Splenic infarction secondary to acute pancreatitis

BACKGROUND AND OBJECTIVE: the close anatomic relationship of the pancreas with the splenic vessels and the spleen is responsible for splenic complications in the course of acute pancreatitis. Our objective was to report two cases of severe acute pancreatitis complicated by splenic infarction. PATIENTS: in a three-month period of time two patients were diagnosed with splenic infarction secondary to acute pancreatitis. In both cases splenic infarction diagnosis and follow-up were carried out using computed tomography. RESULTS: in the first case images clearly showed a narrowing of the splenic artery due to the inflammatory pancreatic condition. In the second case no involvement of the splenic vessels could be demonstrated, hence the only possible etiological explanation was a hypercoagulability state generated by pancreatitis. CONCLUSIONS: it would be advisable that splenic complications were added to the list of relevant extrapancreatic manifestations. CT is very useful for the diagnosis and follow-up of splenic complications arising in acute pancreatitis.     

Spontaneous splenic rupture precipitated by cough: A case report and a review of the literature

Spontaneous rupture of a normal spleen without a history of trauma is a rare clinical entity. We report on a case of atraumatic splenic rupture in a 61-year-old man who presented to the emergency department for abdominal pain and hypotension. There was no evidence of hematologic or infectious disease involving the spleen. The chronic cough described by the patient was the main trigger for the rupture. Although, spontaneous splenic rupture is rare, it is vital that physicians consider this diagnosis when evaluating patients with abdominal pain and hypotension. Failure to consider splenic rupture could be catastrophic and early diagnosis is essential for a better outcome.     

Synchronous isolated splenic metastasis from colon carcinoma and concomitant splenic abscess： A case report and review of the literature

This study aimed to describe a case in which an isolated splenic metastasis was synchronous with the colonic primary and a concomitant splenic abscess was associated. A wide review of the literature was also performed. A 54-year-old woman with abdominal pain and fever was admitted to our department. Abdominal CT revealed two low-density areas in the spleen and wall-thickening of the left colonic flexure, which was indistinguishable from the spleen parenchyma. The patient underwent emergency celiotomy, with the presumptive diagnosis of obstructing colon carcinoma of the splenic flexure, and concomitant splenic abscess. Subtotal colectomy and splenectomy were performed. Pathological findings were consistent with mucinous colonic carcinoma, synchronous isolated splenic metastasis and concomitant splenic abscess. This paper is also a review of the existing literature on the association between colorectal cancer and splenic metastasis. Only 41 cases of isolated splenic metastasis from colon carcinoma have been reported in the literature. This report is the third described case of synchronous isolated splenic metastasis from colon carcinoma. Only one case with concomitant splenic abscess has been previously reported. When obstructing left-sided colorectal cancer is suspected, careful CT examination can allow early diagnosis of splenic involvement by the tumor. The literature review suggests that there might be a significant improvement in survival following splenectomy for a metachronous isolated splenic metastasis from colon carcinoma. Prognosis for synchronous splenic metastasis seems to be related to the advanced stage of the disease. Nevertheless, no definitive conclusions can be drawn because of the small number of cases.     

Spontaneous splenic rupture precipitated by cough: a case report and a review of the literature

Spontaneous rupture of a normal spleen without a history of trauma is a rare clinical entity. We report on a case of atraumatic splenic rupture in a 61-year-old man who presented to the emergency department for abdominal pain and hypotension. There was no evidence of hematologic or infectious disease involving the spleen. The chronic cough described by the patient was the main trigger for the rupture. Although, spontaneous splenic rupture is rare, it is vital that physicians consider this diagnosis when evaluating patients with abdominal pain and hypotension. Failure to consider splenic rupture could be catastrophic and early diagnosis is essential for a better outcome.     

Asian variant of CD5+ intravascular large B-cell lymphoma with splenic infarction

A 57-year-old man was admitted with fever and epigastralgia, and presented with splenomegaly and pancytopenia. A CT scan revealed splenic infarctions. There were no lymphadenopathies, skin lesions, or neurological abnormalities. A splenectomy was performed. Bone marrow involvement with hemophagocytosis was noted. The diagnosis of Asian variant of intravascular diffuse large B-cell lymphoma was based on intravascular and sinusoidal distribution of large CD5+ B cells. The patient died of the disease 11 months after onset. To our knowledge, this is the first report of AIVL that presented with splenic infarction. This distinct lymphoma should be included in the differential diagnosis of splenic infarction.     

Intrahepatic splenic tissue without medical history of splenic injury or splenectomy

Only a few cases of intrahepatic splenic tissue have so far been reported in the English literature. Those cases were developed after splenic injury or a splenectomy. We report here a case of intrahepatic splenic tissue which has two distinctive features compared to previous literature. A 59-year-old female who previously had no medical history of splenic injury or splenectomy underwent hepatic resection for intrahepatic tumor mimicking hepatocellular carcinoma. However, pathologic examination revealed it as intrahepatic splenic tissue directly abutted to the normal liver tissue without a capsule. Lacking an invasive diagnostic modality, the diagnosis of intrahepatic splenic tissue without an accompanying medical history is very difficult.     

Laparoscopic splenectomy for inflammatory pseudotumor of the spleen

We report two cases of inflammatory pseudotumor of the spleen treated by laparoscopic splenectomy. The first patient was a 61-year-old woman with a 3cm splenic tumor detected incidentally by ultrasonography. Computed tomography showed a well-demarcated splenic mass. She underwent hand-assisted laparoscopic splenectomy. The second patient was a 51-year-old man in whom a splenic tumor was found on follow-up computed tomography after resection of occipital malignant neurinoma. Ultrasound and magnetic resonance imaging confirmed a splenic tumor, which showed no uptake on 18F-fluorodeoxyglucose positron emission tomography. Laparoscopic splenectomy was performed. The histopathological diagnosis was inflammatory pseudotumor in both cases. Their postoperative course was uneventful, with a postoperative hospital stay of 11 and 8 days, respectively. Splenectomy is usually performed in patients with splenic tumors because imaging techniques cannot exclude malignancy. Laparoscopic splenectomy may be a useful option for patients with splenic tumors.     

Postoperative isolated splenic metastasis from gallbladder cancer: report of a case

We present a rare case of metachronous splenic metastasis from gallbladder cancer. A 65-year-old female with gallbladder cancer underwent a partial hepatectomy with en-bloc resection of the gallbladder and extrahepatic bile duct. Ten months later, she presented with isolated splenic metastasis and underwent splenectomy with distal pancreatectomy. The histological diagnosis confirmed metastatic adenocarcinoma from gallbladder cancer. She had no signs of recurrence 4 years after the second surgery. To the best of our knowledge, this is the first report of isolated splenic metastasis from gallbladder cancer.     

Isolated splenic vein thrombosis secondary to splenic metastasis: A case report

A 49-year-old, previously healthy woman sought treatment for abdominal pain. Colonoscopy revealed ascending colon cancer. Computed tomography and angiography showed splenic metastasis and thrombosis extending from the splenic vein to the portal vein. She underwent right hemicolectomy, splenectomy, and distal pancreatomy. Histological findings showed no malignant cell in the splenic vein which was filled with organizing thrombus. We postulate the mechanism of splenic vein thrombosis in our case to be secondary to the extrinsic compression of the splenic vein by the splenic metastasis or by the inflammatory process produced by the splenic metastasis. In conclusion, we suggest that splenic metastasis should be added to the list of differential diagnosis which causes splenic vein thrombosis. In the absence of other sites of neoplastic disease, splenectomy seems to be the preferred therapy because it can be performed with low morbidity and harbors the potential for long-term survival.     

Isolated splenic vein thrombosis secondary to splenic metastasis： A case report

INTRODUCTIONIsolated splenic vein thrombosis is a rare clinical syndrome that may lead to left-sided portal hypertension.Metastasis to the spleen from solid tumors is also considered rare.When identified it usually occurs in the setting of widely dissemin…     

Hepatic and splenic mycosis in children with acute leukemia.

Three cases of hepatic and/or splenic mycosis in children with acute leukemia are reported. Patients presented with fever not responding to broad spectrum antibiotics during or after prolonged and profound neutropenia. Noteworthy, in 1 case no abnormality in liver function tests was detectable at diagnosis. CT scan showed focal hepatic lesions in all patients. In 1 patient ultrasounds failed to detect hepatic lesions and showed only splenic lesions, while CT scan detected hepatic and not splenic lesions. Definitive diagnosis was performed by open liver biopsy and histological demonstration of fungal invasion. Cultures were negative in all cases. All patients survived with prolonged amphotericin B treatment (from 36 to 40 mg/kg), combined with flucytosine in two cases. In conclusion, this clinical entity should be taken into account by physicians taking care of neutropenic patients, even in the absence of abnormalities in liver function. CT seems to be the method of choice for diagnosis, although ultrasounds might be useful for detecting concomitant splenic lesions.     

脾动脉阻断技术在射频消融治疗门脉高压性脾功能亢进症中的应用

目的探讨脾动脉阻断技术联合脾脏射频消融（RFA）治疗门静脉高压性脾功能亢进症（脾亢）的有效性和临床应用前景。方法对阻断或未阻断脾动脉主干的接受脾脏RFA治疗的肝硬化性门静脉高压合并重症脾亢患者,分析随访6个月的临床疗效;并评估脾动脉阻断对肝硬化合并脾动脉盗血综合征的治疗效果。结果阻断或未阻断脾动脉主干的接受脾脏RFA治疗的门脉高压性脾亢患者各15例,术后未发生严重并发症。阻断脾动脉后实施脾脏RFA组消融（56±35）%脾脏体积,较未阻断脾动脉组消融体积（38±21）%显著增加（P〈0.01）;且阻断脾动脉组治疗后血小板计数、Child-Pugh评分和分级改善明显优于未阻断脾动脉组。合并巨脾的脾动脉阻断组15例患者经影像学诊断都符合脾动脉盗血综合征诊断,经脾动脉栓塞（13例）和脾动脉结扎（2例）后肝动脉内径显著增粗,肝动脉供血明显改善。结论脾动脉阻断联合脾脏射频消融术是治疗门静脉高压性脾亢,可以显著提高脾亢治疗的安全性和有效性,同时纠正脾动脉盗血综合征和有效改善肝功能。     

An unexpected cause of a febrile patient with huge splenomegaly

We report an unexpected cause of a febrile patient with huge splenomegaly. A 32-year-old patient with fever and huge splenomegaly was admitted to our hospital. Diagnostic splenectomy revealed that the enlarged spleen adhered strongly to the abdominal organs. Pathologically, the splenic parenchyma showed no malignant cells, and the soft tissue adjacent to the splenic hilum showed a proliferation of fibroblastic or myofibroblastic spindle cells with fibrosis and lymphoplasmacytic infiltration. These findings lead to a diagnosis of peritoneal fibrosis, and an administration of 50 mg/day of prednisolone alleviated all the symptoms. The differential diagnosis of huge splenomegaly with fever usually includes hematolymphoid malignancies and infectious diseases; however, our case was diagnosed as idiopathic retroperitoneal fibrosis. Our case suggests that when we see patients with fever and huge splenomegaly, differential diagnosis should include retroperitoneal fibrosis.     

Splenic trauma--a rare complication during colonoscopy

The less frequent complications of colonoscopy include pneumothorax, pneumoperitoneum, emphysema of the retroperitoneum or of the subcutis, septicemia and injuries of visceral organs (mainly the spleen). Since the mid 1970 s more than 30 splenic injuries during colonoscopy have been described. Any cause of increased splenocolic adhesions (inflammatory bowel disease, pancreatitis or prior abdominal surgery) might be a predisposing factor for splenic injury during colonoscopy. Other contributing factors are techniques that result in a strong torsion of the spleno-colic ligament. Patients with left shoulder and abdominal pain, hypotension, and a drop in hemoglobin without rectal bleeding after colonoscopy should be suspected to have splenic injury. Many physicians are not aware of splenic injuries as a potential complication of colonoscopy. Therefore the diagnosis of splenic injury during colonoscopy is often described in the literature as delayed (hours until 10 days). Since a colonoscopic splenic injury can be fatal, this exceedindly rare event must be considered when a patient shows the above-mentioned symptoms and no signs of colon perforation.     

Quantitative Studies of Splenic Erythropoiesis in Polycythaemia Vera and Myelofibrosis

S ummary . A quantitative scanning method employing cyclotron-produced ⁵²Fe has been developed to assess splenic erythropoiesis in patients with myeloproliferative disorders. In 12 patients with myelofibrosis splenic uptake of ⁵²Fe was from 5.0% to 48% of the injected dose. Although a single patient with classical polycythaemia vera had a minor uptake of 2.8% six other patients with this diagnosis showed no concentration of isotope in the splenic area. The fraction of ⁵²Fe in the spleen of four patients with 'transitional'myeloproliferative disorders characterized by a high red cell mass, hypercellular bone marrow and a leucoerythroblastic blood film varied from 5% to 41%. No clear relationship was noted between the degree of splenic erythropoiesis as defined by this technique and the level of haemoglobin, the degree of splenomegaly, the effectiveness of erythropoiesis or traditional ⁵⁹Fe surface counting. If splenectomy is considered in patients with myelofibrosis splenic ⁵²Fe quantitation will provide more precise data on the contribution of splenic erythropoiesis than ⁵⁹Fe surface counting alone.     

Splenic hydatidosis

This report is concerned with ten patients treated surgically for a splenic hydatidosis. Splenic echinococcosis represents 3.5% of abdominal hydatid cysts treated in our Service. When splenic hydatidosis was diagnosed, the spleen was the first and only localization of hydatid disease in three cases. One of these patients underwent surgery for a pulmonary cyst four years later. Splenic cysts were asymptomatic in six patients. The most frequent clinical sign of splenic hydatidosis was a painful mass in the left upper abdominal quadrant. Ultrasonography and axial computed tomography (axial C.T.) were the most useful diagnostic tools. The complications arising from splenic hydatidic cysts were infection, rupture in the abdominal cavity and fistulization to the colon. A splenectomy was performed in every case. There was no mortality and morbidity was principally related to the hepatic-associated hydatidosis. It is concluded that splenic involvement is a rare manifestation of hydatid disease but should be looked for in a systematic way in patients with this diagnosis.     

Diagnostic value of contrast enhanced ultrasound for splenic artery complications following acute pancreatitis

AIM:To assess the value of contrast-enhanced ultrasound(CEUS)in diagnosing splenic artery complications(SACs)after acute pancreatitis(AP).METHODS:One hundred and eighteen patients with AP were enrolled in the study.All patients were examined by CEUS and contrast-enhanced computed tomography(CECT).CECT was accepted as a gold standard for the diagnosis of SACs in AP.The diagnostic accuracy of splenic CEUS and pancreatic CEUS was compared with that of CECT.Splenic infarction was the diagnostic criterion for splenic artery embolism and local dysperfusion of the splenic parenchyma was the diagnostic criterion for splenic arterial stenosis.The incidence of splenic sub-capsular hemorrhage,splenic artery aneurysms,and splenic rupture was all lower than that of SACs.RESULTS:Nine patients were diagnosed as having SACs after AP by CECT among the 118 patients.The patients with SACs were diagnosed with severe acute pancreatitis(SAP).Among them,6 lesions were diagnosed as splenic artery embolism,5 as splenic artery aneurysms,and 1 as splenic arterial stenosis.No lesion was diagnosed by pancreatic CEUS and 5 lesions were diagnosed by splenic CEUS.By splenic CEUS,4 cases were diagnosed as splenic artery embolism and 1 as splenic arterial stenosis.The accuracy of splenic CEUS in diagnosis of SACs in SAP was 41.7%(5/12),which was higher than that of pancreatic CEUS(0%).CONCLUSION:Splenic CEUS is a supplementary method for pancreatic CEUS in AP patients,which can decrease missed diagnosis of SACs.     

Epidermoid cyst of an intrapancreatic accessory spleen--a case report

We report an extremely rare case of a splenic epidermoid cyst of the pancreas in a 51-year-old Japanese male with no clinical symptoms. A cystic tumor of the pancreatic tail was detected incidentally by abdominal ultrasonography. The patient was referred to the Gunma University Hospital for further examination of the pancreatic tumor. Upon diagnosis of a benign cystic tumor, a distal pancreatectomy with splenectomy was performed. Microscopically, the multicystic tumor, which was surrounded by the splenic tissue, was located within the pancreatic tissue. The cysts were lined by non-keratinizing squamous epithelium. The diagnosis of an epidermoid cyst occurring in an intrapancreatic accessory spleen was confirmed. To our knowledge, this is the 4th case ever reported in the English literature.     

Splenic hydatidosis: a rare differential diagnosis in a cystic lesion of the spleen

Cystic tumours of the spleen are generally rare, and a parasitic origin is relatively unlikely. The present case report shows, however that when a splenic cyst is found, the differential diagnosis must always consider the possibility of echinococcosis. We report the case of a patient suffering from a cystic lesion of the spleen where surgery and histopathology yielded the diagnosis of splenic echinococcosis. Abdominal pain in the left upper quadrant and splenomegaly detected by simple abdominal radiology are the most commonly found indicators for this disease. The treatment should be surgical, attempting to preserve as much splenic tissue as possible, although conservative treatment is frequently unfeasable due to massive involvement of the spleen. Although rare, splenic hydatidosis should be included in the differential diagnosis when a cystic splenic lesion is identified with sonography or CT scan.     

Littoral cell angioma presenting as metastatic thyroid carcinoma to the spleen.

Papillary thyroid carcinoma (PTC) commonly metastasizes to cervical lymph nodes. Distant metastases are unusual with the lungs most frequently involved. Well-differentiated thyroid carcinoma very rarely presents with metastases to the spleen. This is the case of a 25-year-old man with a history of PTC (1.4 cm primary; no capsular invasion and negative lymph node metastases). One year after initial surgery, recurrent disease was found in multiple neck nodes by central neck dissection. Whole body scan (WBS) following a therapeutic ablation dose of 150 mCi I(131) revealed mediastinal metastases. Computerized axial tomography (CT) of the chest one year later showed no gross mediastinal or pulmonary disease. However, multiple large splenic lesions were incidentally noted. Evaluation by ultrasound (US) showed lesions to be solid echogenic masses without remarkable Doppler characteristics to suggest vascular tumors. US-guided percutaneous fine-needle aspiration biopsy (FNAB) of one lesion was nondiagnostic. After withdrawal from Levothyroxine, serum TSH was >100 mU/L with a thyroglobulin of 9.4 ng/mL and negative anti-thyroglobulin antibodies. Diagnostic WBS revealed faint splenic uptake but was otherwise unremarkable. Following treatment with 192 mCi I(131), WBS demonstrated increased activity in the mediastinum as well as in the spleen suggesting mediastinal and splenic metastases. Contrast CT of the abdomen showed multiple low-attenuated heterogeneously enhancing splenic masses, normal liver and no intra-abdominal lymphadenopathy. The largest mass (4.5 x 3.5 cm) was exophytic and in close proximity to the splenic capsule. Despite the serum thyroglobulin of only 9.4 ng/mL, the finding of I(131) accumulation within solid splenic masses led to a preoperative diagnosis of thyroid carcinoma metastases. To establish the diagnosis and to remove the risk for splenic rupture, a laparoscopic splenectomy was performed. Histopathologic analysis showed large littoral cell angiomas (LCA). False-positive radioiodine scintigraphy in the setting of PTC involving a vertebral hemangioma has been reported. To our knowledge, this is the first case that describes multiple angiomas mimicking metastatic thyroid carcinoma to the spleen. In one-third of all cases reported, LCA co-exists with various visceral organ cancers or malignant lymphoma. This is the first report of an association between LCA and thyroid carcinoma.