Functional asplenia after severe varicella zoster-infection diagnosis by colour Doppler ultrasound

Infiltrative, inflammatory or thromboembolic processes in the parenchyma of the spleen can cause a functional loss of the organ. This phenomenon is called functional asplenia and occurs as a complication especially in sickle cell disease, lupus erythematosus and after bone marrow transplantation. We present the case of a patient with Crohn's disease under immunosuppressive therapy who developed a spontaneous covered spleen rupture in the course of a septic shock with DIG due to a Varizella zoster infection. Later on, sonography showed a diminution of the spleen size. No flow signals could be derived by colour doppler measurements from the spleen. Because of the colour doppler findings we suspected a functional asplenia which was then verified by spleen scintigraphy and Howell-Jolly-Bodies in the blood count. Remarkably, the Crohn's disease remains in complete remission since the development of the functional asplenia (for 4 years now). The underlying pathomechanism remains unclear.     

Sonographic evaluation of patients with portal hypertension

The availability of real-time sonography has facilitated its use in the assessment of patients suspected of portal hypertension. Dilatation of the portal venous system may occur in portal hypertension, and a portal vein diameter greater than 13 mm is indicative of portal hypertension with a sensitivity of about 50%. Sonographic demonstration of lack of caliber variation of the portal system bas a sensitivity of about 80%. The presence of venous collaterals can be demonstrated in about 90% of patients suitable for sonography. The coronary gastroesophageal varices can be seen in 90% when they are large sized, and in 65% when they are small sized. Other collaterals such as umbilical vein, duodenal varices, and gastrorenal and splenorenal varices can be detected. Sonography is a valuable screening procedure in the evaluation of portal hypertension and provides valuable information regarding the size and morphology of the liver and spleen, caliber and patency of the portal venous system, and the existence and location of the varices.     

Pneumokokkensepsis bei funktioneller Asplenie: Erstmanifestation einer systemischen Autoimmunerkrankung?

A 35 year old female was admitted into the hospital because of rapid onset fever and chills. Streptococcus pneumoniae could be isolated from blood as the responsible pathogen for septicemia. Necroses of fingers and feet occurred. The clinical signs of an overwhelming post-splenectomy infection (OPSI) were evident. High-dose penicillin was administered and the patient recovered. Howell-Jolly-bodies were seen in peripheral blood smears. A spleen within normal size could be demonstrated in CT and sonography. Angiologic findings showed intact splenic arteries and a normal vein, whereas the small splenic vessels were rare. MRT of the spleen using Endorem (Fe), showed only a minimal uptake of the RES. In a scintigram of spleen and liver using 320 MBq Tc-99m nanokoll, the spleen was not visible. Thus, functional asplenia was demonstrated by Howell-Jolly-Bodies and by image methods. An increased antinuclear antibody level and a Sm-antibody lead to the diagnosis of undifferentiated connective tissue disease. As far as we know this is the first case that functional asplenia was the first symptom of a systemic autoimmune disease.     

Influence of the Spleen on Portal Haemodynamics: a Non-invasive Study with Doppler Ultrasound in Chronic Liver Disease and Haematological Disorders

Background: Splanchnic haemodynamic parameters for the differential diagnosis of splenomegalies of different origins are still suboptimal and the role of spleen enlargement in cirrhosis remains controversial. In an attempt to elucidate these questions, we assessed splanchnic haemodynamics in chronic liver diseases and various other disorders with splenomegaly. Methods: Study groups comprised: (i) patients with chronic liver disease (89 with cirrhosis, 35 with chronic hepatitis), (ii) patients with splenomegaly without relevant portal hypertension (14 with haematological splenomegaly and 25 liver transplant recipients without complications), (iii) 15 patients with arterial hypertension, (iv) 22 healthy controls. In all subjects, spleen size, portal flow parameters and splenic artery resistance index were measured using duplex-Doppler ultrasound. Results: Splenic artery resistance index was significantly and selectively increased in patients with cirrhosis (0.63, whereas all other group means ranged between 0.53 and 0.56; P < 0.01). Portal flow velocity was significantly decreased in cirrhosis ( P < 0.01). The combination of these two parameters provided an accuracy of 87.5% in distinguishing portal hypertensive from haematological splenomegaly. In patients with cirrhosis, the degree of spleen enlargement was positively correlated with increasing portal flow volume, portal vein diameter and variceal size, whereas splenic resistance index and portal velocity did not differ in connection with spleen size. Conclusions: Splenoportal Doppler sonography provides specific findings in cirrhosis and may therefore be a useful tool in differentiating between splenomegaly of portal hypertensive or haematological origin. In patients with cirrhosis, the presence of splenomegaly is associated with the presence of larger oesophageal varices.     

Influence of the spleen on portal haemodynamics: a non-invasive study with Doppler ultrasound in chronic liver disease and haematological disorders

BACKGROUND: Splanchnic haemodynamic parameters for the differential diagnosis of splenomegalies of different origins are still suboptimal and the role of spleen enlargement in cirrhosis remains controversial. In an attempt to elucidate these questions, we assessed splanchnic haemodynamics in chronic liver diseases and various other disorders with splenomegaly. METHODS: Study groups comprised: (i) patients with chronic liver disease (89 with cirrhosis, 35 with chronic hepatitis), (ii) patients with splenomegaly without relevant portal hypertension (14 with haematological splenomegaly and 25 liver transplant recipients without complications), (iii) 15 patients with arterial hypertension, (iv) 22 healthy controls. In all subjects, spleen size, portal flow parameters and splenic artery resistance index were measured using duplex-Doppler ultrasound. RESULTS: Splenic artery resistance index was significantly and selectively increased in patients with cirrhosis (0.63, whereas all other group means ranged between 0.53 and 0.56; P < 0.01). Portal flow velocity was significantly decreased in cirrhosis (P < 0.01). The combination of these two parameters provided an accuracy of 87.5% in distinguishing portal hypertensive from haematological splenomegaly. In patients with cirrhosis, the degree of spleen enlargement was positively correlated with increasing portal flow volume, portal vein diameter and variceal size, whereas splenic resistance index and portal velocity did not differ in connection with spleen size. CONCLUSIONS: Splenoportal Doppler sonography provides specific findings in cirrhosis and may therefore be a useful tool in differentiating between splenomegaly of portal hypertensive or haematological origin. In patients with cirrhosis, the presence of splenomegaly is associated with the presence of larger oesophageal varices.     

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.     

Value of Liver and Spleen Aspiration Biopsy in Malignant Diseases when these Organs Show no Signs of Involvement in Sonography

ABSTRACT To determine whether an aspiration biopsy of liver and/or spleen is likely to reveal a clinically silent malignant infiltration, fine-needle aspiration biopsies were carried out in 180 patients with a diagnosed malignancy in whom neither the liver nor the spleen gave signs of involvement in sonography. Few, if any, findings were positive in patients with cancer or Hodgkin's disease. In non-Hodgkin lymphoma, about 25% of the biopsies were positive for malignancy or aroused suspicion of malignancy. We conclude that fine-needle aspiration biopsies of the liver and spleen may be of value in the clinical follow-up of non-Hodgkin lymphoma.     

Contrast-enhanced sonographic drainage control: a feasibility study

Liver abscesses still represent a life-threatening disease. Interventional abscess puncture and/or drainage are often the most adequate treatment. The aim of our study was the evaluation of drainage control with contrast-enhanced sonography. We included 15 patients in our feasibility study, three of whom had infected liver cysts, three had abscesses after liver resection or transplantation, six had intrahepatic abscesses and three had abscesses of other localisations. For drainage control with contrast-enhanced sonography we administered 1 mL of the contrast agent SonoVue? (Bracco, Germany) diluted in 10 mL of 0.9 % of NaCl through the indwelling drainage or an 18-G Chiba needle. A total of 28 sonographic controlled examinations was performed. The position of the drainage, as well as the size of the abscess itself could be demonstrated in all cases. Furthermore, possible septs or the communication of different abscess regions could be seen. Drainage remained in position for an average of 13.3 days. Assessment of drainage position and size of the abscess region is of clinical relevance. The main advantages of the described examination with contrast-enhanced sonography are the lack of radiation and the low costs due to the small amount of contrast medium used.     

Use of B-sonography in the diagnosis of liver diseases

The criteria important for the sonographic judgment of the liver and the value of the sonography in the strategy of the diagnostics of liver diseases are described. Since none of the symptoms mentioned, such as size of the liver, ventral contour, lower margin of the liver, demarcability, sound conduction as well size, density and distribution of the structural reflexes, is typical for a certain disease, an approximate diagnosis or the exclusion of certain diseases is a possible only taking into consideration several symptoms and also extrahepatic, sonographically probable ones. On account of the simplicity and of the undangerousness of the examination it is obvious to use the sonography immediately after the examination and thus to organize the selection of further diagnostic measures more rational.     

Course over several decades of echinococcosis with peritoneal and pulmonary spread

Report on a 67-year-old man with echinococcus-granulosus-cysts in liver, lungs, spleen and mesentery since at least 31 years. In 1969 and 1974 surgical intervention was performed. In 1983 suppurative colliquation and spontaneous depletion by a fistula of a cyst of the liver, output of the cysts of the right lung by coughing. In 1986 spontaneous resorption of a cyst of the left lobe of the liver. In 1987 measurable shrinking of a cyst of the left lower lobe of the lung. Two until today existing cysts (spleen and upper part of the abdomen in the midline) are in supervision by sonography.     

Peroperative echography in 14 cases of pancreatic insulinoma and gastrinoma

Fourteen cases of endocrine tumors (10 insulinomas and 4 gastrinomas) were to studied by intraoperative ultrasonography (IOU). Localization was established by preoperative ultrasonography in 1/14, by CT scan in 1/11, by arteriography in 6/12 and by pancreatic venous sampling in 7/8. Tumor size ranged from 0.5 cm to 2.5 cm. Manual palpation was positive in 10/14. The tumor was accurately and completely localized by IOU in 9/10 insulinomas: the one false negative was probably due to micro-adenoma. The intrapancreatic tumor was localized only in 1/14 gastrinomas. Intraoperative sonography localized lymph nodes in all cases. One distal pancreatectomy was improperly performed because of an accessory spleen. After reviewing 59 other cases in the literature, we propose: a) to abandon venous sampling in insulinomas because of adequate performance of IOU; b) to use IOU as a complementary investigative method along with other preoperative methods of localization in gastrinoma.     

Magnetic resonance imaging in young adults with cystic fibrosis

It is difficult to distinguish between atelectasis, mucoid impaction, and peribronchial inflammation on chest roentgenograms (CXR) in patients with cystic fibrosis (CF). Differentiation between hilar adenopathy and prominent pulmonary vessels is also sometimes difficult. We studied 16 young adults with CF using both magnetic resonance imaging (MRI) and CXR to evaluate the usefulness of MRI in this clinical context. The same patients were studied with abdominal ultrasound and MRI for evaluation of the pancreas, gallbladder, liver, and spleen. The MRI was superior to CXR in detecting hilar and mediastinal adenopathy and in differentiating nodes from prominent vessels. It was useful in the evaluation of bronchiectasis. The CXR was superior for assessing infiltrates, hyperinflation, sternal bowing, volume loss, and hilar retraction. The MRI was only slightly better than sonography in depicting fatty infiltration of the pancreas. The modalities were equally effective in detecting hepatosplenomegaly and signs of portal hypertension. Gallbladder evaluation was far superior with sonography.     

Rodent endosonography to monitor esophageal cancer

Animal models of luminal cancers are important to understand and assess chemopreventive and chemotherapeutic interventions. However, the ability to assess tumor growth and response without animal sacrifice is limited. We assessed the ability of luminal sonography to assess the presence of tumor and its size in a surgical esophagojejunostomy model of esophageal cancer. Luminal sonography had a sensitivity of 88%, specificity of 100%, and accuracy of 93% in identifying the esophageal cancers. The tumor dimensions on luminal sonography were within 11% of autopsy measurements. Minimal tumor dimension was 2 mm and maximum 6.2 mm. The procedure was feasible without technical difficulty. In conclusion, rodent endosonography is a useful technique that can accurately determine the presence of tumors as well as their dimensions.     

The splenomegaly of myeloproliferative disorders: effects on blood volume and red blood count

By means of a scintigraphic method for estimation of spleen size, the relationship was studied between spleen size and anaemia, total blood volume and red cell volume in patients with myeloproliferative disorders. There was significant correlation between spleen size and Hb, RBC and PCV in myelofibrosis. The size of the enlarged spleen did not, however, correlate with the degree of anaemia in the leukaemias. There was positive correlation between spleen size and red cell volume in these conditions. It was not possible to evaluate the severity of polycythaemia from spleen size and the degree of enlargement of the spleen does not appear to be a reliable parameter for staging and deciding on treatment in patients with PPP.     

肝硬化中医辨证分型与彩色多普勒超声特征分析

[目的]探讨肝硬化中医证型与彩色多普勒超声特征的相关性,为肝硬化辨证分型提供客观依据。[方法]采用彩色多普勒超声检测150例6种不同中医证型肝硬化患者的肝、胆、脾,对其肝右叶最大斜径、前后径,肝左叶上下径、前后径,胆囊壁厚度,脾脏大小,肝静脉内径,门静脉及脾静脉内径及血流速度等超声指标进行分析。[结果]不同证型肝硬化患者肝左叶上下径:血瘀证与肝气郁结证、湿热内蕴证、肝肾阴虚证比较明显缩小(P<0.05);脾脏厚度:血瘀证较湿热内蕴证明显增厚(P<0.05);门静脉主干内径:肝肾阴虚证、脾肾阳虚证、血瘀证明显增宽,与湿热内蕴证比较差异有统计学意义(P<0.05);门静脉血流流速:血瘀证流速减慢,与肝气郁结证比较差异有统计学意义(P<0.01)。[结论]彩色多普勒超声与肝硬化中医辨证分型有一定相关性,随着证型的发展,肝脾大小及门静脉血流动力学有相应改变。     

Spleen size in patients with inflammatory bowel disease

The finding that splenic atrophy is associated with a high complication rate in colitis has led to a long-term, prospective study of spleen size in inflammatory bowel disease. The spleen has been measured in 116 patients undergoing laparotomy for inflammatory bowel disease —2-80 Crohn's disease and 36 ulcerative colitis—from 1975 to 1985. Small spleen size, of lesser degree than that of classic splenic atrophy, is associated with presurgery disease complications as well as infective problems after surgery. Spleen size was not related to site or extent of disease, or to recurrence, but the wide range of spleen size seen in inflammatory bowel disease, comparable to that seen in malignancy suggests that more sophisticated tests of splenic function might show a closer correlation with disease patterns Dr. Jorge Pereira was supported by a fellowship from Rotary International.     

自体骨髓干细胞移植术后门静脉血流动力学的变化

目的观察肝硬化自体骨髓于细胞移植术后门静脉血流动力学的变化。方法应用彩色多普勒超声测量50例自体骨髓干细胞移植术后患者门静脉血流动力学的变化,术前～术后半年进行定期随访。记录患者门静脉内径、门静脉平均血流速度及脾脏厚度,比较自体骨髓干细胞移植前后三者的变化。结果（1）术后各时段门静脉内径分别为（1．41±0．15）cm、（1．38±0．11）cm和（1．36±0．17）cm,与术前（1．53±0．18）cm比较明显减小,差异有显著性（P〈0．05）,但术后各时段之间比较差异无显著性（P〉0．01）;（2）术后各时段门静脉血流速度值分别为（15．7±3．6）cm／s、（16．1±2．4）cm/s和（15．9±3．0）cm／s,与术前（11．4±3．3）cm／s比较明显增加,差异有显著性（P〈0．01）,但术后各时段之间比较差异无显著性（P〉0．01）;（3）术后各时段脾脏厚度分别为（4．8±0．3）cm、（4．7±0．6）cm和（4．8±0．5）cm,与术前（5．2±0．7）cm比较明显缩小,差异有显著性（P〈0．01）,但术后各时段之间比较差异无显著性（P〉0．01）。结论自体骨髓干细胞移植术可有效增加门静脉血流速度,并使脾脏缩小,从而降低门静脉压力,减轻门静脉高压。     

Evaluation of splenomegaly in the hepatosplenic form of mansonic schistosomiasis

This study was aimed to evaluate splenomegaly in patients with the hepatosplenic (HS) form of mansonic schistosomiasis (MS), analyzing the size and weight of the spleen and their relationships with patients' gender and age. Between October, 1993 to July, 1998, 78 patients with the HS form of MS had undergone splenectomy as treatment of choice for bleeding due to portal hypertension, at Hospital das Clínicas, Pernambuco, Brazil. By means of abdominal palpation, the excess spleen felt below the left costal edge was measured, and the weight was obtained after splenectomy along with the histopathological analysis. Liver biopsy was performed intraoperatively in order to confirm MS and to rule out other liver diseases. The mean age of the 78 patients were 45 years and 41 of them (53%) were female. The average spleen weight was 912g and the mean spleen size palpable below the left costal edge was 9.1cm. There was a positive relationship between size and weight (p<0.001). Spleen weight and size were larger in males (p=0.007 and p=0.001, respectively). An inverse correlation between age and spleen weight was observed (p<0.001). A classification based upon spleen weight showed 53% of patients presenting a moderate (501-1000g) and 33% a severe (>1001g) splenomegaly. As for the spleen size, the classification showed 64% of patients presenting moderate (4.1-10cm below the left costal edge) and 21% severe (>10cm) splenomegaly. In conclusion, splenomegaly may be considered a key physical finding in patients with HS form of MS, and we found a good correlation between the spleen sizes clinically evaluated with its weight. The majority of cases presents a moderate to severe splenomegaly and spleen size is larger in men and it seems to decrease with aging.     

Splenic tuberculosis in patients with AIDS.

Splenic tuberculosis is an uncommonly considered diagnosis in clinical practice. We report splenic tuberculosis in three patients with AIDS who were admitted to the hospital because of fever and constitutional syndrome. In all of the patients, abdominal sonography and abdominal computed tomography revealed multiple hypoechoic and hypodense lesions, respectively. In two patients needle aspiration of the spleen with sonographic control was the diagnostic procedure. In the third patient the diagnosis was confirmed after splenectomy. In AIDS patients tuberculosis must be included in the differential diagnosis of hypoechoic and hypodense lesions by means of sonography and computed tomography, respectively, especially in those patients with active tuberculosis.     

A comparison of magnetic resonance imaging, sonography, and radiography of the hand in patients with early rheumatoid arthritis

OBJECTIVE: As therapy for rheumatoid arthritis (RA) becomes more effective, more sensitive imaging methods are required to assess disease activity and joint damage. We compared magnetic resonance imaging (MRI), sonography, and radiography for assessment of disease activity for the detection of bony erosions. METHODS: Forty-six patients with newly diagnosed RA (onset within 2 years) received clinical and laboratory assessment followed by radiographs, sonography, and MRI of the right hand at baseline and at 6 months according to a standardized protocol. We determined the presence of edema, synovitis, effusions, tendon fluid, tendon thickening, and size in the same way by MRI and sonography. The intra- and interreader reliability of MRI and radiographs and predictors of MRI erosions at 6 month followup were also examined. RESULTS: At baseline, 39 (85%), 14 (30%), and 17 (37%) patients had erosions identified on MRI, sonography, and radiography, respectively. Over time, the percentage of patients with erosions increased to 91% for MRI, 41% for sonography, and 48% for radiography. The absolute number of erosions increased from 177 to 239 erosions for MRI, from 30 to 43 for sonography, and from 38 to 73 for radiographs. The intra- and interreader reliability for the assessment of erosions and synovitis on MRI was acceptable (intrareader ICC of 0.60 and 0.90; interreader ICC of 0.77 and 0.89, respectively). CONCLUSION: MRI appears to be the most sensitive modality for erosive disease compared with sonography and radiography. Sonography detected more joint and tendon sheath effusions than MRI in this study and therefore may have a role in the assessment of disease activity.