly and may remain silent for years before presenting with carcinoid syndrome. A diagnosis of asymptomatic carcinoid tumor is difficult. Wide resection of the primary tumor and metastatic lesions is the first choice of treatment. Primary carcinoid is sometimes distributed throughout the entire body, but it is rare in the spleen. We herein present a rare case of a symptomless carcinoid tumor that predominantly invaded the spleen with liver metastasis.

Aged↗
PubMed2006

[Laparoscopic splenectomy due to torsion of a wandering spleen].

Wandering spleen is an uncommon entity, characterized by the anomalous position of the spleen, caused by the absence or laxity of its suspensory ligaments. The most common symptoms are usually due to intermittent or complete torsion of the splenic pedicle with subsequent infarction. We report a case of torsion of a wandering spleen. Laparoscopic splenectomy was performed and recovery was uneventful. Although few cases of wandering spleen treated laparoscopically have been reported in the literature, laparoscopy has been demonstrated to be a safe technique for the treatment of this entity.

Adult↗
PubMed1996

Primary care diagnosis of acute abdominal pain.

The abdomen, as the largest cavity in the body, holds both fixed as well as relatively mobile organs, which when either diseased, traumatized, malfunctioning, or infected may present a wide and diverse range of signs and symptoms. Clues to the origin of abdominal pain can be well-localized or referred and quite obtuse. This article reviews the surface anatomy of the abdomen, the types of abdominal pain, approach to the patient with abdominal pain, and history-taking and physical examination. Adjunctive studies, which might help to reduce the differential diagnosis, are mentioned. The goal of this article is to help the reader formulate an accurate diagnosis in a timely manner via a complete but also well-focused physical examination; attention is paid to a comprehensive differential diagnosis to include common and not so common causes of acute abdominal pain. Intra-abdominal sources of abdominal pain include: peritonitis, bowel obstruction, and vascular disorders. Extra-abdominal sources of abdominal pain include the thorax, pelvis, and the abdominal wall. Some metabolic and neurogenic sources of abdominal pain are examined. Life-threatening causes of abdominal pain include ectopic pregnancy, acute myocardial infarction, abdominal aortic aneurysm, splenic rupture, and obstructed bowel. Discussion of these entities concentrates on the initial presentation of the patient, typical progression of symptoms, and appropriate initial treatment as well as referral. The process of ruling out emergent abdominal pain is also examined.

Abdomen, Acute↗
PubMed1990

Aortic intimal sarcoma: an unusual case with pulmonary vasculature involvement.

A disseminated intravascular tumour, presenting initially with splenic and small bowel infarction, caused both clinical and histological diagnostic difficulty. At subsequent autopsy the main tumour mass was identified within the aorta. Dissemination of this tumour was confirmed histologically and lectin and immunohistochemical staining performed. On the basis of the clinical and pathological features, we believe this represents a further case of aortic intimal sarcoma.

Aged↗
PubMedDate not supplied

MR imaging of the spleen: spectrum of abnormalities.

The spleen has the same relationship to the circulatory system that the lymph nodes have to the lymphatic system. A wide range of diseases can affect the spleen. Pathologic conditions of the spleen can be classified into the following categories: congenital diseases (accessory spleen, polysplenia, and asplenia); trauma; inflammation (abscess, candidiasis, histoplasmosis, and sarcoidosis); vascular disorders (infarction, diseases affecting the splenic vasculature, and arteriovenous malformation); hematologic disorders (sickle cell disease and extramedullary hematopoiesis); benign tumors (cysts, hemangioma, diffuse hemangiomatosis of the spleen, and hamartoma); malignant tumors (sarcoma, lymphoma, and metastases); and other disease processes that affect the spleen diffusely (portal hypertension, Gaucher disease, and sickle cell disease) or focally (Gamna-Gandy nodules). New magnetic resonance (MR) imaging techniques have increased the role of MR imaging in detection and characterization of splenic diseases. MR imaging is an excellent tool for diagnosis and evaluation of focal lesions and pathologic conditions of the spleen.

Humans↗