Robotically assisted removal of pelvic splenosis fifty-six years after splenectomy: A case report

BACKGROUND‘Splenosis’ is defined as the autotransplantation of splenic tissue following trauma or surgery, usually in the form of intraperitoneal nodules. The proliferation of imaging techniques has resulted in increased unexpected discoveries of splenosis nodules, and achieving a differential diagnosis can be challenging. Nuclear medicine studies have been playing an increasingly important role in this process, but the clinical significance of asymptomatic nodules remains uncertain.CASE SUMMARYWe present a case of pelvic splenosis in a 73-year-old man diagnosed 56 years after a splenectomy during a computed tomography (CT) follow-up for B-cell lymphoma, presenting intense contrast enhancement of an 18 mm nodule in the right recto-vesical space. 18F-fluorodeoxyglucose demonstrated weak metabolic activity. Since histological diagnosis was deemed necessary, the nodule was easily removed with robotically assisted laparoscopy, together with another 6 mm left a paracolic lesion. The latter was previously undiagnosed but retrospectively visible on the CT scan.CONCLUSIONIn a patient requiring differential diagnosis of splenosis nodules from lymphoma recurrence, the robotic approach provided a safe en bloc removal with short hospitalization. The Da Vinci Xi robot was particularly helpful because its optics can be introduced from all ports, facilitating visualization and lysis of multiple intra-abdominal adhesions.     

超声引导下后穹窿穿刺诊断盆腔脾组织植入1例

<正>患者女,26岁,孕前检查发现盆腔结节,口服红金消结后结节未见明显缩小;因外伤脾破裂行脾摘除术17年。现妇科检查:阴道畅,宫颈光滑,子宫大小正常无压痛,双附件区软。经阴道和腹部超声检查:子宫后方可见2个低回声区,大小分别为2.89 cm×1.59 cm、2.05 cm×1.63 cm,血流信号较丰富,周边环绕并伸入低回声区内(图1)。增强CT检查:子宫后方与直肠间可见多个类圆形结节影,最大者1.94 cm×1.64 cm,增强扫查可见明显强化,CT值98 Hu;下腹部大网膜内可见多发大小不等     

盆腔多发脾种植误诊1例

病例 女,31岁.主因经期腹痛10年,加重3个月入院.患者于13年前因外伤脾破裂行脾脏切除术.查体:体温36.5℃,脉搏75/min,呼吸16/min,血压120/70mmHg.心肺查体未见明显异常.左季肋郎可见手术缀痕.妇科查体:子宫大小正常,活动好,子宫后方可触及直径约4cm×4cm×3cm质韧包块.     

An unusual pelvic mass: Contrast-enhanced sonographic diagnosis of pelvic splenosis

Splenosis is an unusual condition representing auto-transplantation of splenic tissue following splenic trauma or surgery. When detected on imaging studies, the splenosis deposits are usually misinterpreted as pathological masses. We present a case where a pelvic mass incidentally visualized on an MRI examination, was proven to represent a deposit of splenosis by contrast enhanced ultrasound (CEUS). CEUS demonstrated persistent late-phase enhancement characteristic of splenic tissue. Ultrasound practitioners should be aware of this condition when an unusual abdominal or pelvic mass is encountered in a patient with a history of splenic trauma or surgery. CEUS is ideally suited to confirming the diagnosis.     

Chiropractic management of breast-feeding difficulties: a case report

Objective

The purpose of this study is to discuss a chiropractic case of management and resolution of breast-feeding difficulties.

Clinical Features

The case involves an 8-day-old baby unable to breast-feed since 4 days old. Initial examination revealed cervical, cranial, and sacral restrictions. She was diagnosed with craniocervical syndrome by a doctor of chiropractic.

Intervention and Outcome

Following history and examination, the infant received gentle chiropractic manipulation based on clinical findings. Immediate improvement and complete resolution of the nursing problems were observed after 3 treatments over 14 days.

Conclusion

The results of this case suggest that neuromusculoskeletal dysfunction may influence the ability of an infant to suckle successfully and that intervention via chiropractic adjustments may result in improving the infant's ability to suckle efficiently.     

自发性盆腔内血肿1例

病例男,83岁,于2011年1月因咳嗽、咯痰入住当地医院,行CT检查发现盆腔占位病变,约7 cm×10 cm,体检:盆腔内可触及大小约10 cm×7 cm×7 cm的肿块,活动度可,无触痛;直肠指检肿块位于直肠膀胱间,与直肠关系不密切,质地     

原发性盆壁软骨肉瘤1例

患者女,45岁,因反复右臀部及友大腿疼痛1年就诊.查体见右臀部隆起,皮肤表面颜色正常,局部压痛,质地稍硬.     

The butterfies' vertebra-diagnostic difficulties - case report

The hemivertebras constitute about 33% of all congenital defects of spine and can be detected accidentally during diagnostics of pain syndrome of spine or other neurological disturbances. In the paper is introduced the case of patient with pain syndrome of spine (man, physical worker, 47years old), who was directed to the rehabilitation ward with recognition of pathologic fracture of vertebra Th10. In consideration on lack of correlation between radiological pictures and patient's neurological state the diagnostics was extended for 3D CT. CT revealed the presence of development defect of spine. Conducted diagnostics and rehabilitation permitted for improvement of patient's state as well as settlement of principles for further procedures. The necessary verification of diagnosis and diagnostics of patients during inpatient and ambulatory rehabilitation shouldn't be sensation but should constitute standard in contracts with National Health Fund.     

Diagnostic challenges in Creutzfeldt-Jakob disease: case report

Sporadic Creutzfeldt-Jakob disease (CJD) is the most common prion disease. The diagnosis can be confirmed only by histological examination of brain tissue obtained at biopsy or at autopsy. Because of the transmissible nature of the disease, autopsy or brain biopsy cannot be performed at many institutions, which poses numerous challenges in confirming the diagnosis. We report the case of a patient with CJD in which autopsy to confirm the diagnosis was performed after overcoming numerous obstacles and advocating with hospital leadership. This case illustrates the numerous challenges that exist in achieving a definitive diagnosis of CJD and in postmortem disposition of the body, and we provide recommendations to clinicians who face similar challenges.     

A case of splenosis: diagnosis with contrast-enhanced ultrasonography

We performed contrast-enhanced ultrasonography (CEUS) for a patient with known splenosis. One mass was clearly enhanced while another mass showed moderate enhancement. The right kidney showed similar enhancement and was a little confusing. We concluded that CEUS is useful for diagnosing this entity, although it has some limitations. CEUS could be a better diagnostic option than scintigraphic studies.     

一例全心衰竭的临床诊断思维过程

心力衰竭 (心衰 )所致的肝功能损害 ,临床并不少见。但全心衰导致严重肝功能损害 ,以至于临床误诊为重症肝炎实属罕见。我院曾遇 1例全心衰 ,临床症状酷似重症肝炎 ,经多方分析与检查 ,最后证实为细菌性心内膜炎并发主动脉瓣关闭不全和全心衰。为总结与积累经验 ,现结合病例剖析临床诊断思维过程。1　病例资料男 ,2 8岁。因呕吐、腹痛伴腹泻 ,拟“腹痛原因待查”于 1999年 10月 2 4日急诊入院。患者否认慢性心脏病、肾病等病史。自述近期曾因胸闷伴干咳在我院门诊就诊 ,服用头孢拉啶后症状无改善 ,因出现消化道症状来诊。查体 :巩膜与皮肤黄…     

Spontaneous pneumoperitoneum: Diagnostic and management difficulties

Acute abdominal pain is a common presentation to the ED. Most patients undergo a chest radiograph as part of their initial investigations, which occasionally reveals pneumoperitoneum. Pneumoperitoneum on imaging suggests a perforated hollow abdominal viscus and therefore often constitutes a surgical emergency. However, if the patient is neither peritonitic nor septic a management dilemma is faced. Some cases of pneumoperitoneum might be managed conservatively thus avoiding unnecessary laparotomy. We present a case of recurrent spontaneous pneumoperitoneum with abdominal pain that was managed conservatively and discuss the possible aetiologies and management issues of spontaneous pneumoperitoneum.     

A case of intrahepatic splenosis: usefulness of splenic scintigraphy

Abdominal Radiology - We report a 39-year-old male with intrahepatic and peritoneal splenosis, focusing on scintigraphic findings. Dynamic computed tomography (CT) showed a 3&nbsp;cm lesion in...     

少见盆腔滑膜肉瘤1例

病例 女,11岁,缘于3d前无明显诱因出现腹痛症状,腹痛开始较剧烈,逐渐转为持续性钝痛,部位在下腹部,排尿及排便后可有所缓解,无腰背及会阴部放射痛,伴有发热,体温最高38.7℃,当地医院行腹部磁共振检查后提示"盆腔肿物".患者自发病以来精神差,饮食一般,睡眠差,大小便正常,近期体质量无明显减轻,随即于我院行手术治疗,术后患者家属拒绝行放疗及化疗等任何治疗,5月后行MR检查发现肿瘤复发.     

盆腔腹膜后孤立性纤维瘤经直肠超声表现1例

<正>患者女,24岁,2+个月前于健康体检时发现右侧附件区包块,超声提示右附件区一大小约4.3 cm×4.7 cm×4.7 cm的椭圆形实质样低回声包块,未治疗;2 d前超声复查无变化,妇科检查于右侧附件区可扪及一直径约4 cm肿块,活动度好,质硬。术前初步诊断:1右侧卵巢肿瘤;2宫颈肌瘤。行腹腔镜探查时发现双侧卵巢显示良好,盆腔未见明确包块;肛门指诊于直肠右侧7~11点位置可扪及直径约6 cm包块,光滑,不活动,考虑腹膜     

盆腔侵袭性血管黏液瘤CT/MRI影像特征1例报告

正侵袭性血管黏液瘤(aggressive angiomyxoma,AAM)是一种罕见的软组织肿瘤,好发于育龄期妇女。AAM患者常无明显临床症状,体格检查及实验室检查无明显异常,术前难以确诊,常被误诊为前庭大腺囊肿或其他间叶源性肿瘤(如富含黏液成分的脂肪肉瘤、平滑肌瘤及血管瘤等)。术前影像学检查(CT及MRI)可以辅助确定肿瘤范围,具有一定特异性。因此,本文分析了1例AAM患者的     

膀胱外翻合并脐疝及骨盆畸形1例

患者女,40岁.出生后发现下腹部皮肤缺损,黏膜组织外露,于当地诊断为“先天性膀胱外翻畸形”.33年前行“回肠膀胱术”,右下腹留置造瘘口.1年半前发现脐部肿物,肿物随时间逐渐增大.体格检查:见下腹部皮肤缺损,大小约10 cm×7 cm,黏膜组织外露,小阴唇明显右偏,未触及耻骨联合.脐部肿物质软,活动度差,平卧可缩小.     

Swallowing difficulties in adolescents: A case report and suggestion of treatment model

Dysphagia or difficulty swallowing in childhood necessitates multi‐disciplinary evaluation and management. This case report highlights the teamwork required for diagnostic work‐up to distinguish functional dysphagia from organic and psychiatric conditions in an adolescent girl. Treatment model based on cognitive behavioral therapy is also presented.