Diffuse Infiltrative Splenic Lymphoma: Diagnostic Efficacy of Arterial-Phase CT

Energy Technology Data Exchange (ETDEWEB)

Lee, Jeong Eun; Cho, June-Sik; Shin, Kyung Sook; Kim, Song Soo; You, Sun Kyoung; Park, Jae Woo; Shin, Hye Soo; Yoon, Yeo Chang [Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015 (Korea, Republic of)

2016-11-01

To evaluate the diagnostic performance of obliteration of normal heterogeneous enhancement of the spleen (ONHES) on arterial phase (AP) computed tomography (CT) images in diffuse infiltrative splenic lymphoma (DISL). One hundred and thirty-six patients with lymphoma who had undergone two-phase (arterial and portal venous) abdominal CT were included in this study. We retrospectively evaluated the diagnostic performance of ONHES on AP CT in diagnosing DISL. Two observers evaluated ONHES on AP CT using the 5-point confidence level and assessed the presence or absence of subjective splenomegaly on axial CT images. Another two observers measured the splenic index as proposed by objective CT criteria. Statistical analysis included interobserver agreement and diagnostic performance of CT findings. Eleven of the 136 patients with lymphoma had DISL. The area under the receiver operating characteristic curve of ONHES (0.948 for observer 1 and 0.922 for observer 2) was superior to that of the splenic index (0.872 for observer 3 and 0.877 for observer 4), but the difference was not statistically significant (p > 0.05). The diagnostic performance of ONHES in conjunction with subjective splenomegaly showed higher diagnostic performance, as compared with subjective splenomegaly alone (accuracy: 100% and 85.3% for observer 1, 98.5% and 87.5% for observer 2; positive predictive value: 100% and 35.5% for observer 1, 90.9% and 39.3% for observer 2, respectively). Obliteration of normal heterogeneous enhancement of the spleen in conjunction with subjective splenomegaly can improve the diagnostic performance for DISL. Our results suggest that ONHES on AP CT images could be useful as an adjunctive diagnostic indicator of DISL in patients with lymphoma.

Diffuse infiltrative splenic lymphoma; Diagnostic efficacy of arterial-phase CT

Energy Technology Data Exchange (ETDEWEB)

Lee, Jeong Eun; Cho, June Sik; Shin, Kyung Sook; Kim, Song Soo; You, Sun Kyoung; Park, Jae Woo; Shin, Hye Soo; Yoon, Yeo Chang [Dept. of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (Korea, Republic of)

2016-09-15

To evaluate the diagnostic performance of obliteration of normal heterogeneous enhancement of the spleen (ONHES) on arterial phase (AP) computed tomography (CT) images in diffuse infiltrative splenic lymphoma (DISL). One hundred and thirty-six patients with lymphoma who had undergone two-phase (arterial and portal venous) abdominal CT were included in this study. We retrospectively evaluated the diagnostic performance of ONHES on AP CT in diagnosing DISL. Two observers evaluated ONHES on AP CT using the 5-point confidence level and assessed the presence or absence of subjective splenomegaly on axial CT images. Another two observers measured the splenic index as proposed by objective CT criteria. Statistical analysis included interobserver agreement and diagnostic performance of CT findings. Eleven of the 136 patients with lymphoma had DISL. The area under the receiver operating characteristic curve of ONHES (0.948 for observer 1 and 0.922 for observer 2) was superior to that of the splenic index (0.872 for observer 3 and 0.877 for observer 4), but the difference was not statistically significant (p > 0.05). The diagnostic performance of ONHES in conjunction with subjective splenomegaly showed higher diagnostic performance, as compared with subjective splenomegaly alone (accuracy: 100% and 85.3% for observer 1, 98.5% and 87.5% for observer 2; positive predictive value: 100% and 35.5% for observer 1, 90.9% and 39.3% for observer 2, respectively). Obliteration of normal heterogeneous enhancement of the spleen in conjunction with subjective splenomegaly can improve the diagnostic performance for DISL. Our results suggest that ONHES on AP CT images could be useful as an adjunctive diagnostic indicator of DISL in patients with lymphoma.

Diffuse Infiltrative Splenic Lymphoma: Diagnostic Efficacy of Arterial-Phase CT

International Nuclear Information System (INIS)

Lee, Jeong Eun; Cho, June-Sik; Shin, Kyung Sook; Kim, Song Soo; You, Sun Kyoung; Park, Jae Woo; Shin, Hye Soo; Yoon, Yeo Chang

2016-01-01

To evaluate the diagnostic performance of obliteration of normal heterogeneous enhancement of the spleen (ONHES) on arterial phase (AP) computed tomography (CT) images in diffuse infiltrative splenic lymphoma (DISL). One hundred and thirty-six patients with lymphoma who had undergone two-phase (arterial and portal venous) abdominal CT were included in this study. We retrospectively evaluated the diagnostic performance of ONHES on AP CT in diagnosing DISL. Two observers evaluated ONHES on AP CT using the 5-point confidence level and assessed the presence or absence of subjective splenomegaly on axial CT images. Another two observers measured the splenic index as proposed by objective CT criteria. Statistical analysis included interobserver agreement and diagnostic performance of CT findings. Eleven of the 136 patients with lymphoma had DISL. The area under the receiver operating characteristic curve of ONHES (0.948 for observer 1 and 0.922 for observer 2) was superior to that of the splenic index (0.872 for observer 3 and 0.877 for observer 4), but the difference was not statistically significant (p > 0.05). The diagnostic performance of ONHES in conjunction with subjective splenomegaly showed higher diagnostic performance, as compared with subjective splenomegaly alone (accuracy: 100% and 85.3% for observer 1, 98.5% and 87.5% for observer 2; positive predictive value: 100% and 35.5% for observer 1, 90.9% and 39.3% for observer 2, respectively). Obliteration of normal heterogeneous enhancement of the spleen in conjunction with subjective splenomegaly can improve the diagnostic performance for DISL. Our results suggest that ONHES on AP CT images could be useful as an adjunctive diagnostic indicator of DISL in patients with lymphoma

Contrast enhanced ultrasound of splenic lymphoma involvement

International Nuclear Information System (INIS)

Goerg, Christian; Faoro, Charis; Bert, Tillmann; Tebbe, Johannes; Neesse, Albrecht; Wilhelm, Christian

2011-01-01

Objective: The aim of this study was to compare the value of contrast-enhanced ultrasonography (CEUS) with standard B-mode ultrasound (US) for diagnosis of splenic lymphoma involvement. Methods: From 04/2005 to 10/2008 n = 250 lymphoma patients were investigated by standard B-mode US. A homogeneous splenic echotexture was found in 199 patients (79%). To clarify the benefit of CEUS in this group a pilot series was performed with 16 of the 199 lymphoma patients. All patients with an abnormal splenic echotexture on standard B-Mode US (n = 51) including focal hypoechoic splenic lesions (n = 41) and an inhomogeneous splenic texture (n = 10) were studied by CEUS. CEUS data were retrospectively evaluated. The diagnoses included indolent lymphoma (n = 27), aggressive lymphoma (n = 14), and Hodgkin's disease (n = 10). Number and size of lesions were determined by B-mode US and CEUS. The visualisation of splenic lymphoma involvement by CEUS in comparison to B-mode US was classified as worse, equal, or better. Results: All patients with a homogeneous spleen on B-mode US (n = 16) had no visible focal lesions on CEUS. Study patients with focal lesions (n = 41) had a hypoechoic (n = 22) or isoechoic (n = 19) enhancement during the arterial phase, and a hypoechoic enhancement during the parenchymal phase (n = 41). The visualisation of focal splenic lymphoma was equal (n = 32), better (n = 6), or worse (n = 3). In all study patients with an inhomogeneous spleen on B-mode US (n = 10) no focal lesions were found by CEUS and the value of CEUS therefore was classified as worse. Conclusion: CEUS has no clear advantage for diagnosis of splenic lymphoma involvement.

Contrast enhanced ultrasound of splenic lymphoma involvement

Energy Technology Data Exchange (ETDEWEB)

Goerg, Christian, E-mail: goergc@med.uni-marburg.de [Medizinische Universitaetsklinik, Baldingerstrasse, 35033 Marburg/Lahn (Germany); Faoro, Charis [Medizinische Universitaetsklinik, Baldingerstrasse, 35033 Marburg/Lahn (Germany); Bert, Tillmann [Zentralklinik Bad Berka GmbH, Robert-Koch-Allee 9, 99437 Bad Berka (Germany); Tebbe, Johannes [Klinikum Lippe-Detmold, Roentgenstrasse 18, 32756 Detmold (Germany); Neesse, Albrecht; Wilhelm, Christian [Medizinische Universitaetsklinik, Baldingerstrasse, 35033 Marburg/Lahn (Germany)

2011-11-15

Objective: The aim of this study was to compare the value of contrast-enhanced ultrasonography (CEUS) with standard B-mode ultrasound (US) for diagnosis of splenic lymphoma involvement. Methods: From 04/2005 to 10/2008 n = 250 lymphoma patients were investigated by standard B-mode US. A homogeneous splenic echotexture was found in 199 patients (79%). To clarify the benefit of CEUS in this group a pilot series was performed with 16 of the 199 lymphoma patients. All patients with an abnormal splenic echotexture on standard B-Mode US (n = 51) including focal hypoechoic splenic lesions (n = 41) and an inhomogeneous splenic texture (n = 10) were studied by CEUS. CEUS data were retrospectively evaluated. The diagnoses included indolent lymphoma (n = 27), aggressive lymphoma (n = 14), and Hodgkin's disease (n = 10). Number and size of lesions were determined by B-mode US and CEUS. The visualisation of splenic lymphoma involvement by CEUS in comparison to B-mode US was classified as worse, equal, or better. Results: All patients with a homogeneous spleen on B-mode US (n = 16) had no visible focal lesions on CEUS. Study patients with focal lesions (n = 41) had a hypoechoic (n = 22) or isoechoic (n = 19) enhancement during the arterial phase, and a hypoechoic enhancement during the parenchymal phase (n = 41). The visualisation of focal splenic lymphoma was equal (n = 32), better (n = 6), or worse (n = 3). In all study patients with an inhomogeneous spleen on B-mode US (n = 10) no focal lesions were found by CEUS and the value of CEUS therefore was classified as worse. Conclusion: CEUS has no clear advantage for diagnosis of splenic lymphoma involvement.

Delayed splenic vascular injury after nonoperative management of blunt splenic trauma.

Science.gov (United States)

Furlan, Alessandro; Tublin, Mitchell E; Rees, Mitchell A; Nicholas, Dederia H; Sperry, Jason L; Alarcon, Louis H

2017-05-01

Delayed splenic vascular injury (DSVI) is traditionally considered a rare, often clinically occult, harbinger of splenic rupture in patients with splenic trauma that are managed conservatively. The purpose of our study was to assess the incidence of DSVI and associated features in patients admitted with blunt splenic trauma and managed nonoperatively. A retrospective analysis was conducted over a 4-y time. Patients admitted with blunt splenic trauma, managed no-operatively and with a follow-up contrast-enhanced computed tomography (CT) scan study during admission were included. The CT scans were reviewed for American Association for the Surgery of Trauma splenic injury score, amount of hemoperitoneum, and presence of DSVI. Logistic regression models were used to investigate the risk factors associated with DSVI. A total of 100 patients (60 men and 40 women) constituted the study group. Follow-up CT scan demonstrated a 23% incidence of DSVI. Splenic artery angiography validated DSVI in 15% of the total patient population. Most DSVIs were detected only on arterial phase CT scan imaging. The American Association for the Surgery of Trauma splenic injury score (odds ratio = 1.73; P = 0.045) and the amount of hemoperitoneum (odds ratio = 1.90; P = 0.023) on admission CT scan were associated with the development of DSVI on follow-up CT scan. DSVI on follow-up CT scan imaging of patients managed nonoperatively after splenic injury is common and associated with splenic injury score assessed on admission CT scan. Copyright © 2016 Elsevier Inc. All rights reserved.

The involvement of splenic artery in the blood supply of hepatomas: its DSA findings and interventional treatment

International Nuclear Information System (INIS)

Duan Xuhua; Liang Huiming; Feng Gansheng; Zheng Chuangsheng; Ren Jianzhuang

2009-01-01

Objective: To investigate the DSA manifestations of the involvement of splenic artery in supplying blood to hepatomas and to assess the therapeutic value of super-selective interventional embolization. Methods: During the period of March 2005-June 2008, 897 patients with hepatoma underwent angiography and the involvement of splenic artery in the blood supply of hepatoma was confirmed in 7 cases. Splenic arteriography was performed by means of super-selective catheterization with 5 F Yashiro catheter together with 3 F SP catheter. The splenic arteries which supplied blood to hepatomas were embolized with hyper-liquid iodized-oil emulsion mixed with chemotherapy drug, which was followed by the injection of sufficient gelatin sponge or ethanol. The clinical results were analyzed. Results: Splenic arteriography revealed that the splenic artery was the main supplying vessel of the hepatoma in two cases, and was not the main supplying vessel of the hepatoma in five cases. The splenic supplying vessels were completely embolized in all 7 cases. After the procedure, AFP level was decreased over 50%, and in two patients it dropped to normal. CT checkup 4-6 weeks after the surgery revealed that the diameter of tumor decreased to 2.5 - 4.6 cm. Conclusion: The involvement of splenic artery in supplying blood to hepatomas is not common. Super-selective catheterization and sufficient embolization of the splenic supplying vessels are very important for improving the interventional effectiveness. (authors)

CT morphology of splenic vessels in splenoportal fistula

Energy Technology Data Exchange (ETDEWEB)

Mansfeld, L; Poehls, C; Boitz, F

1986-12-01

CT examination of a 53-year-old patient with endocarditis and clinical signs of hepatosplenomegaly revealed an atypical vascular morphology in the hilum of the spleen, for which no diagnosis could be established. Angiography indicated the presence of a symptom-free splenoportal fistula, the histological study of which suggested its congenital genesis. The paper describes the morphology, as ascertained by CT, of the splenic vessels characterised by changed haemodynamics due to a hilar splenoportal fistula.

CT morphology of splenic vessels in splenoportal fistula

International Nuclear Information System (INIS)

Mansfeld, L.; Poehls, C.; Boitz, F.

1986-01-01

CT examination of a 53-year-old patient with endocarditis and clinical signs of hepatosplenomegaly revealed an atypical vascular morphology in the hilum of the spleen, for which no diagnosis could be established. Angiography indicated the presence of a symptom-free splenoportal fistula, the histological study of which suggested its congenital genesis. The paper describes the morphology, as ascertained by CT, of the splenic vessels characterised by changed haemodynamics due to a hilar splenoportal fistula. (orig.) [de

CT of hepatic and splenic injury in children: Role in the decision for laparotomy

International Nuclear Information System (INIS)

Brick, S.H.; Taylor, G.A.; Potter, B.M.; Eichelberger, M.R.

1987-01-01

Two hundred seventy-four children were examined with CT after incurring blunt trauma to the abdomen. Hepatic and/or splenic injuries were detected in 36 patients. Of 12 children with moderate to severe hepatic injuries, only one required operative intervention. Of 13 children with moderate to sever splenic injuries, only one required splenorrhaphy. Only two of 16 patients with a moderate to large hemoperitoneum required surgery for hepatic or splenic injury. The authors conclude that the decision for laparotomy should not be based on the extent of injury as seen on CT, but on the physiologic condition of the child

CT finding of ruptured splenic artery aneurysm after cesarean section : a case report

Energy Technology Data Exchange (ETDEWEB)

Ryu, Chang Woo; Kim, Hee Jin [CHA Medical College, Pundang CHA Gerneral Hospital Sungnam, (Korea, Republic of)

2000-03-01

Spontaneous rupture of a splenic artery aneurysm during puerperium is rare and is due to the non-specific clinical appearance, diagnosis is difficult. We describe a case of spontaneous rupture of splenic artery aneurysm after a Cesarean section. CT showed high-density ascites localized in the lesser sac and left retroperitoneum.

CT finding of ruptured splenic artery aneurysm after cesarean section : a case report

International Nuclear Information System (INIS)

Ryu, Chang Woo; Kim, Hee Jin

2000-01-01

Spontaneous rupture of a splenic artery aneurysm during puerperium is rare and is due to the non-specific clinical appearance, diagnosis is difficult. We describe a case of spontaneous rupture of splenic artery aneurysm after a Cesarean section. CT showed high-density ascites localized in the lesser sac and left retroperitoneum

The comparative study between multi-slice spiral CT angiography and color flow ultrasonography in hepatic and splenic trauma

International Nuclear Information System (INIS)

Yan Youxia; Zhang Jin'e; Chen Xiaocong; Cai Shufang

2007-01-01

Objective: To investigate the clinical value of multi-slice spiral CT angiography and color flow ultra- sonography in hepatic and splenic trauma. Methods Thirty-six cases of hepatic and splenic trauma were collected, the MSCT were analyzed and compared with that of color flow ultrasonography. Results: Seventeen cases were Hepatic trauma including nine cases of hepatic contusion, six cases of sub-envelope hematoma, two cases of both sub-envelope hematoma and hepatic contusion. Nineteen cases were splenic trauma including nine cases of splenic contusion, ten cases of sub-envelope hematoma. Conclusion: Multi-slice spiral CT angiography show hepatic and splenic trauma clearer than that of color flow ultrasonography, and can provide reliable basis for clinic diagnosis and therapy. (authors)

Arterial phase CT for the detection of splenic injuries in blunt trauma: would it improve clinical outcomes?

Science.gov (United States)

Corwin, Michael T; Fananapazir, Ghaneh; Lamba, Ramit; Salcedo, Edgardo S; Holmes, James F

2016-01-01

To determine if the addition of an arterial phase abdominal computed tomography (CT) improves clinical outcomes in patients with blunt splenic injuries. Retrospective review of patients who underwent CT of the abdomen revealing splenic injuries. Clinical management in these patients was determined. Fifty-one of three thousand five hundred twenty-five patients had splenic injuries. Twenty-five patients underwent nonsurgical management, and 3 failed. The theoretical additional arterial phase resulted in a 62% increase in mean effective dose compared to the portal venous phase alone. Routine use of arterial phase CT in blunt trauma patients may not be warranted as there is minimal improvement in outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

US and CT Findings of Splenic Hydatid Cyst: A Case Report

Energy Technology Data Exchange (ETDEWEB)

Kim, Il Young; Kim, Sang Won; Shin, Hyeong Cheol; Han, Jong Kyu [Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of)

2009-03-15

Hydatid disease is a parasitic infection caused by the larvae of the cestode worms Echinococcus. In humans, the most commonly affected organ is the liver, the next second common organ is the lung. The third common affected organ is the spleen. In the case of splenic hydatid cyst, most cysts remain clinically silent and are diagnosed incidentally or when complications occur. We experienced a case of splenic hydatid cyst in a 28-year-old man. The patient complained of abdominal pain for 1 month. Abdominal ultrasound revealed a cystic lesion with daughter cysts in the spleen. The CT imaging also showed a cystic lesion with daughter cysts. We diagnosed it as a splenic hydatid cyst which was confirmed by pathology after surgery

US and CT Findings of Splenic Hydatid Cyst: A Case Report

International Nuclear Information System (INIS)

Kim, Il Young; Kim, Sang Won; Shin, Hyeong Cheol; Han, Jong Kyu

2009-01-01

Hydatid disease is a parasitic infection caused by the larvae of the cestode worms Echinococcus. In humans, the most commonly affected organ is the liver, the next second common organ is the lung. The third common affected organ is the spleen. In the case of splenic hydatid cyst, most cysts remain clinically silent and are diagnosed incidentally or when complications occur. We experienced a case of splenic hydatid cyst in a 28-year-old man. The patient complained of abdominal pain for 1 month. Abdominal ultrasound revealed a cystic lesion with daughter cysts in the spleen. The CT imaging also showed a cystic lesion with daughter cysts. We diagnosed it as a splenic hydatid cyst which was confirmed by pathology after surgery

Splenic abscess after splenic blunt injury angioembolization.

Science.gov (United States)

Tartaglia, Dario; Galatioto, Christian; Lippolis, Piero Vincenzo; Modesti, Matteo; Gianardi, Desirée; Bertolucci, Andrea; Cucinotta, Monica; Zocco, Giuseppe; Seccia, Massimo

2014-11-03

Splenic Angioembolization (SAE), during Nonoperative Management (NOM) of Blunt Splenic Injury (BSI), is an effective therapy for hemodynamically stable patients with grade III, IV, and V OIS splenic injuries. We report a case of a patient with a blunt abdominal trauma due to an accidental fall, who presented splenic abscess a week after SAE and a review of the literature. A 38-year-old male arrived at Emergency after an accidental fall with contusion of the left upper quadrant of the abdomen. Abdominal CT scan revealed the fracture of the lower splenic pole with intraparenchymal pseudoaneurysms (OIS spleen injury scale IV). Considering the hemodynamic stability, NOM was undertaken and SAE was performed. After a week, the patient developed a splenic abscess confirmed by Abdominal CT; therefore, splenectomy was performed. There was no evidence of bacterial growing in the perisplenic hematoma cultures but the histological examination showed multiple abscess and hemorrhagic areas in the spleen. Splenic abscess after SAE during NOM of BSI is a rare major complication. The most frequently cultured organisms include Clostridium perfringens, Alpha-Hemoliticus Streptococcus, gram-positive Staphylococcus, gram-negative Salmonella, Candida, and Aspergillus. This case represents our first reported splenic abscess after SAE. SAE is a very useful tool for BSI managing; splenic abscess can occur in a short time, even if it is a rare major complication, so it may be useful to monitor patients undergoing SAE, focusing not only on the hemodynamic parameters but also on the inflammatory and infectious aspects.

CT imaging of splenic sequestration in sickle cell disease

International Nuclear Information System (INIS)

Sheth, S.; Piomelli, S.; Ruzal-Shapiro, C.; Berdon, W.E.

2000-01-01

Pooling of blood in the spleen is a frequent occurrence in children with sickle cell diseases, particularly in the first few years of life, resulting in what is termed ''splenic sequestration crisis.'' The spectrum of severity in this syndrome is wide, ranging from mild splenomegaly to massive enlargement, circulatory collapse, and even death. The diagnosis is usually clinical, based on the enlargement of the spleen with a drop in hemoglobin level by >2 g/dl, and it is rare that imaging studies are ordered. However, in the patient who presents to the emergency department with non-specific findings of an acute abdomen, it is important to recognize the appearance of sequestration on imaging studies. We studied seven patients utilizing contrast-enhanced CT scans and found two distinct patterns - multiple, peripheral, non-enhancing low-density areas or large, diffuse areas of low density in the majority of the splenic tissue. Although radiological imaging is not always necessary to diagnose splenic sequestration, in those situations where this diagnosis is not immediately obvious, it makes an important clarifying contribution. (orig.)

Active hemorrhage and vascular injuries in splenic trauma: utility of the arterial phase in multidetector CT.

Science.gov (United States)

Uyeda, Jennifer W; LeBedis, Christina A; Penn, David R; Soto, Jorge A; Anderson, Stephan W

2014-01-01

To determine whether the addition of arterial phase computed tomography (CT) to the standard combination of portal venous and delayed phase imaging increases sensitivity in the diagnosis of active hemorrhage and/or contained vascular injuries in patients with splenic trauma. The institutional review board approved this HIPAA-compliant retrospective study; the requirement to obtain informed consent was waived. The study included all patients aged 15 years and older who sustained a splenic injury from blunt or penetrating trauma and who underwent CT in the arterial and portal venous phases of image acquisition during a 74-month period (September 2005 to November 2011). CT scans were reviewed by three radiologists, and a consensus interpretation was made to classify the splenic injuries according to the American Association for the Surgery of Trauma splenic injury scale. One radiologist independently recorded the presence of contained vascular injuries or active hemorrhage and the phase or phases at which these lesions were seen. Clinical outcome was assessed by reviewing medical records. The relationship between imaging findings and clinical management was assessed with the Fisher exact test. One hundred forty-seven patients met the inclusion criteria; 32 patients (22%) had active hemorrhage and 22 (15%) had several contained vascular injuries. In 13 of the 22 patients with contained injuries, the vascular lesion was visualized only at the arterial phase of image acquisition; the other nine contained vascular injuries were seen at all phases. Surgery or embolization was performed in 11 of the 22 patients with contained vascular injury. The arterial phase of image acquisition improves detection of traumatic contained splenic vascular injuries and should be considered to optimize detection of splenic injuries in trauma with CT. ©RSNA, 2013.

Computed tomography of splenic trauma

Energy Technology Data Exchange (ETDEWEB)

Jeffrey, R.B.; Laing, F.C.; Federle, M.P.; Goodman, P.C.

1981-12-01

Fifty patients with abdominal trauma and possible splenic injury were evaluated by computed tomography (CT). CT correctly diagnosed 21 of 22 surgically proved traumatic sesions of the spleen (96%). Twenty-seven patients had no evidence of splenic injury. This was confirmed at operation in 1 patient and clinical follow-up in 26. There were one false negative and one false positive. In 5 patients (10%), CT demonstrated other clinically significant lesions, including hepatic or renal lacerations in 3 and large retroperitoneal hematomas in 2. In adolescents and adults, CT is an accurate, noninvasive method of rapidly diagnosing splenic trauma and associated injuries. Further experience is needed to assess its usefulness in evaluating splenic injuries in infants and small children.

Computed tomography of splenic trauma

International Nuclear Information System (INIS)

Jeffrey, R.B.; Laing, F.C.; Federle, M.P.; Goodman, P.C.

1981-01-01

Fifty patients with abdominal trauma and possible splenic injury were evaluated by computed tomography (CT). CT correctly diagnosed 21 of 22 surgically proved traumatic sesions of the spleen (96%). Twenty-seven patients had no evidence of splenic injury. This was confirmed at operation in 1 patient and clinical follow-up in 26. There were one false negative and one false positive. In 5 patients (10%), CT demonstrated other clinically significant lesions, including hepatic or renal lacerations in 3 and large retroperitoneal hematomas in 2. In adolescents and adults, CT is an accurate, noninvasive method of rapidly diagnosing splenic trauma and associated injuries. Further experience is needed to assess its usefulness in evaluating splenic injuries in infants and small children

Computed tomography characteristics of hepatic and splenic abscesses associated with melioidosis: a 7- year study

International Nuclear Information System (INIS)

Apisarnthanarak, Piyaporn; Thairatananon, Atita; Muangsomboon, Kobkum

2011-01-01

Full text: This study aimed to characterise the CT findings associated with hepatic and splenic melioid abscesses. Patients with CT evidence of hepatic and/or splenic abscesses were retrospectively evaluated for clinical evidence of melioidosis over a 7-year period. After blinded review of the CT characteristics of intra-abdominal abscesses (IAA), we conducted a stratified analysis of patients with and without melioid IAA. Among 49 patients with CT evidence of hepatic and/or splenic IAA, the mean age was 50.2 years, 22 (44.9%) were women and eight (16.3%) had laboratory confirmation of melioidosis. For the 113 IAA, 33 were melioid abscesses (15 liver and 18 spleen) and 80 were non-melioid abscesses (69 liver and 11 spleen). Splenic IAA were more common in the melioid group (P = 0.001) and smaller in diameter than the hepatic IAA (P < 0.001). Melioid IAA were smaller than non-melioid IAA (P < 0.001) and the CT necklace sign was the strongest predictor for melioid IAA (odds ratio = 24.6, P = 0.006) with 100% specificity. Other significant predictors for melioidosis were concurrent hepatic and splenic involvement (P = 0.009), multiple abscesses (P = 0.015) and residence in an endemic area (P = 0.047). By multivariate analysis, concurrent hepatic and splenic involvement was the sole predictor of melioi dosis (adjusted odds ratio = 11.3, 95% confidence interval = 1.6-77.5, P = 0.014). The CT necklace sign, along with concurrent hepatic and splenic IAA, were highly suggestive of melioidosis in persons from Central Thailand.

[Splenic abscesses: From diagnosis to therapy].

Science.gov (United States)

Davido, B; Dinh, A; Rouveix, E; Crenn, P; Hanslik, T; Salomon, J

2017-09-01

Splenic abscess is septic collection which occurs after haematogenous spread or local dissemination. Splenic abscess is an uncommon and rare condition, more frequently affecting male and immunocompromised patients. There are no guidelines regarding its diagnosis and management. Computed tomography (CT) scan is highly sensitive and specific (95% and 92%, respectively) in the diagnosis of splenic abscess. Diagnosis is based on blood cultures which are positive in 24 to 80% of cases. Bacterial growth culture of abscess after drainage is more efficient (50-80%) and can be performed after surgery or percutaneous drainage under imaging, including CT scan. Microorganisms involved are frequently enterobacteriaceae, gram-positive cocci and anaerobes. This particular ecology leads to an empiric broad-spectrum antibiotic therapy, with a variable duration, from 10days to more than one month. Management remains very close to the one applied in case of liver abscesses. The role of splenectomy in the prevention of recurrence remains controversial. We reviewed the literature regarding splenic abscesses, from diagnosis to therapy. Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Computed tomographic diagnosis of the splenic trauma

International Nuclear Information System (INIS)

Suzuki, Masayuki; Takashima, Tsutomu; Funaki, Hiromi; Uogishi, Makoto; Isobe, Tsugimasa; Kanno, Shoichi; Ushitani, Kenji; Fuchuh, Kosei; Sakita, Tsuyoshi.

1985-01-01

Three cases (3-year-old, 51-year-old and 17-year-old males) in which splenic trauma was diagnosed by plain computed tomography (CT) are presented. CT images revealed retention of fluid in the abdominal cavity in all cases and clear splenic hematoma and laceration in one case. CT is superior in the visualization of splenic hematoma and hemorrhage in the abdominal cavity accompanied by splenic trauma. It should, however, be noted that the presence of laceration is frequently difficult to detect due to artifacts. Indication for surgery should be decided by evaluating the severity of clinical symptoms. (Namekawa, K.)

Computed tomographic diagnosis of the splenic trauma

Energy Technology Data Exchange (ETDEWEB)

Suzuki, Masayuki; Takashima, Tsutomu; Funaki, Hiromi; Uogishi, Makoto; Isobe, Tsugimasa; Kanno, Shoichi; Ushitani, Kenji; Fuchuh, Kosei; Sakita, Tsuyoshi

1985-01-01

Three cases (3-year-old, 51-year-old and 17-year-old males) in which splenic trauma was diagnosed by plain computed tomography (CT) are presented. CT images revealed retention of fluid in the abdominal cavity in all cases and clear splenic hematoma and laceration in one case. CT is superior in the visualization of splenic hematoma and hemorrhage in the abdominal cavity accompanied by splenic trauma. It should, however, be noted that the presence of laceration is frequently difficult to detect due to artifacts. Indication for surgery should be decided by evaluating the severity of clinical symptoms. (Namekawa, K.).

Primary splenic torsion in a Boston terrier

International Nuclear Information System (INIS)

Ohta, H.; Takagi, S.; Murakami, M.; Sasaki, N.; Yoshikawa, M.; Nakamura, K.; Hwang, S.J.; Yamasaki, M.; Takiguchi, M.

2009-01-01

A 7-year-old female Boston terrier was referred to Hokkaido University Veterinary Teaching Hospital with a history of hemoglobinuria and anemia for several days. Abdominal radiographs showed splenomegaly, and ultrasonography revealed a hypoechoic splenic parenchyma with interspersed linear echoes consistent with the ultrasonographic appearance of splenic torsion. Ultrasonography and computed tomography (CT) indicated a C-shaped spleen. Exploratory laparotomy confirmed the diagnosis of splenic torsion. A splenectomy was performed, and the dog recovered well without complications. This is the first report of splenic torsion in Boston terriers, and the usefulness of ultrasonographic and CT findings of the splenic torsion was also confirmed

Primary splenic torsion in a Boston terrier.

Science.gov (United States)

OHTA, Hiroshi; TAKAGI, Satoshi; MURAKAMI, Masahiro; SASAKI, Noboru; YOSHIKAWA, Muneyoshi; NAKAMURA, Kensuke; HWANG, Shiang-Jyi; YAMASAKI, Masahiro; TAKIGUCHI, Mitsuyoshi

2009-11-01

A 7-year-old female Boston terrier was referred to Hokkaido University Veterinary Teaching Hospital with a history of hemoglobinuria and anemia for several days. Abdominal radiographs showed splenomegaly, and ultrasonography revealed a hypoechoic splenic parenchyma with interspersed linear echoes consistent with the ultrasonographic appearance of splenic torsion. Ultrasonography and computed tomography (CT) indicated a C-shaped spleen. Exploratory laparotomy confirmed the diagnosis of splenic torsion. A splenectomy was performed, and the dog recovered well without complications. This is the first report of splenic torsion in Boston terriers, and the usefulness of ultrasonographic and CT findings of the splenic torsion was also confirmed.

[Spleen-preserving surgery after blunt abdominal trauma with splenic hilum involvement].

Science.gov (United States)

Navas-Cuéllar, José Aurelio; Cañete-Gómez, Jesús; López-Bernal, Francisco; García-Rivera, Carla; Pareja-Ciuró, Felipe; Padillo-Ruiz, Javier

2015-01-01

Splenic involvement secondary to blunt abdominal trauma is often treated by performing a splenectomy. The severity of the post-splenectomy syndrome is currently well known (blood loss, sepsis), so there is an increasing tendency to preserve the spleen. The case is presented of splenic preservation after blunt abdominal trauma with hilum involvement, emphasising the role of Floseal as a haemostatic agent, as well as the use of resorbable meshes to preserve the spleen. A 22-year-old woman presenting with a grade IV splenic lesion secondary to a blunt abdominal trauma after a traffic accident. Partial splenic resection was performed and bleeding was controlled with Floseal and use of a reinforcing polyglycolic acid mesh. No postoperative complications occurred, being discharged on day 5. The long-term follow-up has been uneventful. The use of haemostatic agents such as thrombin and the gelatine gel (FloSeal) and the use of polyglycolic acid meshes enable spleen-preserving surgery, making it a feasible and reproducible procedure and an alternative to classical splenectomy. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

The value of MDCT in diagnosis of splenic artery aneurysms

International Nuclear Information System (INIS)

Sun Cong; Liu Cheng; Wang Ximing; Wang Daoping

2008-01-01

Objective: To evaluate the clinical value of multiple detector computed tomography (MDCT) in the diagnosis and planning the treatment of splenic aneurysms. Methods: Eight cases with splenic artery aneurysms (SAA) were retrospectively reviewed. Sixty four-slice spiral CT scans were performed. Intravenous contrast material was injected at 4 ml/s, and arterial and venous phase images were obtained. Subsequently, arterial phase images were analyzed and made for CT angiography. The diagnosis was made by using axial and reconstructive images. All of the patients were also performed Doppler color echocardiography. Results: All patients showed splenic artery and splenic artery aneurysms clearly with CT arterial phase images. Among them, six patients had splenic artery aneurysms, one had giant splenic artery aneurysms (GSAA) and one had splenic artery pseudoaneurysms. Ultrasound examination only diagnosed six of them. Conclusion: MDCT is a noninvasive and valuable method in diagnosis of splenic artery aneurysms and has high value in determination of treatment plan

The value of MDCT in diagnosis of splenic artery aneurysms

Energy Technology Data Exchange (ETDEWEB)

Sun Cong [Shandong University, Shandong Provincial Medical Imaging Institute, Road jing-wu No. 324, Jinan, Shandong 250021 (China)], E-mail: suncong03@163.com; Liu Cheng; Wang Ximing; Wang Daoping [Shandong University, Shandong Provincial Medical Imaging Institute, Road jing-wu No. 324, Jinan, Shandong 250021 (China)

2008-03-15

Objective: To evaluate the clinical value of multiple detector computed tomography (MDCT) in the diagnosis and planning the treatment of splenic aneurysms. Methods: Eight cases with splenic artery aneurysms (SAA) were retrospectively reviewed. Sixty four-slice spiral CT scans were performed. Intravenous contrast material was injected at 4 ml/s, and arterial and venous phase images were obtained. Subsequently, arterial phase images were analyzed and made for CT angiography. The diagnosis was made by using axial and reconstructive images. All of the patients were also performed Doppler color echocardiography. Results: All patients showed splenic artery and splenic artery aneurysms clearly with CT arterial phase images. Among them, six patients had splenic artery aneurysms, one had giant splenic artery aneurysms (GSAA) and one had splenic artery pseudoaneurysms. Ultrasound examination only diagnosed six of them. Conclusion: MDCT is a noninvasive and valuable method in diagnosis of splenic artery aneurysms and has high value in determination of treatment plan.

Splenic tuberculosis. Report of twelve cases

International Nuclear Information System (INIS)

Adil, A.; Chikhaoui, N.; Ousehal, A.; Kadiri, R.

1995-01-01

Tuberculosis of the spleen is not exceptional. The authors report ten cases which occurred with a predominance in young male adults. All patients had at least one other site of tuberculosis without any HIV infection. All patients had focal splenic lesions in the form of scattered hypo-echogenic and hypodense nodules. These nodules had a pseudo-tumor appearance in one case. CT-guided puncture was performed in one case. Splenic tuberculosis is not as rare as is sometimes thought. The CT-guided splenic puncture is now performed routinely and remains the ideal diagnostic approach. (authors). 9 refs., 5 figs

Splenic injury diagnosis & splenic salvage after trauma

NARCIS (Netherlands)

Olthof, D.C.

2014-01-01

Non-operative management (NOM) has replaced surgery as the treatment of choice for hemodynamically stable patients with splenic injury after trauma. The growing use of NOM for blunt abdominal organ injury has been made possible by the progress in the quality and availability of the multidetector CT

Decreased splenic enhancement on CT in traumatized hypotensive patients

International Nuclear Information System (INIS)

Berland, L.L.; VanDyke, J.A.

1985-01-01

Three patients with transient episodes of hypotension following blunt abdominal trauma incurred in motor vehicle accidents were examined by computed tomography within 6 hours of injury. None of the patients had splenic injury evident on autopsy, surgery, or clinical follow-up study (one case each), nor did they have other characteristic features of splenic infarction. However, in each case the spleen was less enhanced than the liver, leading to an erroneous impression in one patient that the splenic artery had been disrupted. Physiologic studies have shown that splenic perfusion decreases with sympathetic stimulation; this may have been the cause of the diminished enhancement. Decreased splenic enhancement should be interpreted cautiously in traumatized hypotensive patients

Decreased splenic enhancement on CT in traumatized hypotensive patients

Energy Technology Data Exchange (ETDEWEB)

Berland, L.L.; VanDyke, J.A.

1985-08-01

Three patients with transient episodes of hypotension following blunt abdominal trauma incurred in motor vehicle accidents were examined by computed tomography within 6 hours of injury. None of the patients had splenic injury evident on autopsy, surgery, or clinical follow-up study (one case each), nor did they have other characteristic features of splenic infarction. However, in each case the spleen was less enhanced than the liver, leading to an erroneous impression in one patient that the splenic artery had been disrupted. Physiologic studies have shown that splenic perfusion decreases with sympathetic stimulation; this may have been the cause of the diminished enhancement. Decreased splenic enhancement should be interpreted cautiously in traumatized hypotensive patients.

Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

International Nuclear Information System (INIS)

Foley, P. T.; Kavnoudias, H.; Cameron, P. U.; Czarnecki, C.; Paul, E.; Lyon, S. M.

2015-01-01

PurposeTo compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels.Materials and MethodsPatients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population.ResultsOf the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation—a difference that could not be attributed to differences in age, grade of injury or residual splenic volume.ConclusionIgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function

Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

Energy Technology Data Exchange (ETDEWEB)

Foley, P. T., E-mail: pfoley@doctors.org.uk [The Canberra Hospital, Department of Medical Imaging (Australia); Kavnoudias, H., E-mail: h.kavnoudias@alfred.org.au [The Alfred Hospital, Radiology Research Unit, Radiology Department (Australia); Cameron, P. U., E-mail: paul.cameron@unimelb.edu.au [The Alfred Hospital, Infectious Diseases Unit (Australia); Czarnecki, C., E-mail: caroline.czarnecki@gmail.com [Royal Melbourne Hospital, Radiology Department (Australia); Paul, E., E-mail: eldho.paul@monash.edu [Monash University, Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Alfred Hospital (Australia); Lyon, S. M., E-mail: lyonsey@optusnet.com.au [Melbourne Endovascular (Australia)

2015-10-15

PurposeTo compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels.Materials and MethodsPatients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population.ResultsOf the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation—a difference that could not be attributed to differences in age, grade of injury or residual splenic volume.ConclusionIgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

Science.gov (United States)

Foley, P T; Kavnoudias, H; Cameron, P U; Czarnecki, C; Paul, E; Lyon, S M

2015-10-01

To compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels. Patients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population. Of the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation-a difference that could not be attributed to differences in age, grade of injury or residual splenic volume. IgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

Association of splenic and renal infarctions in acute abdominal emergencies

Energy Technology Data Exchange (ETDEWEB)

Romano, Stefania E-mail: stefromano@libero.it; Scaglione, Mariano; Gatta, Gianluca; Lombardo, Patrizia; Stavolo, Ciro; Romano, Luigia; Grassi, Roberto

2004-04-01

Introduction: Splenic and renal infarctions are usually related to vascular disease or haematologic abnormalities. Their association is infrequent and rarely observed in trauma. In this study, we analyze our data to look at the occurrence of renal and splenic infarctions based on CT findings in a period of 4 years. Materials and Methods: We retrospectively reviewed the imaging findings of 84 patients admitted to our Department of Diagnostic Imaging from June 1998 to December 2002, who underwent emergency abdominal spiral CT examination and in whom there was evidence of splenic and/or renal infarction. Results: We found 40 cases of splenic infarction and 54 cases of renal infarction, associated in 10 patients. In 26 patients, there was also evidence of intestinal infarction. A traumatic origin was found in 19 cases; non-traumatic causes were found in 65 patients. Association between renal and splenic infarction in the same patient was related to trauma in two cases. Conclusions: Although renal and splenic infarctions are a common manifestation of cardiac thromboembolism, other systemic pathologies, infections or trauma may lead to this occurrence. Renal infarction may be clinically and/or surgically managed with success in most cases. There are potential complications in splenic infarction, such as development of pseudocysts, abscesses, hemorrhage, subcapsular haematoma or splenic rupture; splenectomy in these cases may be necessary. Some patients with splenic and/or renal infarction may be clinically asymptomatic. The high accuracy of CT examination is needed to allow a correct evaluation of infarcted organs.

Association of splenic and renal infarctions in acute abdominal emergencies

International Nuclear Information System (INIS)

Romano, Stefania; Scaglione, Mariano; Gatta, Gianluca; Lombardo, Patrizia; Stavolo, Ciro; Romano, Luigia; Grassi, Roberto

2004-01-01

Introduction: Splenic and renal infarctions are usually related to vascular disease or haematologic abnormalities. Their association is infrequent and rarely observed in trauma. In this study, we analyze our data to look at the occurrence of renal and splenic infarctions based on CT findings in a period of 4 years. Materials and Methods: We retrospectively reviewed the imaging findings of 84 patients admitted to our Department of Diagnostic Imaging from June 1998 to December 2002, who underwent emergency abdominal spiral CT examination and in whom there was evidence of splenic and/or renal infarction. Results: We found 40 cases of splenic infarction and 54 cases of renal infarction, associated in 10 patients. In 26 patients, there was also evidence of intestinal infarction. A traumatic origin was found in 19 cases; non-traumatic causes were found in 65 patients. Association between renal and splenic infarction in the same patient was related to trauma in two cases. Conclusions: Although renal and splenic infarctions are a common manifestation of cardiac thromboembolism, other systemic pathologies, infections or trauma may lead to this occurrence. Renal infarction may be clinically and/or surgically managed with success in most cases. There are potential complications in splenic infarction, such as development of pseudocysts, abscesses, hemorrhage, subcapsular haematoma or splenic rupture; splenectomy in these cases may be necessary. Some patients with splenic and/or renal infarction may be clinically asymptomatic. The high accuracy of CT examination is needed to allow a correct evaluation of infarcted organs

Splenic epithelial cyst

International Nuclear Information System (INIS)

Yousuf, M.; Jalali, U.

2011-01-01

Cysts of spleen are rare entities. Congenital splenic cysts are even more uncommon comprising of only 10% of benign non-parasitic cysts. We report a case of 22 years old female who presented with history of 2 years abdominal pain and gradual distension. Ultrasound and computed tomography (CT) both were suggestive of splenic cyst. Laboratory tests show thrombocytopenia with platelets count of 97000 per cubic millimeter and anemia with hemoglobin 8.7 gram per deciliter. Serological tests were negative for parasitic infection. Splenectomy was done and the weight of the spleen was found to be 1.5 kilogram. Histopathological findings are consistent with splenic epithelial cyst. The aetiology, diagnostic modalities and treatment options are discussed in the case report. (author)

Inter-radiologist agreement for CT scoring of pediatric splenic injuries and effect on an established clinical practice guideline.

Science.gov (United States)

Leschied, Jessica R; Mazza, Michael B; Davenport, Matthew; Chong, Suzanne T; Smith, Ethan A; Hoff, Carrie N; Ladino-Torres, Maria F; Khalatbari, Shokoufeh; Ehrlich, Peter F; Dillman, Jonathan R

2016-02-01

The American Pediatric Surgical Association (APSA) advocates for the use of a clinical practice guideline to direct management of hemodynamically stable pediatric spleen injuries. The clinical practice guideline is based on the CT score of the spleen injury according to the American Association for the Surgery of Trauma (AAST) CT scoring system. To determine the potential effect of radiologist agreement for CT scoring of pediatric spleen injuries on an established APSA clinical practice guideline. We retrospectively analyzed blunt splenic injuries occurring in children from January 2007 to January 2012 at a single level 1 trauma center (n = 90). Abdominal CT exams performed at clinical presentation were reviewed by four radiologists who documented the following: (1) splenic injury grade (AAST system), (2) arterial extravasation and (3) pseudoaneurysm. Inter-rater agreement for AAST injury grade was assessed using the multi-rater Fleiss kappa and Kendall coefficient of concordance. Inter-rater agreement was assessed using weighted (AAST injury grade) or prevalence-adjusted bias-adjusted (binary measures) kappa statistics; 95% confidence intervals were calculated. We evaluated the hypothetical effect of radiologist disagreement on an established APSA clinical practice guideline. Inter-rater agreement was good for absolute AAST injury grade (kappa: 0.64 [0.59–0.69]) and excellent for relative AAST injury grade (Kendall w: 0.90). All radiologists agreed on the AAST grade in 52% of cases. Based on an established clinical practice guideline, radiologist disagreement could have changed the decision for intensive care management in 11% (10/90) of children, changed the length of hospital stay in 44% (40/90), and changed the time to return to normal activity in 44% (40/90). Radiologist agreement when assigning splenic AAST injury grades is less than perfect, and disagreements have the potential to change management in a substantial number of pediatric patients.

Inter-radiologist agreement for CT scoring of pediatric splenic injuries and effect on an established clinical practice guideline

International Nuclear Information System (INIS)

Leschied, Jessica R.; Smith, Ethan A.; Ladino-Torres, Maria F.; Dillman, Jonathan R.; Mazza, Michael B.; Chong, Suzanne T.; Hoff, Carrie N.; Davenport, Matthew S.; Khalatbari, Shokoufeh; Ehrlich, Peter F.

2016-01-01

The American Pediatric Surgical Association (APSA) advocates for the use of a clinical practice guideline to direct management of hemodynamically stable pediatric spleen injuries. The clinical practice guideline is based on the CT score of the spleen injury according to the American Association for the Surgery of Trauma (AAST) CT scoring system. To determine the potential effect of radiologist agreement for CT scoring of pediatric spleen injuries on an established APSA clinical practice guideline. We retrospectively analyzed blunt splenic injuries occurring in children from January 2007 to January 2012 at a single level 1 trauma center (n = 90). Abdominal CT exams performed at clinical presentation were reviewed by four radiologists who documented the following: (1) splenic injury grade (AAST system), (2) arterial extravasation and (3) pseudoaneurysm. Inter-rater agreement for AAST injury grade was assessed using the multi-rater Fleiss kappa and Kendall coefficient of concordance. Inter-rater agreement was assessed using weighted (AAST injury grade) or prevalence-adjusted bias-adjusted (binary measures) kappa statistics; 95% confidence intervals were calculated. We evaluated the hypothetical effect of radiologist disagreement on an established APSA clinical practice guideline. Inter-rater agreement was good for absolute AAST injury grade (kappa: 0.64 [0.59-0.69]) and excellent for relative AAST injury grade (Kendall w: 0.90). All radiologists agreed on the AAST grade in 52% of cases. Based on an established clinical practice guideline, radiologist disagreement could have changed the decision for intensive care management in 11% (10/90) of children, changed the length of hospital stay in 44% (40/90), and changed the time to return to normal activity in 44% (40/90). Radiologist agreement when assigning splenic AAST injury grades is less than perfect, and disagreements have the potential to change management in a substantial number of pediatric patients. (orig.)

Inter-radiologist agreement for CT scoring of pediatric splenic injuries and effect on an established clinical practice guideline

Energy Technology Data Exchange (ETDEWEB)

Leschied, Jessica R.; Smith, Ethan A.; Ladino-Torres, Maria F.; Dillman, Jonathan R. [University of Michigan Health System, Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States); Mazza, Michael B.; Chong, Suzanne T.; Hoff, Carrie N. [University of Michigan Health System, Department of Radiology, Division of Emergency Radiology, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States); Davenport, Matthew S. [University of Michigan Health System, Department of Radiology, Division of Abdominal Imaging, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States); Khalatbari, Shokoufeh [University of Michigan, Michigan Institute for Clinical and Health Research, Ann Arbor, MI (United States); Ehrlich, Peter F. [University of Michigan Health System, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States)

2016-02-15

The American Pediatric Surgical Association (APSA) advocates for the use of a clinical practice guideline to direct management of hemodynamically stable pediatric spleen injuries. The clinical practice guideline is based on the CT score of the spleen injury according to the American Association for the Surgery of Trauma (AAST) CT scoring system. To determine the potential effect of radiologist agreement for CT scoring of pediatric spleen injuries on an established APSA clinical practice guideline. We retrospectively analyzed blunt splenic injuries occurring in children from January 2007 to January 2012 at a single level 1 trauma center (n = 90). Abdominal CT exams performed at clinical presentation were reviewed by four radiologists who documented the following: (1) splenic injury grade (AAST system), (2) arterial extravasation and (3) pseudoaneurysm. Inter-rater agreement for AAST injury grade was assessed using the multi-rater Fleiss kappa and Kendall coefficient of concordance. Inter-rater agreement was assessed using weighted (AAST injury grade) or prevalence-adjusted bias-adjusted (binary measures) kappa statistics; 95% confidence intervals were calculated. We evaluated the hypothetical effect of radiologist disagreement on an established APSA clinical practice guideline. Inter-rater agreement was good for absolute AAST injury grade (kappa: 0.64 [0.59-0.69]) and excellent for relative AAST injury grade (Kendall w: 0.90). All radiologists agreed on the AAST grade in 52% of cases. Based on an established clinical practice guideline, radiologist disagreement could have changed the decision for intensive care management in 11% (10/90) of children, changed the length of hospital stay in 44% (40/90), and changed the time to return to normal activity in 44% (40/90). Radiologist agreement when assigning splenic AAST injury grades is less than perfect, and disagreements have the potential to change management in a substantial number of pediatric patients. (orig.)

Reliability of injury grading systems for patients with blunt splenic trauma.

Science.gov (United States)

Olthof, D C; van der Vlies, C H; Scheerder, M J; de Haan, R J; Beenen, L F M; Goslings, J C; van Delden, O M

2014-01-01

The most widely used grading system for blunt splenic injury is the American Association for the Surgery of Trauma (AAST) organ injury scale. In 2007 a new grading system was developed. This 'Baltimore CT grading system' is superior to the AAST classification system in predicting the need for angiography and embolization or surgery. The objective of this study was to assess inter- and intraobserver reliability between radiologists in classifying splenic injury according to both grading systems. CT scans of 83 patients with blunt splenic injury admitted between 1998 and 2008 to an academic Level 1 trauma centre were retrospectively reviewed. Inter and intrarater reliability were expressed in Cohen's or weighted Kappa values. Overall weighted interobserver Kappa coefficients for the AAST and 'Baltimore CT grading system' were respectively substantial (kappa=0.80) and almost perfect (kappa=0.85). Average weighted intraobserver Kappa's values were in the 'almost perfect' range (AAST: kappa=0.91, 'Baltimore CT grading system': kappa=0.81). The present study shows that overall the inter- and intraobserver reliability for grading splenic injury according to the AAST grading system and 'Baltimore CT grading system' are equally high. Because of the integration of vascular injury, the 'Baltimore CT grading system' supports clinical decision making. We therefore recommend use of this system in the classification of splenic injury. Copyright © 2012 Elsevier Ltd. All rights reserved.

Chemoembolization Via Branches from the Splenic Artery in Patients with Hepatocellular Carcinoma

International Nuclear Information System (INIS)

Choi, Jin Woo; Kim, Hyo-Cheol; Chung, Jin Wook; Kim, Ji Dae; Kim, Gyoung Min; Lee, In Joon; Jae, Hwan Jun; Park, Jae Hyung

2012-01-01

Purpose: This study was designed to evaluate the radiologic findings and imaging response of chemoembolization via branches of the splenic artery in patients with hepatocellular carcinoma (HCC). Methods: From January 2001 to July 2010, we observed tumor staining supplied by branches of the splenic artery in 34 (0.6%) of 5,413 patients with HCC. Computed tomography (CT) scans and digital subtraction angiograms of these patients were retrospectively reviewed in consensus by two investigators. Results: A total of 39 tumor feeding-vessels in 34 patients were identified: omental branches from the left gastroepiploic artery (n = 5), branches from the short gastric artery (n = 9), and omental branches directly from the splenic artery (n = 25). Branches of the splenic artery that supplied tumors were revealed on the celiac angiogram in 29 (85%) of 34 patients and were detected on pre-procedure CT images in 27 (79%) of 34 patients. Selective chemoembolization was achieved in 38 of 39 tumor-feeding vessels. Complete or partial response of the tumor fed by branches of the splenic artery, as depicted on follow-up CT scans, was achieved in 21 (62%) patients. No patient developed severe complications directly related to chemoembolization via branches of the splenic artery. Conclusions: Omental branches directly from the splenic artery are common tumor-feeding vessels of the splenic artery in cases of advanced HCC with multiple previous chemoembolizations. Tumor-feeding vessels of the splenic artery are usually visualized on the celiac angiogram or CT scan, and chemoembolization through them can be safely performed in most patients.

Radiological features of a symptomatic splenic hamartoma

International Nuclear Information System (INIS)

Thompson, S.E.; Walsh, E.A.; Cramer, B.C.; Pushpanathan, C.C.; Hollett, P.; Ingram, L.; Price, D.

1996-01-01

Symptomatic splenic hamartomas are rare in the pediatric age group, with only four previous reports in the literature. Splenic hamartoma has been reported as a solid homogeneous mass without calcification on CT and ultrasound (US), and only one previous report of the findings on MRI has been published. We report a case of a large symptomatic splenic hamartoma in a 14-year-old girl who presented with splenomegaly, pancytopenia and growth retardation. A solid mass with multiple punctate foci resembling calcifications was seen on US. The mass was heterogeneous and better demarcated on enhanced CT. Radiocolloid scintigraphy demonstrated uptake within the lesion, but less than that of normal spleen. The mass was isointense relative to normal splenic tissue on T1-weighted MRI (0.5 T) and of increased intensity with T2 weighting. At splenectomy, a red pulp hamartoma was identified, which contained nodules of hyalinization and necrosis thought to account for the punctate foci seen on US. (orig.). With 4 figs

Radiological features of a symptomatic splenic hamartoma

Energy Technology Data Exchange (ETDEWEB)

Thompson, S.E. [Department of Radiology, Janeway Child Health Centre and Memorial University of Newfoundland, Janeway Place, St. John`s, NF A1A 1R8 (Canada); Walsh, E.A. [Department of Radiology, Janeway Child Health Centre and Memorial University of Newfoundland, Janeway Place, St. John`s, NF A1A 1R8 (Canada); Cramer, B.C. [Department of Radiology, Janeway Child Health Centre and Memorial University of Newfoundland, Janeway Place, St. John`s, NF A1A 1R8 (Canada); Pushpanathan, C.C. [Department of Pathology, Janeway Child Health Centre and Memorial University of Newfoundland, St. John`s, NF (Canada); Hollett, P. [Department of Nuclear Medicine, Health Sciences Centre and Memorial University of Newfoundland, St. John`s, NF (Canada); Ingram, L. [Department of Pediatrics, Janeway Child Health Centre and Memorial University of Newfoundland, St. John`s, NF (Canada); Price, D. [Department of Surgery, Janeway Child Health Centre and Memorial University of Newfoundland, St. John`s, NF (Canada)

1996-09-01

Symptomatic splenic hamartomas are rare in the pediatric age group, with only four previous reports in the literature. Splenic hamartoma has been reported as a solid homogeneous mass without calcification on CT and ultrasound (US), and only one previous report of the findings on MRI has been published. We report a case of a large symptomatic splenic hamartoma in a 14-year-old girl who presented with splenomegaly, pancytopenia and growth retardation. A solid mass with multiple punctate foci resembling calcifications was seen on US. The mass was heterogeneous and better demarcated on enhanced CT. Radiocolloid scintigraphy demonstrated uptake within the lesion, but less than that of normal spleen. The mass was isointense relative to normal splenic tissue on T1-weighted MRI (0.5 T) and of increased intensity with T2 weighting. At splenectomy, a red pulp hamartoma was identified, which contained nodules of hyalinization and necrosis thought to account for the punctate foci seen on US. (orig.). With 4 figs.

RE: Imaging Features of Hepato-Splenic Amyloidosis at PET/CT

Energy Technology Data Exchange (ETDEWEB)

Mainenti, Pier Paolo [IBB CNR, Napoli (Italy)

2012-06-15

Regarding the imaging of hepatic amyloidosis with PET/CT, we read with interest the case report by Son and colleagues (1) in the Sep-Oct 2011 issue of the Korean Journal of Radiology. A few points need to be discussed with more detail. First, although the enhanced CT scan of the spleen exhibited a decreased and diffuse parenchymal attenuation, this observation was not sufficiently emphasized within the manuscript. The radiological finding of splenic hypoperfusion has been well described in the literature as a marker of systemic amyloidosis, which presents a useful clue when clinical findings fail to determine the proper diagnosis (2). In the case reported by Son and colleagues, if the radiologist had immediately suggested the correct diagnostic hypothesis, the patient would have been directed to have the the appropriate laboratory examinations conducted. Specifically, the abdominal fat aspirate test which would have eliminated the need for the PET/CT scan and a risky invasive procedure such as a liver biopsy. The PET/CT images revealed a marked and diffuse increase in the 18F-FDG uptake in the enlarged liver. How do the Authors explain this finding considering the diagnosis of the disease which is characterized by the deposition and storage of an amorphous substance including amyloid? Did the compressed hepatic cells and the encased bile duct epithelium increase the glucose metabolism or was the amyloid deposition accompanied by the inflammation due to the infiltration of cells? The authors might offer us an hypothesis about the physio-pathological mechanism causing the 18F-FDG uptake in the amyloidotic liver.

Splenic artery aneurysm: a diagnostic challenge in the setting of extensive portal venous collaterals

Energy Technology Data Exchange (ETDEWEB)

Phillips, Grace S.; Vo, Nghia J.; Ishak, Gisele E.; Swanson, Jonathan O.; Otto, Randolph K. [University of Washington, Seattle Children' s Hospital, Department of Radiology, Seattle, WA (United States)

2010-07-15

We present a 16-year-old boy with autoimmune liver disease and longstanding portal hypertension in whom a CT arteriogram demonstrated a large aneurysm arising from the distal, extra-parenchymal portion of the splenic artery. Because of its location adjacent to multiple venous collaterals, the aneurysm was indistinguishable from splenic varices on initial imaging with Doppler sonography and on portal venous-phase CT. There is an increased risk of rupture of splenic artery aneurysms in the post-liver transplant period, with high associated mortality, and therefore diagnosis of splenic artery aneurysm prior to liver transplantation is clinically important. It is quite possible that the diagnosis of splenic artery aneurysm in this case would have been missed in the absence of dedicated arterial-phase imaging. As radiologists strive to reduce radiation exposure in children, this case highlights a potential diagnostic pitfall of both Doppler sonography and venous or single-acquisition arterial/venous-phase CT angiogram in children with venous collaterals and an undiagnosed splenic artery aneurysm. (orig.)

Splenic artery aneurysm: a diagnostic challenge in the setting of extensive portal venous collaterals

International Nuclear Information System (INIS)

Phillips, Grace S.; Vo, Nghia J.; Ishak, Gisele E.; Swanson, Jonathan O.; Otto, Randolph K.

2010-01-01

We present a 16-year-old boy with autoimmune liver disease and longstanding portal hypertension in whom a CT arteriogram demonstrated a large aneurysm arising from the distal, extra-parenchymal portion of the splenic artery. Because of its location adjacent to multiple venous collaterals, the aneurysm was indistinguishable from splenic varices on initial imaging with Doppler sonography and on portal venous-phase CT. There is an increased risk of rupture of splenic artery aneurysms in the post-liver transplant period, with high associated mortality, and therefore diagnosis of splenic artery aneurysm prior to liver transplantation is clinically important. It is quite possible that the diagnosis of splenic artery aneurysm in this case would have been missed in the absence of dedicated arterial-phase imaging. As radiologists strive to reduce radiation exposure in children, this case highlights a potential diagnostic pitfall of both Doppler sonography and venous or single-acquisition arterial/venous-phase CT angiogram in children with venous collaterals and an undiagnosed splenic artery aneurysm. (orig.)

Nonsurgical drainage of splenic abscess

International Nuclear Information System (INIS)

Berkman, W.A.; Harris, S.A. Jr.; Bernardino, M.E.

1983-01-01

The mortality associated with intraabdominal abscess remains high despite modern surgical methods and antibiotics. Draingae of abscesses of the abdomen, retroperitoneum, pelvis, pancreatic pseudocyst, mediastinum, and lung may be treated effectively by percutaneous catheter placement. In several reports of percutaneous abdominal abscess drainage, only three cases of splenic abscess drainage have been reported. The authors have recently drained two splenic abscesses with the aid of computed tomography (CT) and emphasize several advantages of the percutaneous guided approach

Spontaneous splenic rupture. Radiological findings in three cases

International Nuclear Information System (INIS)

Arenal, F.; Barrera, J.; Merino, S.; Pedrosa, C. S.

1999-01-01

Spontaneous splenic rupture not associated with previous trauma is an uncommon disease. It can appear in the course of multiple systemic diseases or over a normal splenic architecture, which is even more infrequent. An early diagnosis results mandatory, since it is a potentially fatal disease if it is not promptly diagnosed and managed. We present three cases of spontaneous splenic rupture (two sub capsular hematomas opened to peritoneum and a rupture of splenic parenchyma). One patient had infectious mononucleosis, other was in the acute phase of a chronic pancreatitis and the third one had a normal splenic architecture. We emphasize the importance of CT in the early diagnosis of this entity. (Author) 21 refs

Blunt splenic trauma: Can contrast enhanced sonography be used for the screening of delayed pseudoaneurysms?

Energy Technology Data Exchange (ETDEWEB)

Poletti, Pierre-Alexandre, E-mail: Pierre-Alexandre.Poletti@hcuge.ch [Department of Radiology, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland); Becker, Christoph D.; Arditi, Daniel; Terraz, Sylvain [Department of Radiology, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland); Buchs, Nicolas [Department of Surgery, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland); Shanmuganathan, Kathirkamanathan [Department of Diagnostic Radiology and Nuclear Medicine, 22 S. Greene Street, Baltimore, MD 21201 (United States); Platon, Alexandra [Department of Radiology, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland)

2013-11-01

Purpose: To assess the value of contrast-enhanced sonography (CES) for the detection of delayed post-traumatic splenic pseudo-aneurysms, usually considered an indication for angiographic embolization. Methods: Sixty-three consecutive hemodynamically stable trauma patients in whom admission CT displayed a splenic injury of grade II or higher (AAST classification), without evidence of vascular involvement, were included in the study. CES of the spleen using a second generation contrast agent was systematically performed within 48–72 h after admission, for the detection of a pooling of contrast media suggestive of pseudoaneurysm. Within 6 h after contrast-enhanced sonography, all patients underwent an abdominal CT for control purposes. CES results were compared to CT findings, which were considered the reference standard. This study received approval from the institutional ethical board. Results: CES showed a blush of contrast consistent with a pseudoaneurysm in 6 of the 63 patients. All were confirmed at subsequent control CT. Pooling of contrast was found at CT in 2 patients in whom contrast-enhanced sonography was negative. There was no false positive CES examination for the suspicion of pseudoaneurysms. When compared to CT, the sensitivity, specificity, positive and negative predictive values of CES to suggest a pseudoaneurysms, were 75% (6/8), 100% (55/55), 100% (6/6), and 96% (55/57), respectively. Conclusion: Our data suggest that CES may be useful for the screening of delayed traumatic splenic pseudoaneurysms: if a negative CES does not absolutely rule out a pseudoaneurysm, a positive CES warrants an angiography, without need of control CT.

Blunt splenic trauma: Can contrast enhanced sonography be used for the screening of delayed pseudoaneurysms?

International Nuclear Information System (INIS)

Poletti, Pierre-Alexandre; Becker, Christoph D.; Arditi, Daniel; Terraz, Sylvain; Buchs, Nicolas; Shanmuganathan, Kathirkamanathan; Platon, Alexandra

2013-01-01

Purpose: To assess the value of contrast-enhanced sonography (CES) for the detection of delayed post-traumatic splenic pseudo-aneurysms, usually considered an indication for angiographic embolization. Methods: Sixty-three consecutive hemodynamically stable trauma patients in whom admission CT displayed a splenic injury of grade II or higher (AAST classification), without evidence of vascular involvement, were included in the study. CES of the spleen using a second generation contrast agent was systematically performed within 48–72 h after admission, for the detection of a pooling of contrast media suggestive of pseudoaneurysm. Within 6 h after contrast-enhanced sonography, all patients underwent an abdominal CT for control purposes. CES results were compared to CT findings, which were considered the reference standard. This study received approval from the institutional ethical board. Results: CES showed a blush of contrast consistent with a pseudoaneurysm in 6 of the 63 patients. All were confirmed at subsequent control CT. Pooling of contrast was found at CT in 2 patients in whom contrast-enhanced sonography was negative. There was no false positive CES examination for the suspicion of pseudoaneurysms. When compared to CT, the sensitivity, specificity, positive and negative predictive values of CES to suggest a pseudoaneurysms, were 75% (6/8), 100% (55/55), 100% (6/6), and 96% (55/57), respectively. Conclusion: Our data suggest that CES may be useful for the screening of delayed traumatic splenic pseudoaneurysms: if a negative CES does not absolutely rule out a pseudoaneurysm, a positive CES warrants an angiography, without need of control CT

CT findings of lymphoma with peritoneal, omental and mesenteric involvement: Peritoneal lymphomatosis

International Nuclear Information System (INIS)

Karaosmanoglu, Devrim; Karcaaltincaba, Musturay; Oguz, Berna; Akata, Deniz; Ozmen, Mustafa; Akhan, Okan

2009-01-01

Purpose: We aimed to describe computed tomography (CT) findings in patients with peritoneal, omental and mesenteric lymphoma involvement. Materials and methods: We searched our archive retrospectively to find out patients with peritoneal, omental and mesenteric lymphoma involvement. We found 16 patients with non-hodgkin lymphoma meeting these criteria. CT studies of these patients were reevaluated for the presence of peritoneal involvement, ascites, omental mass, organomegaly, retroperitoneal lymphadenopathy, bowel wall thickening and other associated findings. Results: There were 14 males and 2 females with peritoneal and/or mesenteric and omental lymphoma involvement. Mean age was 39 (range 4-76). Subgroups of non-hodgkin lymphoma were diffuse large B-cell lymphoma (n = 11), small cell lymphocytic lymphoma (n = 2), small cleaved cell lymphoma (n = 1), T-cell lymphoma (n = 1) and Burkitt's lymphoma (n = 1). Peritoneal involvement was seen in 15 patients (93.8%) in the form of linear (n = 12) and nodular (n = 3) thickening. Ascites was seen in 12 (75%) patients. Omental and mesenteric masses were present in 10 (66.6%) and 10 (66.6%) patients, respectively. Bowel wall thickening, retroperitoneal lymphadenopathy and hepatosplenomegaly were also common and observed in 10, 10 and 11 patients, respectively. Solid organ involvement in the form of liver and splenic lesions was seen in 9 (56%) patients. Conclusion: Peritoneal involvement can be seen in many subtypes of lymphoma and most frequently in diffuse large B-cell lymphoma. Peritoneal lymphomatosis can mimic peritoneal carcinomatosis and should be included in the differential diagnosis list in patients with ascites, hepatosplenic lesions and unidentified cause of peritoneal thickening on CT in a male patient.

Disseminated cryptococcosis with splenic and meningeal involvement in a patient with AIDS

International Nuclear Information System (INIS)

Lizarazo, Jairo; Parra, Edgar; Parada, Oscar

2010-01-01

We present the case of a 37-year-old woman with a recent diagnosis of HIV-infection. The patient consulted because of headache, diarrhea, vomit and fever of two weeks' evolution. The patient had a wasting syndrome, and severe splenomegaly. Cerebral spinal fluid study showed meningitis by Cryptococcus neoformans. CT-scan revealed splenomegaly with focal lesions. Percutaneous biopsy with 18-gauge needle from one of the focal lesions confirmed cryptococcosis. The treatment was initiated with amphotericin B, followed by fluconazole. The patient's evolution has been satisfactory. Splenic lesions resolved and the patient is now asymptomatic and on secondary prophylaxis with fluconazole and antiretroviral treatment

Blunt trauma induced splenic blushes are not created equal

Directory of Open Access Journals (Sweden)

Burlew Clay

2012-03-01

Full Text Available Abstract Background Currently, evidence of contrast extravasation on computed tomography (CT scan is regarded as an indication for intervention in splenic injuries. In our experience, patients transferred from other institutions for angioembolization have often resolved the blush upon repeat imaging at our hospital. We hypothesized that not all splenic blushes require intervention. Methods During a 10-year period, we reviewed all patients transferred with blunt splenic injuries and contrast extravasation on initial postinjury CT scan. Results During the study period, 241 patients were referred for splenic injuries, of whom 16 had a contrast blush on initial CT imaging (88% men, mean age 35 ± 5, mean ISS 26 ± 3. Eight (50% patients were managed without angioembolization or operation. Comparing patients with and without intervention, there was a significant difference in admission heart rate (106 ± 9 vs 83 ± 6 and decline in hematocrit following transfer (5.3 ± 2.0 vs 1.0 ± 0.3, but not in injury grade (3.9 ± 0.2 vs 3.5 ± 0.3, systolic blood pressure (125 ± 10 vs 115 ± 6, or age (38.5 ± 8.2 vs 30.9 ± 4.7. Of the 8 observed patients, 3 underwent repeat imaging immediately upon arrival with resolution of the blush. In the intervention group, 4 patients had ongoing extravasation on repeat imaging, 2 patients underwent empiric embolization, and 2 patients underwent splenectomy for physiologic indications. Conclusions For blunt splenic trauma, evidence of contrast extravasation on initial CT imaging is not an absolute indication for intervention. A period of observation with repeat imaging could avoid costly, invasive interventions and their associated sequelae.

Image guided percutaneous splenic interventions

International Nuclear Information System (INIS)

Kang, Mandeep; Kalra, Naveen; Gulati, Madhu; Lal, Anupam; Kochhar, Rohit; Rajwanshi, Arvind

2007-01-01

Aim: The objective of this study is to evaluate the efficacy and safety of image-guided percutaneous splenic interventions as diagnostic or therapeutic procedures. Materials and methods: We performed a retrospective review of our interventional records from July 2001 to June 2006. Ninety-five image-guided percutaneous splenic interventions were performed after informed consent in 89 patients: 64 men and 25 women who ranged in age from 5 months to 71 years (mean, 38.4 years) under ultrasound (n = 93) or CT (n = 2) guidance. The procedures performed were fine needle aspiration biopsy of focal splenic lesions (n = 78) and aspiration (n = 10) or percutaneous catheter drainage of a splenic abscess (n = 7). Results: Splenic fine needle aspiration biopsy was successful in 62 (83.78%) of 74 patients with benign lesions diagnosed in 43 (58.1%) and malignancy in 19 (25.67%) patients. The most common pathologies included tuberculosis (26 patients, 35.13%) and lymphoma (14 patients, 18.91%). Therapeutic aspiration or pigtail catheter drainage was successful in all (100%) patients. There were no major complications. Conclusions: Image-guided splenic fine needle aspiration biopsy is a safe and accurate technique that can provide a definitive diagnosis in most patients with focal lesions in the spleen. This study also suggests that image-guided percutaneous aspiration or catheter drainage of splenic abscesses is a safe and effective alternative to surgery

Splenic Involvement in Hereditary Hemorrhagic Telangiectasia

Directory of Open Access Journals (Sweden)

Susumu Takamatsu

2016-01-01

Full Text Available A 33-year-old man who presented with prolonged epigastric pain was referred to our hospital. He had experienced recurrent epistaxis and had a family history of hereditary hemorrhagic telangiectasia. Computed tomography and magnetic resonance imaging revealed splenomegaly and a 9 cm hypervascular mass in his spleen. Computed tomography also showed a pulmonary arteriovenous malformation and heterogeneous enhancement of the liver parenchyma, suggesting the presence of arteriosystemic shunts and telangiectases. Based on these findings, the patient was definitely diagnosed with hereditary hemorrhagic telangiectasia according to Curaçao criteria. He underwent splenectomy, and his symptoms disappeared after surgery. Pathological examination of the resected specimen revealed that the hypervascular lesion of the spleen was not a tumor but was composed of abnormal vessels associated with hereditary hemorrhagic telangiectasia. Symptomatic splenic involvement may be a rare manifestation of hereditary hemorrhagic telangiectasia but can be revealed by imaging modalities.

Factors Associated with Diffusely Increased Splenic F-18 FDG Uptake in Patients with Cholangiocarcinoma

Energy Technology Data Exchange (ETDEWEB)

Kim, Keunyoung; Kim, Seongjang; Kim, Injoo; Kim, Dong Uk; Kim, Heeyoung; Kim, Sojung; Ahn, Sang Hyun [Pusan National Univ. Hospital, Busan (Korea, Republic of)

2014-06-15

Although diffuse splenic {sup 18}F-fluorodeoxyglucose (F-18 FDG) uptake exceeding hepatic activity, is considered abnormal, its clinical significance is rarely discussed in the literature. The aim of this study was to determine the contributing factors causing diffusely increased splenic FDG uptake in patients with cholangiocarcinoma. From January 2010 to March 2013, 140 patients (84 men, 56 women) were enrolled in this study. All patients had been diagnosed with cholangiocarcinoma and underwent F-18 FDG positron emission tomography/computed tomography (PET/CT) for the pretreatment staging work up. Clinical records were reviewed retrospectively. Various hematological parameters, C-reactive protein (CRP) level, CEA, CA19-9, pancreatic enzymes and liver function tests were conducted within 2 days after the F-18 FDG PET/CT study. Diffuse splenic uptake was observed in 23 patients (16.4%). Of those, 19 patients (82.6%) underwent endoscopic retrograde cholangiopancreastography (ERCP) 7 days before F-18 FDG PET/CT. The CRP level (p <0.001) and white blood cell count (p =0.023) were significantly higher in the group of patients with diffuse splenic FDG uptake. The hemoglobin (p <0.001) and the hematocrit (p <0.001) were significantly lower in patients with diffuse splenic FDG uptake. Pancreatic enzymes, liver function test results, and tumor markers were not significantly different between the patients who did or did not have diffusely increased splenic FDG uptake. The significant factors for diffuse splenic F-18 FDG uptake exceeding hepatic F-18 FDG uptake on multivariate analysis included: performing ERCP before F-18 FDG PET-CT (odds ratio [OR], 77.510; 95% CI, 7.624-132.105), and the presence of leukocytosis (OR, 12.436; 95% CI, 2.438-63.445) or anemia (OR, 1.211; 95% CI, 1.051-1.871). In conclusion, our study demonstrated that concurrent inflammation could be associated with diffusely increased splenic FDG uptake. We suggest that performing ERCP before F-18 FDG PET/CT

Factors Associated with Diffusely Increased Splenic F-18 FDG Uptake in Patients with Cholangiocarcinoma

International Nuclear Information System (INIS)

Kim, Keunyoung; Kim, Seongjang; Kim, Injoo; Kim, Dong Uk; Kim, Heeyoung; Kim, Sojung; Ahn, Sang Hyun

2014-01-01

Although diffuse splenic 18 F-fluorodeoxyglucose (F-18 FDG) uptake exceeding hepatic activity, is considered abnormal, its clinical significance is rarely discussed in the literature. The aim of this study was to determine the contributing factors causing diffusely increased splenic FDG uptake in patients with cholangiocarcinoma. From January 2010 to March 2013, 140 patients (84 men, 56 women) were enrolled in this study. All patients had been diagnosed with cholangiocarcinoma and underwent F-18 FDG positron emission tomography/computed tomography (PET/CT) for the pretreatment staging work up. Clinical records were reviewed retrospectively. Various hematological parameters, C-reactive protein (CRP) level, CEA, CA19-9, pancreatic enzymes and liver function tests were conducted within 2 days after the F-18 FDG PET/CT study. Diffuse splenic uptake was observed in 23 patients (16.4%). Of those, 19 patients (82.6%) underwent endoscopic retrograde cholangiopancreastography (ERCP) 7 days before F-18 FDG PET/CT. The CRP level (p <0.001) and white blood cell count (p =0.023) were significantly higher in the group of patients with diffuse splenic FDG uptake. The hemoglobin (p <0.001) and the hematocrit (p <0.001) were significantly lower in patients with diffuse splenic FDG uptake. Pancreatic enzymes, liver function test results, and tumor markers were not significantly different between the patients who did or did not have diffusely increased splenic FDG uptake. The significant factors for diffuse splenic F-18 FDG uptake exceeding hepatic F-18 FDG uptake on multivariate analysis included: performing ERCP before F-18 FDG PET-CT (odds ratio [OR], 77.510; 95% CI, 7.624-132.105), and the presence of leukocytosis (OR, 12.436; 95% CI, 2.438-63.445) or anemia (OR, 1.211; 95% CI, 1.051-1.871). In conclusion, our study demonstrated that concurrent inflammation could be associated with diffusely increased splenic FDG uptake. We suggest that performing ERCP before F-18 FDG PET/CT

CT appearance of splenosis

Energy Technology Data Exchange (ETDEWEB)

Mendelson, D.S.; Cohen, B.A.; Armas, R.R.

1982-12-01

Splenosis is an unusual complication of splenic trauma. The computed tomographic (CT) appearance of splenosis is described. One should consider this diagnosis when faced with a history of splenic trauma and multiple round or oval masses at CT.

CT appearance of splenosis

International Nuclear Information System (INIS)

Mendelson, D.S.; Cohen, B.A.; Armas, R.R.

1982-01-01

Splenosis is an unusual complication of splenic trauma. The computed tomographic (CT) appearance of splenosis is described. One should consider this diagnosis when faced with a history of splenic trauma and multiple round or oval masses at CT

Renal versus splenic maximum slope based perfusion CT modelling in patients with portal-hypertension

Energy Technology Data Exchange (ETDEWEB)

Fischer, Michael A. [University Hospital Zurich, Department of Diagnostic and Interventional Radiology, Zurich (Switzerland); Karolinska Institutet, Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden); Brehmer, Katharina [Karolinska University Hospital Huddinge, Department of Radiology, Stockholm (Sweden); Svensson, Anders; Aspelin, Peter; Brismar, Torkel B. [Karolinska Institutet, Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden); Karolinska University Hospital Huddinge, Department of Radiology, Stockholm (Sweden)

2016-11-15

To assess liver perfusion-CT (P-CT) parameters derived from peak-splenic (PSE) versus peak-renal enhancement (PRE) maximum slope-based modelling in different levels of portal-venous hypertension (PVH). Twenty-four patients (16 men; mean age 68 ± 10 years) who underwent dynamic P-CT for detection of hepatocellular carcinoma (HCC) were retrospectively divided into three groups: (1) without PVH (n = 8), (2) with PVH (n = 8), (3) with PVH and thrombosis (n = 8). Time to PSE and PRE and arterial liver perfusion (ALP), portal-venous liver perfusion (PLP) and hepatic perfusion-index (HPI) of the liver and HCC derived from PSE- versus PRE-based modelling were compared between the groups. Time to PSE was significantly longer in PVH groups 2 and 3 (P = 0.02), whereas PRE was similar in groups 1, 2 and 3 (P > 0.05). In group 1, liver and HCC perfusion parameters were similar for PSE- and PRE-based modelling (all P > 0.05), whereas significant differences were seen for PLP and HPI (liver only) in group 2 and ALP in group 3 (all P < 0.05). PSE is delayed in patients with PVH, resulting in a miscalculation of PSE-based P-CT parameters. Maximum slope-based P-CT might be improved by replacing PSE with PRE-modelling, whereas the difference between PSE and PRE might serve as a non-invasive biomarker of PVH. (orig.)

Intrasplenic masses of ``preserved`` functioning splenic tissue in sickle cell disease: correlation of imaging findings (CT, ultrasound, MRI, and nuclear scintigraphy)

Energy Technology Data Exchange (ETDEWEB)

Levin, T.L. [Department of Radiology, Columbia-Presbyterian Medical Center, Babies and Children`s Hospital of New York, 3959 Broadway, BHN 3-318, New York, NY 10032 (United States); Berdon, W.E. [Department of Radiology, Columbia-Presbyterian Medical Center, Babies and Children`s Hospital of New York, 3959 Broadway, BHN 3-318, New York, NY 10032 (United States); Haller, J.O. [Department of Radiology, SUNY Downstate Medical Center, Brooklyn, New York (United States); Ruzal-Shapiro, C. [Department of Radiology, Columbia-Presbyterian Medical Center, Babies and Children`s Hospital of New York, 3959 Broadway, BHN 3-318, New York, NY 10032 (United States); Hurlet-Jenson, A. [Department of Pediatrics, Columbia-Presbyterian Medical Center, Babies and Children`s Hospital of New York, New York (United States)

1996-09-01

Purpose. We studied six patients with sickle cell disease (SSD), five homozygous for sickle cell anemia and one with sickle beta-thalassemia, in whom rounded intrasplenic masses proved to be preserved functioning splenic tissue. Materials and methods. Available images including computed tomography, ultrasonography, bone scans (Tc-99m MDP), liver spleen scans (Tc-99m sulfur colloid), and MRI were evaluated. Results. The masses were low density on CT (in an otherwise calcified spleen), hypoechoic relative to the echogenic spleen on US, and had the imaging characteristics of normal spleen on MRI. They failed to accumulate Tc-99m MDP but did demonstrate uptake of Tc-99m sulfur colloid. Conclusion. In a patient with SSD and intrasplenic masses, proper correlation of multiple imaging modalities will establish the diagnosis of functioning splenic tissue and avoid mistaken diagnosis of splenic abscess or infarction. (orig.). With 2 figs., 1 tab.

Intrasplenic masses of ''preserved'' functioning splenic tissue in sickle cell disease: correlation of imaging findings (CT, ultrasound, MRI, and nuclear scintigraphy)

International Nuclear Information System (INIS)

Levin, T.L.; Berdon, W.E.; Haller, J.O.; Ruzal-Shapiro, C.; Hurlet-Jenson, A.

1996-01-01

Purpose. We studied six patients with sickle cell disease (SSD), five homozygous for sickle cell anemia and one with sickle beta-thalassemia, in whom rounded intrasplenic masses proved to be preserved functioning splenic tissue. Materials and methods. Available images including computed tomography, ultrasonography, bone scans (Tc-99m MDP), liver spleen scans (Tc-99m sulfur colloid), and MRI were evaluated. Results. The masses were low density on CT (in an otherwise calcified spleen), hypoechoic relative to the echogenic spleen on US, and had the imaging characteristics of normal spleen on MRI. They failed to accumulate Tc-99m MDP but did demonstrate uptake of Tc-99m sulfur colloid. Conclusion. In a patient with SSD and intrasplenic masses, proper correlation of multiple imaging modalities will establish the diagnosis of functioning splenic tissue and avoid mistaken diagnosis of splenic abscess or infarction. (orig.). With 2 figs., 1 tab

Splenic Infarct: A Rare Presentation in a Pediatric Patient

Directory of Open Access Journals (Sweden)

Palla Bhattarai

2014-12-01

Full Text Available A previously healthy 16-year-old male presented with a two day history of persistent epigastric pain. His physical examination was significant for tenderness in the left hypochondriac region with a palpable spleen 2cm below the left sub-costal margin. A CT scan of the abdomen showed a splenic infarct. Heterophile and EBV VCA IgM antibody test were positive. This is a rare case of infectious mononucleosis presenting with splenic infarct in an adolescent male without comorbidities. Keywords: infectious mononucleosis; splenic infarct.

Proximal splenic angioembolization does not improve outcomes in treating blunt splenic injuries compared with splenectomy: a cohort analysis.

Science.gov (United States)

Duchesne, Juan C; Simmons, Jon D; Schmieg, Robert E; McSwain, Norman E; Bellows, Charles F

2008-12-01

Although splenic angioembolization (SAE) has been introduced and adopted in many trauma centers, the appropriate selection for and utility of SAE in trauma patients remains under debate. This study examined the outcomes of proximal SAE as part of a management algorithm for adult traumatic splenic injury compared with splenectomy. A retrospective cohort analysis was performed on all hemodynamically stable (HDS) blunt trauma patients with isolated splenic injury and computed tomographic (CT) evidence of active contrast extravasation that presented to a level 1 Trauma Center over a period of 5 years. The cohorts were defined by two separate 30 month periods and included 78 patients seen before (group I) and 76 patients seen after (group II) the introduction of an institutional SAE protocol. Demographics, splenic injury grade, and outcomes of the two groups were compared using Student's t test, or chi2 test. Analysis was by intention-to-treat. Six hundred eighty-two patients with blunt splenic injury were identified; 154 patients (29%) were HDS with CT evidence of active contrast extravasation. Group I (n = 78) was treated with splenectomy and group II (n = 76) was treated with proximal SAE. There was no difference in age (33 +/- 14 vs. 37 +/- 17 years), Injury Severity Score (31 +/- 13 vs. 29 +/- 11), or mortality (18% vs. 15%) between the two groups. However, the incidence of Adult Respiratory Distress Syndrome (ARDS) was 4-fold higher in those patients that underwent proximal SAE compared with those that underwent splenectomy (22% vs. 5%, p = 0.002). Twenty two patients failed nonoperative management (NOM) after SAE. This failure appeared to be directly related to the grade of splenic organ injury (grade I and II: 0%; grade III: 24%; grade IV: 53%; and grade V: 100%). Introduction of proximal SAE in NOM of HDS splenic trauma patients with active extravasation did not alter mortality rates at a Level 1 Trauma Center. Increased incidence of ARDS and association of

The efficacy of transcatheter arterial embolization (TAE) in children with blunt splenic injury

International Nuclear Information System (INIS)

Park, Si Kyun; Kim, Young Ju; Kwon, Taek Sang; Kim, Jong Jin; Ko, Sung Min; Sung, Ki Joon

1998-01-01

The purpose of this study is to evaluate the efficacy of transcatheter arterial embolization (TAE) in children with blunt splenic injury. The results of transcatheter splenic arterial embolization in nine children who suffered splenic injury after blunt abdominal trauma were retrospectively studied. This injury was demonstrated by CT, and the findings were evaluated according to the classification of Mirvis et al.; two patients were grade 3 and seven were grade 4. All were carefully observed in intensive care before embolization. TAE was performed if a patient satisfied the following criteria : (1) transfusion and/or fluid replacement required to maintain hemodynamic stability; or (2) rapid Hb/Hct decrease; or (3) both. Splenic function was subsequently estimated according to the results of 09m Tc-sulfur colloid scintigraphy and/or CT scanning. TAE was successful in all nine children. Two were embolized with a coil only, three with gelfoam, and four with gelfoam and a coil. Seven were embolized in the main trunk of the splenic artery and others in both the main trunk and its branches. Splenic function was preserved in all nine children, during follow-up, none suffered rebleeding. TAE of the splenic artery can be a safe and effective nonsurgical approach to the management of blunt splenic injury in children, and can preserve splenic function. (author). 18 refs., 2 tabs., 3 figs

The efficacy of transcatheter arterial embolization (TAE) in children with blunt splenic injury

Energy Technology Data Exchange (ETDEWEB)

Park, Si Kyun; Kim, Young Ju; Kwon, Taek Sang; Kim, Jong Jin; Ko, Sung Min; Sung, Ki Joon [Yonsei University, Wonju (Korea, Republic of). Wonju Coll. of Medicine

1998-06-01

The purpose of this study is to evaluate the efficacy of transcatheter arterial embolization (TAE) in children with blunt splenic injury. The results of transcatheter splenic arterial embolization in nine children who suffered splenic injury after blunt abdominal trauma were retrospectively studied. This injury was demonstrated by CT, and the findings were evaluated according to the classification of Mirvis et al.; two patients were grade 3 and seven were grade 4. All were carefully observed in intensive care before embolization. TAE was performed if a patient satisfied the following criteria : (1) transfusion and/or fluid replacement required to maintain hemodynamic stability; or (2) rapid Hb/Hct decrease; or (3) both. Splenic function was subsequently estimated according to the results of {sup 09m}Tc-sulfur colloid scintigraphy and/or CT scanning. TAE was successful in all nine children. Two were embolized with a coil only, three with gelfoam, and four with gelfoam and a coil. Seven were embolized in the main trunk of the splenic artery and others in both the main trunk and its branches. Splenic function was preserved in all nine children, during follow-up, none suffered rebleeding. TAE of the splenic artery can be a safe and effective nonsurgical approach to the management of blunt splenic injury in children, and can preserve splenic function. (author). 18 refs., 2 tabs., 3 figs.

The pathologic splenic rupture of a patient with scrub typhus: a case report

International Nuclear Information System (INIS)

Kim, Kum Rae; Park, Won Kyu; Chang, Jay Chun; Cho, Jae Ho; Kim, Jae Woon; Hwang, Mi Soo; Park, Bok Hwan

2008-01-01

A pathologic splenic rupture is rare, occurring primarily in a spleen affected by infective, hematological, and neoplastic disease. To the best of our knowledge, no prior reports of a pathologic splenic rupture due to scrub typhus exist. Intrasplenic pseudoaneurysms and focal infarctions are visible on an initial CT scan. Moreover, the spontaneous splenic rupture occurred a week later. We report a case of nontraumatic-splenic rupture in a patient with scrub typhus

The pathologic splenic rupture of a patient with scrub typhus: a case report

Energy Technology Data Exchange (ETDEWEB)

Kim, Kum Rae; Park, Won Kyu; Chang, Jay Chun; Cho, Jae Ho; Kim, Jae Woon; Hwang, Mi Soo; Park, Bok Hwan [College of Medicine, Yeungnam University, Daegu (Korea, Republic of)

2008-01-15

A pathologic splenic rupture is rare, occurring primarily in a spleen affected by infective, hematological, and neoplastic disease. To the best of our knowledge, no prior reports of a pathologic splenic rupture due to scrub typhus exist. Intrasplenic pseudoaneurysms and focal infarctions are visible on an initial CT scan. Moreover, the spontaneous splenic rupture occurred a week later. We report a case of nontraumatic-splenic rupture in a patient with scrub typhus.

Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol.

Science.gov (United States)

Brillantino, A; Iacobellis, F; Robustelli, U; Villamaina, E; Maglione, F; Colletti, O; De Palma, M; Paladino, F; Noschese, G

2016-10-01

The advantages of the conservative approach for major spleen injuries are still debated. This study was designed to evaluate the safety and effectiveness of NOM in the treatment of minor (grade I-II according with the American Association for the Surgery of Trauma; AAST) and severe (AAST grade III-V) blunt splenic trauma, following a standardized treatment protocol. All the hemodynamically stable patients with computer tomography (CT) diagnosis of blunt splenic trauma underwent NOM, which included strict clinical and laboratory observation, 48-72 h contrast-enhanced ultrasonography (CEUS) follow-up and splenic angioembolization, performed both in patients with admission CT evidence of vascular injuries and in patients with falling hematocrit during observation. 87 patients [32 (36.7 %) women and 55 (63.2 %) men, median age 34 (range 14-68)] were included. Of these, 28 patients (32.1 %) had grade I, 22 patients (25.2 %) grade II, 20 patients (22.9 %) grade III, 11 patients (12.6 %) grade IV and 6 patients (6.8 %) grade V injuries. The overall success rate of NOM was 95.4 % (82/87). There was no significant difference in the success rate between the patients with different splenic injuries grade. Of 24 patients that had undergone angioembolization, 22 (91.6 %) showed high splenic injury grade. The success rate of embolization was 91.6 % (22/24). No major complications were observed. The minor complications (2 pleural effusions, 1 pancreatic fistula and 2 splenic abscesses) were successfully treated by EAUS or CT guided drainage. The non operative management of blunt splenic trauma, according to our protocol, represents a safe and effective treatment for both minor and severe injuries, achieving an overall success rate of 95 %. The angiographic study could be indicated both in patients with CT evidence of vascular injuries and in patients with high-grade splenic injuries, regardless of CT findings.

Use of radionuclide techniques for assessment of splenic function and detection of splenic remnants

International Nuclear Information System (INIS)

Ganguly, S.; Sinha, S.; Sarkar, B.R.; Basu, S.; Ghosh, S.

1998-01-01

Full text: The spleen is often involved in hematological malignancies; it is also the site of RBC destruction in thalassemia and ITP. In latter cases, splenectomy is often performed and postoperatively, detection of functioning splenic remnants affect the prognosis adversely. In this study, we assessed the usefulness of radionuclide techniques in : a) assessment of splenic function in primarily non-splenic diseases (benign or malignant), and b) detection of splenic remnant after splenectomy. 12 patients of splenomegaly and 5 patients after splenectomy underwent splenic imaging; imaging was performed using both 99m Tc-sulphur colloid (with first pass) and 99m Tc labelled heat denatured RBCs as tracers. Thus splenic perfusion, morphology and RBC trapping functions were all assessed. The colloid images usually matched the RBC images except in 2 cases where photogenic areas (presumably infarcts) were visualized on RBC scans that were missed on colloid scans. Three of the post splenectomy cases revealed functioning splenic remnants, which was also better visualized on RBC scans. It is concluded that radionuclide imaging could be used regularly for assessing function of spleen, or detecting splenic remnants

Endovascular treatment of splenic artery aneurysms

International Nuclear Information System (INIS)

Lagana, Domenico; Carrafiello, Gianpaolo; Mangini, Monica; Fontana, Federico; Dizonno, Massimiliano; Fugazzola, Carlo; Castelli, Patrizio

2005-01-01

Purpose. To assess the feasibility and effectiveness of endovascular treatment of splenic artery aneurysm (SAAs). Materials and methods. Between May 2000 and June 2003 we treated 11 true SAAs in 9 patients (7 females and 2 males; mean age 58 years), 8 saccular and 3 fusiform, 4 located at the middle tract of the splenic artery, 5 at the distal tract and 2 intra-parenchymal. The diagnosis was performed with colour-Doppler ultrasound and/or CT-angiography; 7 patients were symptomless, 1 had left hypochondriac pain, and 1 had acute abdomen caused by a ruptured SAA. Four SAAs were treated by micro coil embolisation of the aneurysmal sac with preservation of splenic artery patency; in 2 cases this was associated with transcatheter injection of N-butyl-2-cyanoacrylate. Four cases were treated by endovascular ligature, with sectoral spleen ischaemia. One ruptured SAA received emergency treatment with splenic artery cyanoacrylate embolisation. Two intra-parenchymal SAAs were excluded, one by cyanoacrylate embolisation of the afferent artery and the other by transcatheter thrombin injection in the aneurysmal sac. Results. Technical success was observed in all cases (in 10/11 at the end of the procedure; in 1/11 at CT performed 3 days after the procedure). The follow-up (mean 18 months; range 6-36) was performed by colour-Doppler ultrasound and/or CT-angiography 3, 6 and 12 months after the procedure and subsequently once a year; the complete exclusion of the aneurysms was confirmed in 11/11 cases. The complications were: 4 cases of mild pleuritis; fever and left hypochondriac pain 1 day after the procedure (in the same 4 patients and in one other case); 5 cases of sectorial spleen ischaemia and 1 case of diffuse spleen infarction with partial revascularization by collateral vessels. No alteration of the levels of pancreatic enzymes was found; a transitory increase in platelet count occurred only in the patient with diffuse spleen infarction. Conclusions. Using different

Difficult preoperative diagnosis of a patient with sclerosing splenic hemangioma

International Nuclear Information System (INIS)

Edoute, Y.; Ben-Haim, S.A.; Ben-Arie, Y.; Fishman, A.; Barzilai, D.

1989-01-01

We present a young asymptomatic woman with splenomegaly and a large isolated splenic mass demonstrated by ultrasonography, 99m Tc sulfur colloid, and gallium scintigraphy studies. Computerized tomography (CT) and three-phase 99mTc-labeled red blood cell imaging suggested a malignant lesion. Repeated sonographically guided fine needle aspiration (FNA) obtained only blood, suggesting the possible vascular nature of the tumor. Splenectomy established the diagnosis of splenic hemangioma (SH) with marked sclerotic changes. We conclude from this case that (1) the sclerotic and cystic changes in the SH and the abdominal lymphadenopathy could explain why the three-phase red blood cell and CT scanning, respectively, suggested that the lesion was malignant rather than benign; (2) guided FNA of a splenic mass suspected to be hemangioma may be an additional safe and useful diagnostic procedure. Multiple aspirations yielding blood alone suggest hemangioma and may prevent an unnecessary operation. To the best of our knowledge, this is the first reported case in the literature of FNA of splenic hemangioma

Computed tomographic findings of splenic injury and correlation with treatment

International Nuclear Information System (INIS)

Kim, Dong Jin; Koh, Joo Yaul; Kim, Myung Soon; Hong, In Soo; Cho, Whi Youl; Sung, Ki Joon

1990-01-01

According to recently reported classification, 46 patients with blunt splenic trauma were evaluate preoperatively with computed tomography(CT). Injures were graded I through IV and describe as capsular or subcapsular disruptions without parenchymal injury(3 patients); capsular and parenchymal injuries(23 patients); injuries involving hilum(3 patients); and fragmentation(17 patients). Nineteen patients were managed conservatively and 27 patients were managed surgically. Twelve patients(47%) out of those with Type I or Type II were managed surgically including five hemodynamically unstable patients and seven hemodynamically stable patients with associated injuries and unknown surgical criteria. On the other hand hemodynamically stable patients(25%) out of those with Type III or Type IV were managed surgically. The amount of hemoperitoneum was graded into small, moderate and large; small in three patients, moderate in 39 patients, and large in two patients. The amount of hemoperitoneum in patients with conservative treatment was moderate in 16 patients and large in one patient. And the amount of hemoperitoneum in patients with operative treatment was small in three patients, moderate in 23 patients and large in one patient. We concluded that CT was accurate method of determining the extent of splenic injury and evaluation of hemoperitoneum, but treatment choice should be based on the hemodynamic status of patients rather than the type of injury or the amount of hemoperitoneum by CT

Computed tomographic findings of splenic injury and correlation with treatment

Energy Technology Data Exchange (ETDEWEB)

Kim, Dong Jin; Koh, Joo Yaul; Kim, Myung Soon; Hong, In Soo; Cho, Whi Youl; Sung, Ki Joon [Yonsei University Wonju College of Medicine, Wonju (Korea, Republic of)

1990-12-15

According to recently reported classification, 46 patients with blunt splenic trauma were evaluate preoperatively with computed tomography(CT). Injures were graded I through IV and describe as capsular or subcapsular disruptions without parenchymal injury(3 patients); capsular and parenchymal injuries(23 patients); injuries involving hilum(3 patients); and fragmentation(17 patients). Nineteen patients were managed conservatively and 27 patients were managed surgically. Twelve patients(47%) out of those with Type I or Type II were managed surgically including five hemodynamically unstable patients and seven hemodynamically stable patients with associated injuries and unknown surgical criteria. On the other hand hemodynamically stable patients(25%) out of those with Type III or Type IV were managed surgically. The amount of hemoperitoneum was graded into small, moderate and large; small in three patients, moderate in 39 patients, and large in two patients. The amount of hemoperitoneum in patients with conservative treatment was moderate in 16 patients and large in one patient. And the amount of hemoperitoneum in patients with operative treatment was small in three patients, moderate in 23 patients and large in one patient. We concluded that CT was accurate method of determining the extent of splenic injury and evaluation of hemoperitoneum, but treatment choice should be based on the hemodynamic status of patients rather than the type of injury or the amount of hemoperitoneum by CT.

Splenic flexure volvulus presenting with gangrene

International Nuclear Information System (INIS)

Machado, Norman O; Chopra, Pradeep J; Subramanian, Sureshkannan K

2009-01-01

Volvulus of the splenic flexure is very rare cause of colonic obstruction constituting 2% of cases of colonic segmental volvulus. Primary splenic flexure volvulus (SFV) is due to congenital absence or laxity of the phrenocolic, gastro colic, and splenocolic ligaments while secondary volvulus is due to other causes including some prior surgery releasing these ligaments. A preoperative diagnosis can be established based on the characteristic radiological findings on plain x-ray abdomen and CT scan. We present a case of SFV in a young man who presented with acute abdominal pain, and distension, and illustrate the usefulness of CT scan, and plain x-ray of the abdomen in making a preoperative diagnosis. Laparotomy revealed a gangrenous SFV, which was resected and primary anastomosis was carried out. Literature is reviewed with regards to predisposing factors, presentation, investigation, and management among the more than 32 cases reported so far. (author)

Management of splenic and pancreatic trauma.

Science.gov (United States)

Girard, E; Abba, J; Cristiano, N; Siebert, M; Barbois, S; Létoublon, C; Arvieux, C

2016-08-01

The spleen and pancreas are at risk for injury during abdominal trauma. The spleen is more commonly injured because of its fragile structure and its position immediately beneath the ribs. Injury to the more deeply placed pancreas is classically characterized by discordance between the severity of pancreatic injury and its initial clinical expression. For the patient who presents with hemorrhagic shock and ultrasound evidence of major hemoperitoneum, urgent "damage control" laparotomy is essential; if splenic injury is the cause, prompt "hemostatic" splenectomy should be performed. Direct pancreatic injury is rarely the cause of major hemorrhage unless a major neighboring vessel is injured, but if there is destruction of the pancreatic head, a two-stage pancreatoduodenectomy (PD) may be indicated. At open laparotomy when the patient's hemodynamic status can be stabilized, it may be possible to control splenic bleeding without splenectomy; it is always essential to search for injury to the pancreatic duct and/or the adjacent duodenum. Pancreatic contusion without ductal rupture is usually treated by drain placement adjacent to the injury; ductal injuries of the pancreatic body or tail are treated by resection (distal pancreatectomy with or without splenectomy), with generally benign consequences. For injuries of the pancreatic head with pancreatic duct disruption, wide drainage is usually performed because emergency PD is a complex gesture prone to poor results. Postoperatively, the placement of a ductal stent by endoscopic retrograde catheterization may be decided, while management of an isolated pancreatic fistula is often straightforward. Non-operative management is the rule for the trauma victim who is hemodynamically stable. In addition to the clinical examination and conventional laboratory tests, investigations should include an abdominothoracic CT scan with contrast injection, allowing identification of all traumatized organs and assessment of the severity of

Multidetector CT findings of splenic artery aneurysm in children with chronic liver disease

International Nuclear Information System (INIS)

Ulu, Esra Meltem Kayahan; Kirbas, Ismail; Emiroglu, Feride Kural; Cakir, Banu; Harman, Ali; Coskun, Mehmet; Bakar, Coskun

2008-01-01

Splenic artery aneurysm (SAA) is a well-known complication of chronic liver disease and portal hypertension in adults. The incidence of SAA in children undergoing selective hepatic angiography prior to liver transplantation is reported as 4%, but there are few systematic studies. To investigate the SAAs detected by multidetector CT angiography (MDCTA) among children with chronic liver disease. A total of 124 children (71 girls, 53 boys; mean age 118 months; age range 5 days to 204 months) with chronic liver disease underwent MDCTA to display the vascular anatomy and any vascular complications during the pretransplantation period. Of these children, 23 also underwent coeliac angiography. The digital subtraction angiography (DSA) and MDCTA findings were compared. SAAs were detected in 13 children (10.4%); none was detectable by US. All patients had more than one aneurysm; ten patients had more than three. In all except one patient, the SAAs were located only in the intraparenchymal branches of the splenic artery; in one patient they were located in the intraparenchymal segment and in the distal third of the splenic artery. The mean size of the aneurysms was 6.5 mm (range 2.5-18 mm). All patients with aneurysms had splenomegaly and vascular collaterals. Nine of the children with SAAs had portal vein pathologies (two occlusions, two stenoses, five dilatations). A statistically significant difference existed with regard to the size of spleen (P < 0.05) and patient age (P < 0.05) between children with SAAs and children without SAAs. There was an increased risk of SAAs in patients with portal vein pathologies. In 19 patients without SAAs on MDCTA, no SAAs were seen on DSA. It is likely that the incidence of SAA in children with chronic liver disease will increase with improved survival of children with long-standing portal hypertension and chronic liver disease. MDCTA with multiplanar reconstruction is a noninvasive and effective means of imaging paediatric patients with

Multidetector CT findings of splenic artery aneurysm in children with chronic liver disease

Energy Technology Data Exchange (ETDEWEB)

Ulu, Esra Meltem Kayahan; Kirbas, Ismail; Emiroglu, Feride Kural; Cakir, Banu; Harman, Ali; Coskun, Mehmet [Baskent University Faculty of Medicine, Department of Radiology, Ankara (Turkey); Bakar, Coskun [Baskent University Faculty of Medicine, Department of Public Health, Ankara (Turkey)

2008-10-15

Splenic artery aneurysm (SAA) is a well-known complication of chronic liver disease and portal hypertension in adults. The incidence of SAA in children undergoing selective hepatic angiography prior to liver transplantation is reported as 4%, but there are few systematic studies. To investigate the SAAs detected by multidetector CT angiography (MDCTA) among children with chronic liver disease. A total of 124 children (71 girls, 53 boys; mean age 118 months; age range 5 days to 204 months) with chronic liver disease underwent MDCTA to display the vascular anatomy and any vascular complications during the pretransplantation period. Of these children, 23 also underwent coeliac angiography. The digital subtraction angiography (DSA) and MDCTA findings were compared. SAAs were detected in 13 children (10.4%); none was detectable by US. All patients had more than one aneurysm; ten patients had more than three. In all except one patient, the SAAs were located only in the intraparenchymal branches of the splenic artery; in one patient they were located in the intraparenchymal segment and in the distal third of the splenic artery. The mean size of the aneurysms was 6.5 mm (range 2.5-18 mm). All patients with aneurysms had splenomegaly and vascular collaterals. Nine of the children with SAAs had portal vein pathologies (two occlusions, two stenoses, five dilatations). A statistically significant difference existed with regard to the size of spleen (P < 0.05) and patient age (P < 0.05) between children with SAAs and children without SAAs. There was an increased risk of SAAs in patients with portal vein pathologies. In 19 patients without SAAs on MDCTA, no SAAs were seen on DSA. It is likely that the incidence of SAA in children with chronic liver disease will increase with improved survival of children with long-standing portal hypertension and chronic liver disease. MDCTA with multiplanar reconstruction is a noninvasive and effective means of imaging paediatric patients with

The application of 18F-FDG PET/CT for exploring the metastatic carcinoma of spleen

International Nuclear Information System (INIS)

Yu Dangfan; Guan Yihui; Zhao Jun; Zuo Chuantao; Lin Xiangtong; Dai Jiazhong

2005-01-01

Objective: To investigate the value of 18 F-fluorodeoxyglucose PET/CT for diagnosing the metastatic carcinoma of spleen. Methods: Retrospectively reviewed all the 8 cases with splenic metastases diagnosed by PET/CT, and compared the diagnostic result of PET/CT with that of CT alone, that of PET alone, that of B-ultrasonic scan and that of clinical information, all the diagnoses were refered to the confirmation by the clinical findings during follow-up. Results: All the 8 cases of splenic metastases diagnosed by PET/CT were proved by follow-up. PET revealed 6, CT revealed 4 and B-ultrasonic scan only 1. PET/CT did not miss either of the 2 splenic metastases had been diagnosed before PET/CT. Conclusions: PET/CT determined the location of the splenic metastases better than CT alone or PET alone did. PET/CT could increase the detection rate of splenic metastases. (authors)

[Splenic infarction].

Science.gov (United States)

Cuquerella, J; Ferrer, L; Rivera, P; Tuset, J A; Medina, E; Pamós, S; Ariete, V; Tomé, A; García, V

1996-06-01

A 53-year-old male suffered splenic infarction etiologically related to atrial fibrillation and non-obstructive hypertrophic cardiomyopathy. The main clinical manifestations were a one-month history of epigastric and left upper quadrant pain, with tenderness to palpation in the later zone. Laboratory tests revealed a slight leucocytosis (14.700) with left shift and a marked increase in LDH concentration (945 IU). Abdominal CAT and arteriography established the diagnosis, Echography proved normal. Patient evolution was satisfactory with conservative medical treatment. We conclude that splenic infarction should be considered in all cases of acute or chronic pain in the left hypochondrium. The diagnosis is established by CAT, arteriography and hepatosplenic gammagraphy. Medical management is initially advocated, surgery being reserved for those cases involving complications or in which diagnosis is not clear. Emphasis is placed on the main etiological, clinical, diagnostic and management characteristics of splenic infarction.

CT-based injury classification

International Nuclear Information System (INIS)

Mirvis, S.E.; Whitley, N.O.; Vainright, J.; Gens, D.

1988-01-01

Review of preoperative abdominal CT scans obtained in adults after blunt trauma during a 2.5-year period demonstrated isolated or predominant liver injury in 35 patients and splenic injury in 33 patients. CT-based injury scores, consisting of five levels of hepatic injury and four levels of splenic injury, were correlated with clinical outcome and surgical findings. Hepatic injury grades I-III, present in 33 of 35 patients, were associated with successful nonsurgical management in 27 (82%) or with findings at celiotomy not requiring surgical intervention in four (12%). Higher grades of splenic injury generally required early operative intervention, but eight (36%) of 22 patients with initial grade III or IV injury were managed without surgery, while four (36%) of 11 patients with grade I or II injury required delayed celiotomy and splenectomy (three patients) or emergent rehospitalization (one patient). CT-based injury classification is useful in guiding the nonoperative management of blunt hepatic injury in hemodynamically stable adults but appears to be less reliable in predicting the outcome of blunt splenic injury

Mixed reality for robotic treatment of a splenic artery aneurysm.

Science.gov (United States)

Pietrabissa, Andrea; Morelli, Luca; Ferrari, Mauro; Peri, Andrea; Ferrari, Vincenzo; Moglia, Andrea; Pugliese, Luigi; Guarracino, Fabio; Mosca, Franco

2010-05-01

Techniques of mixed reality can successfully be used in preoperative planning of laparoscopic and robotic procedures and to guide surgical dissection and enhance its accuracy. A computer-generated three-dimensional (3D) model of the vascular anatomy of the spleen was obtained from the computed tomography (CT) dataset of a patient with a 3-cm splenic artery aneurysm. Using an environmental infrared localizer and a stereoscopic helmet, the surgeon can see the patient's anatomy in transparency (augmented or mixed reality). This arrangement simplifies correct positioning of trocars and locates surgical dissection directly on top of the aneurysm. In this way the surgeon limits unnecessary dissection, leaving intact the blood supply from the short gastric vessels and other collaterals. Based on preoperative planning, we were able to anticipate that the vascular exclusion of the aneurysm would result in partial splenic ischemia. To re-establish the flow to the spleen, end-to-end robotic anastomosis of the splenic artery with the Da Vinci surgical system was then performed. Finally, the aneurysm was fenestrated to exclude arterial refilling. The postoperative course was uneventful. A control CT scan 4 weeks after surgery showed a well-perfused and homogeneous splenic parenchyma. The final 3D model showed the fenestrated calcified aneurysm and patency of the re-anastomosed splenic artery. The described technique of robotic vascular exclusion of a splenic artery aneurysm, followed by re-anastomosis of the vessel, clearly demonstrates how this technology can reduce the invasiveness of the procedure, obviating an otherwise necessary splenectomy. Also, the use of intraoperative mixed-reality technology proved very useful in this case and is expected to play an increasing role in the operating room of the future.

Synchronic volvulus of splenic flexure and caecum: a very rare cause of large bowel obstruction.

Science.gov (United States)

Islam, Shariful; Hosein, Devin; Harnarayan, Patrick; Naraynsingh, Vijay

2016-01-18

Colonic volvulus involving the caecum and splenic flexure of the colon is an extremely rare surgical entity and, as a result, it is rarely entertained as a differential diagnosis for large bowel obstruction. The most common site of volvulus is located at the sigmoid colon (75%) followed by caecum (22%). Rare sites of colonic volvulus include the transverse colon (about 2%) and splenic flexure (1-2%). Synchronous double colonic volvulus is very rare. The presentation of this condition can be similar to the signs and symptoms of large bowel obstruction. CT imaging of the abdomen can be diagnostic; however, the diagnosis is often missed due to the rarity of this condition--in such cases, it can only be made at laparotomy. Management of this condition should be expedited to prevent a fatal outcome. We present the case of a 56-year-old woman with synchronous volvulus of the caecum and splenic flexure of the colon. 2016 BMJ Publishing Group Ltd.

CT of hemodynamically unstable abdominal trauma

International Nuclear Information System (INIS)

Petridis, A.; Pilavaki, M.; Vafiadis, E.; Palladas, P.; Finitsis, S.; Drevelegas, A.

1999-01-01

This article is an appraisal of the use of CT in the management of patients with unstable abdominal trauma. We examined 41 patients with abdominal trauma using noncontrast dynamic CT. In 17 patients a postcontrast dynamic CT was also carried out. On CT, 25 patients had hemoperitoneum. Thirteen patients had splenic, 12 hepatic, 6 pancreatic, 8 bowel and mesenteric, 12 renal and 2 vascular injuries. Seven patients had retroperitoneal and 2 patients adrenal hematomas. All but five lesions (three renal, one pancreatic, and one splenic) were hypodense when CT was performed earlier than 8 h following the injury. Postcontrast studies (n = 17), revealed 4 splenic, 3 hepatic, 1 pancreatic, 3 renal, and 2 bowel and mesenteric injuries beyond what was found on noncontrast CT. Surgical confirmation (n = 21) was obtained in 81.81 % of splenic, 66.66 % of hepatic, 83.33 % of pancreatic, 100 % of renal, 100 % of retroperitoneal, and 85.71 % of bowel and mesenteric injuries. The majority of false diagnoses was obtained with noncontrast studies. Computed tomography is a remarkable method for evaluation and management of patients with hemodynamically unstable abdominal trauma, but only if it is revealed in the emergency room. Contrast injection, when it could be done, revealed lesions that were not suspected on initial plain scans. (orig.)

Primary Germ Cell Tumor of Testes with Extensive Lymph Nodal and Splenic Metastases Masquerading Lymphoma on 18-F-FDG PET/CT

Science.gov (United States)

Tripathy, Sarthak; Mukherjee, Anirban; Bal, Chandrasekhar; Tripathi, Madhavi; Mallick, Saumyaranjan; Shamim, Shamim Ahmed

2017-01-01

Germ cell tumors (GCT) account for the 95% of the malignancies associated with testes. They are the most common solid malignancies affecting the males in the age group of 15–35 years. It is known to be bilateral in 3% of cases. We herein present FDG PET-CT findings of a case with biopsy proven GCT with multiple lymph nodal and splenic metastases mimicking lymphomatous neoplasm. PMID:28533651

CT and MR imaging of splenic leiomyoma in a child with ataxia telangiectasia

Energy Technology Data Exchange (ETDEWEB)

Coskun, M. [Dept. of Radiology, Hacettepe University Hospital, Ankara (Turkey); Aydingoez, Ue. [Dept. of Radiology, Hacettepe University Hospital, Ankara (Turkey); Tacal, T. [Dept. of Radiology, Hacettepe University Hospital, Ankara (Turkey); Ariyuerek, M. [Dept. of Radiology, Hacettepe University Hospital, Ankara (Turkey); Demirkazik, F. [Dept. of Radiology, Hacettepe University Hospital, Ankara (Turkey); Oguzkurt, L. [Dept. of Radiology, Hacettepe University Hospital, Ankara (Turkey)

1995-02-01

Computed tomographic and magnetic resonance imaging findings of a splenic leiomyoma in an 8-year-old boy with ataxia telangiectasia are presented. This is the first reported case of a splenic leiomyoma in the literature. (orig.)

CT and MR imaging of splenic leiomyoma in a child with ataxia telangiectasia

International Nuclear Information System (INIS)

Coskun, M.; Aydingoez, Ue.; Tacal, T.; Ariyuerek, M.; Demirkazik, F.; Oguzkurt, L.

1995-01-01

Computed tomographic and magnetic resonance imaging findings of a splenic leiomyoma in an 8-year-old boy with ataxia telangiectasia are presented. This is the first reported case of a splenic leiomyoma in the literature. (orig.)

Non-operative management of adult blunt splenic injuries

Institute of Scientific and Technical Information of China (English)

YANG Jun; GAO Jin-mou; Jean-Claude Baste

2006-01-01

Objective: To investigate the indication of nonoperative management of adult blunt splenic injuries.Methods: A retrospective review was performed on all adult patients (age ＞ 15 years ) with blunt splenic injuries admitted to the department of vascular surgery of Pellegrin hospital in France from 1999 to 2003. We managed splenic injuries non-operatively in all appropriate patients without regard to age.Results: During the 4 years, 54 consecutive adult patients with blunt splenic injuries were treated in the hospital. A total of 27 patients with stable hemodynamic status were treated non-operatively at first, of which 2 patients were failed to non-operative treatment. The successful percentage of non-operative management was 92.6 %. In the 54 patients, 7 of 8 patients older than 55 years were treated with non-operative management. Two cases developing postoperatively subphrenic infection were healed by proper treatment. In the series, there was no death.Conclusions: Non-operative management of low-grade splenic injuries can be accomplished with an acceptable low-failure rate. If the clinical and laboratory parameters difficult for surgeons to make decisions, they can depend on Resciniti' s CT (computed tomography)scoring system to select a subset of adults with splenic trauma who are excellent candidates for a trial of nonoperative management. The patients older than 55 years are not absolutely inhibited to receive non-operative management.

CT of hemodynamically unstable abdominal trauma

Energy Technology Data Exchange (ETDEWEB)

Petridis, A.; Pilavaki, M.; Vafiadis, E.; Palladas, P.; Finitsis, S.; Drevelegas, A. [Department of Radiology, General Hospital ``G. Papanikolaou,`` Thessaloniki (Greece)

1999-03-01

This article is an appraisal of the use of CT in the management of patients with unstable abdominal trauma. We examined 41 patients with abdominal trauma using noncontrast dynamic CT. In 17 patients a postcontrast dynamic CT was also carried out. On CT, 25 patients had hemoperitoneum. Thirteen patients had splenic, 12 hepatic, 6 pancreatic, 8 bowel and mesenteric, 12 renal and 2 vascular injuries. Seven patients had retroperitoneal and 2 patients adrenal hematomas. All but five lesions (three renal, one pancreatic, and one splenic) were hypodense when CT was performed earlier than 8 h following the injury. Postcontrast studies (n = 17), revealed 4 splenic, 3 hepatic, 1 pancreatic, 3 renal, and 2 bowel and mesenteric injuries beyond what was found on noncontrast CT. Surgical confirmation (n = 21) was obtained in 81.81 % of splenic, 66.66 % of hepatic, 83.33 % of pancreatic, 100 % of renal, 100 % of retroperitoneal, and 85.71 % of bowel and mesenteric injuries. The majority of false diagnoses was obtained with noncontrast studies. Computed tomography is a remarkable method for evaluation and management of patients with hemodynamically unstable abdominal trauma, but only if it is revealed in the emergency room. Contrast injection, when it could be done, revealed lesions that were not suspected on initial plain scans. (orig.) With 6 figs., 5 tabs., 20 refs.

Radiologic viewpoint of splenic abscess

International Nuclear Information System (INIS)

Chang, Jae Chun; Jung, Kyung Hwa; Byun, Woo Mok; Kim, Sun Yong; Hwang, Mi Soo; Park, Bok Hwan

1988-01-01

Splenic abscess is not a common disease, and has been infrequently diagnosed during life because of vague symptom and presence of underlying disease. However, advent of newer diagnostic imaging and interventional technology have augmented our ability to diagnose and treat the abscess. Authors experienced eight cases of splenic abscess, which were confirmed by operation or aspiration and, herein, we describe the radiological viewpoint and clinical course. Summary is follows: 1. Radiological finding was well defined, noncontrast enhancing wedge or lentiform lower density lesion, either single or multiple, focal or massive, parenchymal or subcapsular in location. Prognosis was favorable in focal parenchymal lesion after medical treatment. 2. Pancreatitis is the most common combined disease and this made the localization delay. 3. High incidence of sterile culture suggests possibility of anaerobic of fungal infection. 4. Hypoechoic lesion suggesting splenic abscess should be aspirated under the guidance of ultrasound and The aspirate should be cultured including anaerobic and fungus. C.T. scan should be done for better evaluation of the lesion. 5. According to pathology, organism and loculation pattern, various treatment modalities can be considered rather than routine splenectomy.

Massive splenic infarction in Saudi patients with sickle cell anemia: a unique manifestation.

Science.gov (United States)

Jama, Ali Hassan Al; Salem, Ahmed Hassan Al; Dabbous, Ibrahim Abdalla Al

2002-03-01

Splenic infarcts are common in patients with sickle cell anemia (SCA), but these are usually small and repetitive, leading ultimately to autosplenectomy. Massive splenic infarcts on the other hand are extremely rare. This is a report of our experience with 8 (4 males and 4 females) cases of massive splenic infarction in patients with SCA. Their ages ranged from 16 to 36 years (mean 22 years). Three presented with left upper quadrant abdominal pain and massive splenic infarction on admission, while the other 5 developed massive splenic infarction while in hospital. In 5 the precipitating factors were high altitude, postoperative, postpartum, salmonella septicemia, and strenuous exercise in one each, while the remaining 3 had severe generalized vasoocclusive crises. Although both ultrasound and CT scan of the abdomen were of diagnostic value, we found CT scan more accurate in delineating the size of infarction. All our patients were managed conservatively with I.V. fluids, analgesia, and blood transfusion when necessary. Diagnostic aspiration under ultrasound guidance was necessary in two patients to differentiate between massive splenic infarction and splenic abscess. Two patients required splenectomy during the same admission because of suspicion of secondary infection and abscess formation, while a third patient had splenectomy 2 months after the attack because of persistent left upper quadrant abdominal pain. In all the 3 histology of the spleen showed congestive splenomegaly with massive infarction. All of our patients survived. Two patients subsequently developed autosplenectomy while the remaining 3 continue to have persistent but asymptomatic splenomegaly. Massive splenic infarction is a rare and unique complication of SCA in the Eastern Province of Saudi Arabia, and for early diagnosis and treatment, physicians caring for these patients should be aware of such a complication.

Initial thoracic involvement in lymphoma. CT assessment

International Nuclear Information System (INIS)

Bustos, A.; Corredoira, J.; Ferreiros, J.; Cabeza, B.; Jorquera, M.; Pedrosa, I.; Martinez, R.; Fernandez, C.

2002-01-01

To analyze the initial thoracic involvement by CT in a consecutive series of patients with lymphoma. A retrospective analysis was made of thoracic CT studies made at the time of diagnosis of 259 patients with lymphoma. Mediastinal pulmonary, pleural, pericardial and chest wall involvement was assessed by CT. Of 259 patients (129 men y 130 women), 56 had Hodgkin's disease (HD) and 203 had non-Hodgkin lymphoma (NHL). Forty-two percent (42.5%, 110/259) of the patients had chest involvement on CT: 33 of 56 patients with HD (58.9%) and 77 of 203 patients with NHL (37.9%). All the patients with thoracic HD) and 71.4% of patients with thoracic NHL, had mediastinal lymph node involvement. of the patients with thoracic involvement 12.1% (4/33) of the patient with HD and 23.3% (18/77) of the patients with NHL had pulmonary involvement. Thoracic involvement on CT was more frequent in HD. Mediastinal lymph node involvement was the most common finding fundamentally in HD. Pulmonary disease always occurred in the presence of mediastinal lymph node involvement in HD but could occur as an isolated finding in NHL. (Author) 24 refs

Juvenile colon cancer at the splenic flexure with a splenic abscess developing 22 years after irradiation for a neuroblastoma

International Nuclear Information System (INIS)

Tamura, Toshihisa; Higure, Aiichiro; Akiyama, Masaki; Nagata, Naoki; Hirata, Keiji; Yamaguchi, Koji

2010-01-01

A 23-year-old woman who had an operation and chemo-radiation therapy for a neuroblastoma of the left adrenal gland at the age of five months developed a fever and left hypochondralgia when she was 22 years old. A splenic abscess was noted. Percutaneous drainage was done, but the splenic abscess recurred. There was no recurrence of the neuroblastoma. Conservative therapy was unsuccessful and a laparotomy was performed. Operative findings included a bulky mass at the splenic flexure which involved the spleen, pancreas tail, and jejunum. Colectomy at the splenic flexure was performed with coresection of the spleen, pancreas tail, and jejunum. The surgical specimen showed mucinous carcinoma of the splenic flexure which invaded the spleen. This case was considered to be an radiation-induced secondary colon cancer. (author)

Non-operative management of blunt splenic injuries in a paediatric population: a 12-year experience.

Science.gov (United States)

Kirkegård, Jakob; Avlund, Tue Højslev; Amanavicius, Nerijus; Mortensen, Frank Viborg; Kissmeyer-Nielsen, Peter

2015-02-01

Non-operative management (NOM) is now the primary treatment for blunt splenic injuries in children. Only one study has examined the use of NOM in a Scandinavian population. Thus, the purpose of this study is to report our experience in treating children with blunt splenic injuries with NOM at a Danish university hospital. We conducted a retrospective observational study of 34 consecutive children (aged 16 years or less) admitted to our level 1-trauma centre with blunt splenic injury in the 12-year period from 1 January 2001 to 31 December 2012. Data on patients and procedures were obtained by review of all medical records and re-evaluation of all initial computed tomographies (CT). We included 34 children with a median age of 10.5 years (67.6% males) in this study. All patients were scheduled for NOM, and two (5.9%) patients underwent splenic artery embolisation (SAE). Two (5.9%) patients later needed surgical intervention. The NOM success rate was 88% (95% confidence interval (CI): 73-97%) without SAE and 94% (95% CI: 80-99%) with SAE. We found no difference in the American Association for the Surgery of Trauma grade when comparing the initial CT evaluation (mean 2.59 ± 1.1) with the CT re-evaluation (mean 2.71 ± 0.94); p = 0.226. We demonstrated a high degree of success and safety of non-operative treatment in children with blunt splenic injury in a Scandinavian setting. Our results are comparable to international findings.

SOLITARY SPLENIC METASTASIS OF COLON CANCER: A CASE REPORT

Directory of Open Access Journals (Sweden)

Sh. Hashemzadeh M. Safari

2004-11-01

Full Text Available Although splenic metastasis is fairly common in disseminated cancer, solitary splenic metastasis in the absence of diffuse dissemination is rare. We report a case of 44 year-old man who developed isolated splenic metastasis of colon cancer. The patient had undergone right sided hemicolectomy for colon cancer in 1988. In 2001, he underwent reoperation because of local recurrence of tumor in the anastomotic site. The patient was admitted to our hospital on Sep 2003 with abdominal pain. Chest X-ray was normal. Abdominal CT scan showed a large cystic lesion in the spleen. Splenectomy was performed for the patient. The spleen was enlarged, firm and irregular. Histological examination showed metastatic mucinous adenocarcinoma. Based on this case, we recommend that clinicians consider possibility of metastasis in cystic lesions of spleen, especially in patients with a history of a malignant disease.

A Case of a Chronic Pancreatic Pseudocyst Causing Atraumatic Splenic Rupture without Evidence of Acute Pancreatitis

Directory of Open Access Journals (Sweden)

P. Moori

2016-01-01

Full Text Available Atraumatic splenic rupture is a rare complication of a pancreatic pseudocyst (PP, described in the setting of chronic pancreatitis. There is common understanding, within the literature, that an inflammatory process at the tail of the pancreas may disrupt the spleen and result in such splenic complications. The authors present a case report of a 29-year-old male with a PP, associated with chronic pancreatitis. The patient had a history of excessive alcohol intake and presented to the emergency department with a short history of abdominal pain and vomiting. He denied any significant history of trauma and serum amylase levels were normal. An admission computed tomography (CT scan of the abdomen confirmed the presence of a PP in direct contact with the spleen. The CT also demonstrated a heterogenous hypodense area of the splenic hilum, along with perisplenic fluid. The patient was admitted for observation. His abdominal pain progressed, and he became haemodynamically unstable. An emergency ultrasound scan (USS at this time revealed intra-abdominal haemorrhage. A subsequent CT confirmed splenic rupture, which was managed surgically with a full recovery. Few such cases are documented within the literature and more understanding of preempting such events is needed.

CT findings in children with blunt trauma in the spleen

International Nuclear Information System (INIS)

Nishiguchi, Hiroyasu; Shimizu, Toshihisa; Ohmura, Makoto; Kawai, Naoki; Tauchi, Hayato; Hayakawa, Masao; Nishio, Yoshinori; Watanabe, Shinsuke.

1991-01-01

We evaluated CT findings in 19 children with blunt injuries in the spleen. CT demonstrated laceration of the spleen in 7 children, rupture of the spleen in 7, and splenic hematoma in 5. Leakage of the contrast medium was observed in 3 children, of whom 1 was treated by arterial embolization. Laparotomy was performed in 3 children (15.8%) other than the 3 showing contrast medium leakage; hemostasis by compression was performed in 1 with laceration, and splenectomy in 2 with rupture. Late splenic rupture or abscess did not occur in any child. One child (5.3%) died of complicating injuries. Many of children with blunt splenic injuries can be successfully treated with conservative treatment, and CT scanning is useful for evaluating the degree of splenic injuries and complicating injuries. (author)

CT findings in children with blunt trauma in the spleen

Energy Technology Data Exchange (ETDEWEB)

Nishiguchi, Hiroyasu; Shimizu, Toshihisa; Ohmura, Makoto; Kawai, Naoki; Tauchi, Hayato; Hayakawa, Masao; Nishio, Yoshinori (Kyoto Second Red Cross Hospital (Japan)); Watanabe, Shinsuke

1991-09-01

We evaluated CT findings in 19 children with blunt injuries in the spleen. CT demonstrated laceration of the spleen in 7 children, rupture of the spleen in 7, and splenic hematoma in 5. Leakage of the contrast medium was observed in 3 children, of whom 1 was treated by arterial embolization. Laparotomy was performed in 3 children (15.8%) other than the 3 showing contrast medium leakage; hemostasis by compression was performed in 1 with laceration, and splenectomy in 2 with rupture. Late splenic rupture or abscess did not occur in any child. One child (5.3%) died of complicating injuries. Many of children with blunt splenic injuries can be successfully treated with conservative treatment, and CT scanning is useful for evaluating the degree of splenic injuries and complicating injuries. (author).

Role of multidetector abdominal CT in the evaluation of abnormalities in polyarteritis nodosa

International Nuclear Information System (INIS)

Singhal, M.; Gupta, P.; Sharma, A.; Lal, A.; Rathi, M.; Khandelwal, N.

2016-01-01

Aim: To identify arterial and end-organ abnormalities on abdominal computed tomography (CT) in patients with polyarteritis nodosa (PAN). Materials and methods: A prospective study comprising 27 consecutive patients with PAN was conducted from 2007 to 2013. Departmental ethics committee approval was obtained. All patients underwent contrast-enhanced CT comprising an arterial and a portal venous phase. Images were assessed for arterial irregularity, aneurysms, stenosis, and occlusion. End-organ changes, including infarcts, haematoma, and bowel involvement, were also recorded. Results: A positive CT was recorded in 15 patients including eight females. The mean age was 32 years. The most common abnormalities were aneurysms seen in 12 patients. The renal artery was the most common site of aneurysms (n=9). The hepatic (n=3), superior mesenteric (n=3) and splenic arteries (n=1) were also involved. Contour irregularity was noted in four patients involving the hepatic, splenic, and superior mesenteric arteries. Stenosis/occlusion was also noted in seven patients. The most common end-organ abnormality was infarct (n=9), followed by bowel wall thickening (n=3), and perinephric haematoma (n=2). Conclusion: A combination of arterial and end-organ abnormalities on abdominal CT enables an accurate diagnosis of PAN in occult cases and may obviate the need for angiography and, sometimes, biopsy. - Highlights: • A combination of findings on CT allows a diagnosis of PAN. • Specific findings include arterial and end organ abnormalities. • The most common abnormalities on CTA and CT are aneurysms and infarcts.

The efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury

International Nuclear Information System (INIS)

Kwack, Kyu Sung; Kim, Young Ju; Lee, Myung Sub; Kim, Dong Jin; Hong, In Soo

2000-01-01

To evaluate the efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury after blunt abdominal trauma. We retrospectively analyzed the results of transcatheter arterial embolization in 23 patients who suffered splenic injury after blunt abdominal trauma. Fourteen of the patients were male, and 9 were female; 13 were adults, and 10 were children. Transcatheter arterial embolization was performed in patients with hypotension, tachycardia, evidence of hemodynamic instability due, for example, to low levels of Hgb and Hct, or those who needed fluid therapy or blood transfusion. After embolization the patients' progress was monitored by CT scanning, abdominal sonography, or 99m Tc-sulfur colloid scintigraphy. The degree of splenic injury was classified according to the system devised by Mirvis et al.; nine cases were CT grade III, and 14 were grade IV. After demonstrating angiographically the site of contrast leakage, embolization was performed; for this, a coil only was used in 16 cases, gelfoam only in four, and both coil and gelfoam in three. There were three sites of vascular embolization: 16 procedures were performed in the proximal part of the main trunk of the splenic artery, four in a superselected branch of this same artery, and three in both the splenic artery and one of its superselected branches. Of the 23 cases, 18 recovered without splenectomy after embolization, three adult patients died from coexisting conditions (spinal or cerebral injuries, liver cirrhosis, or pelvic bone fracture) or complications (acute renal failure or disseminated intravascular coagulation). Due to co-existing pancreatic and mesenteric vessel injury, two of the adult patients who underwent TAE also underwent delayed surgery; intraoperatively, there was no evidence of splenic rebleeding. In all patients who did not undergo surgery, follow-up observation revealed a decreased volume of hemoperitoneum, increased uptake of radionuclide in

The efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury

Energy Technology Data Exchange (ETDEWEB)

Kwack, Kyu Sung; Kim, Young Ju; Lee, Myung Sub; Kim, Dong Jin; Hong, In Soo [Wonju Christian Hospital, College of Medicine, Yonsei University, Wonju (Korea, Republic of)

2000-07-01

To evaluate the efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury after blunt abdominal trauma. We retrospectively analyzed the results of transcatheter arterial embolization in 23 patients who suffered splenic injury after blunt abdominal trauma. Fourteen of the patients were male, and 9 were female; 13 were adults, and 10 were children. Transcatheter arterial embolization was performed in patients with hypotension, tachycardia, evidence of hemodynamic instability due, for example, to low levels of Hgb and Hct, or those who needed fluid therapy or blood transfusion. After embolization the patients' progress was monitored by CT scanning, abdominal sonography, or {sup 99m}Tc-sulfur colloid scintigraphy. The degree of splenic injury was classified according to the system devised by Mirvis et al.; nine cases were CT grade III, and 14 were grade IV. After demonstrating angiographically the site of contrast leakage, embolization was performed; for this, a coil only was used in 16 cases, gelfoam only in four, and both coil and gelfoam in three. There were three sites of vascular embolization: 16 procedures were performed in the proximal part of the main trunk of the splenic artery, four in a superselected branch of this same artery, and three in both the splenic artery and one of its superselected branches. Of the 23 cases, 18 recovered without splenectomy after embolization, three adult patients died from coexisting conditions (spinal or cerebral injuries, liver cirrhosis, or pelvic bone fracture) or complications (acute renal failure or disseminated intravascular coagulation). Due to co-existing pancreatic and mesenteric vessel injury, two of the adult patients who underwent TAE also underwent delayed surgery; intraoperatively, there was no evidence of splenic rebleeding. In all patients who did not undergo surgery, follow-up observation revealed a decreased volume of hemoperitoneum, increased uptake of

A PROSPECTIVE STUDY ON SPLENIC INJURY

Directory of Open Access Journals (Sweden)

Palanivel Rajagopal

2017-04-01

Full Text Available BACKGROUND An injured spleen is a well-known entity to those involved in trauma care. The majority of individual with a splenic injury now receive nonoperative intervention and therapy. This shift from operative to nonoperative treatment over the past several decades is a tremendous success story in which clinical judgment and reason triumphed over standard surgical dogma. In emergency room, restoration of airway, breathing and circulation should be focussed on. A careful history is the most important one. Nevertheless, the severity of the splenic injury plays a dominant part in determining whether nonoperative management is appropriate or-if-not-whether splenorrhaphy or splenectomy will be the more appropriate surgical option. As a general rule, younger, healthier patients with lower grade splenic injuries and fewer associated injuries and comorbidities are usually managed nonoperatively or with splenic repair, whether unstable, actively bleeding patients with more severe splenic trauma and/or multiple associated injuries require splenectomy. The aim of the study is to evaluate- 1. The impact of blunt or penetrating abdominal trauma on spleen. 2. Various modes of injury. 3. Various modes of clinical presentation of cases. 4. The value of various available investigations employed. 5. The various methods of treatment. 6. The morbidity and mortality. MATERIALS AND METHODS This study was a prospective study of 20 cases of splenic injury admitted in the triage ward of Mahatma Gandhi Memorial Government Medical College Hospital, Trichy, over a period of 2 years from December 2014 to December 2016. Once the patient is admitted, the name, age, sex and mode of injury are noted. The time interval between splenic injury and admission and time interval between admission to hospital and surgery are recorded. After resuscitating the patient, all patients were subjected to careful clinical examination. RESULTS The total number of patients who had sustained

Management of Splenic Injuries in a University Teaching Hospital in ...

African Journals Online (AJOL)

Splenectomy was the most frequently performed procedure. Challenges identified in the management of patients with splenic injuries in Nigeria include delayed presentation, underutilization of CT, unavailability of interventional radiology, inadequate ICUs, limited vaccination, discharge against medical advice and poor ...

Molecular detection of vector-borne pathogens in blood and splenic samples from dogs with splenic disease.

Science.gov (United States)

Movilla, Rebeca; Altet, Laura; Serrano, Lorena; Tabar, María-Dolores; Roura, Xavier

2017-03-13

The spleen is a highly perfused organ involved in the immunological control and elimination of vector-borne pathogens (VBP), which could have a fundamental role in the pathogenesis of splenic disease. This study aimed to evaluate certain VBP in samples from dogs with splenic lesions. Seventy-seven EDTA-blood and 64 splenic tissue samples were collected from 78 dogs with splenic disease in a Mediterranean area. Babesia spp., Bartonella spp., Ehrlichia/Anaplasma spp., Hepatozoon canis, Leishmania infantum, hemotropic Mycoplasma spp. and Rickettsia spp. were targeted using PCR assays. Sixty EDTA-blood samples from dogs without evidence of splenic lesions were included as a control group. More than half (51.56%) of the biopsies (33/64) were consistent with benign lesions and 48.43% (31/64) with malignancy, mostly hemangiosarcoma (25/31). PCR yielded positive results in 13 dogs with spleen alterations (16.67%), for Babesia canis (n = 3), Babesia gibsoni (n = 2), hemotropic Mycoplasma spp. (n = 2), Rickettsia massiliae (n = 1) and "Babesia vulpes" (n = 1), in blood; and for B. canis, B. gibsoni, Ehrlichia canis and L. infantum (n = 1 each), in spleen. Two control dogs (3.3%) were positive for B. gibsoni and H. canis (n = 1 each). Benign lesions were detected in the 61.54% of infected dogs (8/13); the remaining 38.46% were diagnosed with malignancies (5/13). Infection was significantly associated to the presence of splenic disease (P = 0.013). There was no difference in the prevalence of infection between dogs with benign and malignant splenic lesions (P = 0.69); however B. canis was more prevalent in dogs with hemangiosarcoma (P = 0.006). VBP infection could be involved in the pathogenesis of splenic disease. The immunological role of the spleen could predispose to alterations of this organ in infected dogs. Interestingly, all dogs with B. canis infection were diagnosed with hemangiosarcoma in the present survey. As previously

Spontaneous resolution of splenic infarcts after distal splenorenal shunt in children with extra hepatic portal venous obstruction: Our experience

Directory of Open Access Journals (Sweden)

Arbinder Kumar

2014-01-01

Full Text Available Background: In cases of portal hypertension with splenic infarcts, splenectomy with proximal splenorenal shunt has been recommended. We are sharing our experience with distal splenorenal shunt in these cases contrary to the popular belief. Materials and Methods: Splenic infarcts were graded as mild, moderate and severe according to the pre-operative CT portogram. Mild, moderate and severe infarcts were defined as an infarct involving 50% area of the spleen, respectively. Mild and moderate infarcts were managed by spleen-preserving distal splenorenal shunt while those with extensive infarcts were subjected to splenectomy and proximal splenorenal shunt. Those with spleen-preserving shunts were closely followed in the post-operative period according to a uniform protocol. Clinical examination was regularly done to assess the size of the spleen and note the presence of pain, tenderness in the left intercostal space. An ultrasound Doppler was done after 7 days to assess shunt patency while CT portogram was repeated at 6 monthly intervals. Results: Fourteen cases with splenic infarcts formed the study group. Eight cases had mild infarcts, 3 had moderate infarcts and 3 had severe infarcts. Four underwent proximal splenorenal shunt, and 10 underwent warren′s shunt (8 with mild and 2 with moderate infarcts. In 9/10 (90%, spleen could eventually be retained. Spleen completely regressed in them and so did the infarct. Conclusions:Spleen-preserving distal splenorenal shunt can be considered as a viable option in the management of cases with mild and carefully selected moderate splenic infarcts.

Use of computed tomographic scanning and embolization to improve the nonoperative management of splenic trauma: critically appraised topic

International Nuclear Information System (INIS)

Elliott, J.E.; Millward, S.F.; Kribs, S.W.

2003-01-01

A patient with a grade 3 splenic laceration, who was stable and being treated with nonoperative management (NOM) underwent contrast-enhancement abdominal computed tomography (CT) 3 days after the injury. The scan showed a 2-cm well-defined hyperdense contrast collection within the splenic laceration. (author)

Use of computed tomographic scanning and embolization to improve the nonoperative management of splenic trauma: critically appraised topic

Energy Technology Data Exchange (ETDEWEB)

Elliott, J.E.; Millward, S.F.; Kribs, S.W. [Univ. of Western Ontario, London Health Services Centre, London, Ontario (Canada)

2003-06-01

A patient with a grade 3 splenic laceration, who was stable and being treated with nonoperative management (NOM) underwent contrast-enhancement abdominal computed tomography (CT) 3 days after the injury. The scan showed a 2-cm well-defined hyperdense contrast collection within the splenic laceration. (author)

Concomitant hollow viscus injuries in patients with blunt hepatic and splenic injuries: an analysis of a National Trauma Registry database.

Science.gov (United States)

Swaid, Forat; Peleg, Kobi; Alfici, Ricardo; Matter, Ibrahim; Olsha, Oded; Ashkenazi, Itamar; Givon, Adi; Kessel, Boris

2014-09-01

Non-operative management has become the standard approach for treating stable patients sustaining blunt hepatic or splenic injuries in the absence of other indications for laparotomy. The liberal use of computed tomography (CT) has reduced the rate of unnecessary immediate laparotomies; however, due to its limited sensitivity in the diagnosis of hollow viscus injuries (HVI), this may be at the expense of a rise in the incidence of missed HVI. The aim of this study was to assess the incidence of concomitant HVI in blunt trauma patients diagnosed with hepatic and/or splenic injuries, and to evaluate whether a correlation exists between this incidence and the severity of hepatic or splenic injuries. A retrospective cohort study involving blunt trauma patients with splenic and/or liver injuries, between the years 1998 and 2012 registered in the Israel National Trauma Registry. The association between the presence and severity of splenic and/or liver injuries and the incidence of HVI was examined. Of the 57,130 trauma victims identified as suffering from blunt torso injuries, 2335 (4%) sustained hepatic injuries without splenic injuries (H group), 3127 (5.4%) had splenic injuries without hepatic injuries (S group), and 564 (1%) suffered from both hepatic and splenic injuries (H+S group). Overall, 957 patients sustained 1063 HVI. The incidence of HVI among blunt torso trauma victims who sustained neither splenic nor hepatic injuries was 1.5% which is significantly lower than in the S (3.1%), H (3.1%), and H+S (6.7%) groups. In the S group, there was a clear correlation between the severity of the splenic injury and the incidence of HVI. This correlation was not found in the H group. The presence of blunt splenic and/or hepatic injuries predicts a higher incidence of HVI, especially if combined. While in blunt splenic injury patients there is a clear correlation between the incidence of HVI and the severity of splenic injury, such a correlation does not exist in patients

Splenic calcifications caused by Trichosporon beigelli infection: CT and ultrasound demonstration

International Nuclear Information System (INIS)

Sklair-Levy, M.; Libson, Y.; Lossos, I.S.; Bugomolsky-Yahalom, V.

1998-01-01

Trichosporon beigelli is an uncommon but frequently fatal invasive fungal infection in immunosupressed patients. We report on a patient with acute myeloid leukemia who developed splenic calcifications following Trichosporon beigelli infection. (orig.)

Splenic Artery Pseudoaneurysm Presenting as Massive Hematemesis: A Diagnostic Dilemma

Directory of Open Access Journals (Sweden)

Peeyush Varshney

2014-01-01

Full Text Available Introduction. Splenic artery Pseudoaneurysm, a complication of chronic pancreatitis, presenting as massive hematemesis is a rare presentation. Case Report. We present a case of 38-year-old male admitted with chief complaints of pain in the upper abdomen and massive hematemesis for the last 15 days. On examination there was severe pallor. On investigating the patient, Hb was 4.0 gm/dL, upper GI endoscopy revealed a leiomyoma in fundus of stomach, and EUS Doppler also supported the UGI findings. On further investigation of the patient, CECT of the abdomen revealed a possibility of distal pancreatic carcinoma encasing splenic vessels and infiltrating the adjacent structure. FNA taken at the time of EUS was consistent with inflammatory pathology. Triple phase CT of the abdomen revealed a splenic artery pseudoaneurysm with multiple splenic infarcts. After resuscitation we planned an emergency laparotomy; splenic artery pseudoaneurysm densely adherent to adjacent structures and associated with distal pancreatic necrosis was found. We performed splenectomy with repair of the defect in the stomach wall and necrosectomy. Postoperative course was uneventful and patient was discharged on day 8. Conclusion. Pseudoaneurysm can be at times a very difficult situation to manage; options available are either catheter embolisation if patient is vitally stable, or otherwise, exploration.

[Application of Da Vinci surgical robot in the dissection of splenic hilar lymph nodes for gastric cancer patients with total gastrectomy].

Science.gov (United States)

Yang, Kun; Chen, Xinzu; Zhang, Weihan; Chen, Xiaolong; Hu, Jiankun

2016-08-25

To investigate the feasibility and safety of Da Vinci surgical robot in the dissection of splenic hilar lymph nodes for gastric cancer patients with total gastrectomy. Clinical data of two cases who underwent total gastrectomy for cardia cancer at our department in January 2016 were analyzed retrospectively. Two male patients were 62 and 55 years old respectively, with preoperative diagnosis as cT2-3N0M0 and cT1-2N0M0 gastric cancer by gastroscope and biopsy, and both received robotic total gastrectomy spleen-preserving splenic hilar lymph node dissection successfully. The operative time for splenic hilar lymph node dissection was 30 min and 25 min respectively. The intraoperative estimated blood loss was both 100 ml, while the number of total harvested lymph node was 38 and 33 respectively. One dissected splenic hilar lymph node and fatty tissues in two patients were proven by pathological examinations. There were no anastomotic leakage, pancreatic fistula, splenic infarction, intraluminal bleeding, digestive tract bleeding, aneurysm of splenic artery, and other operation-associated complications. Both patients suffered from postoperative pneumonia, and were cured by conservative therapy. The robotic spleen-preserving splenic hilar lymph node dissection is feasible and safe, but its superiority needs further evaluation.

The multidetector computed tomography angiography (MDCTA) in the diagnosis of splenic artery aneurysm and pseudoaneurysm

International Nuclear Information System (INIS)

Saba, Luca; Mallarini, Giorgio; Anzidei, Michele; Lucatelli, Pierleone

2011-01-01

Splenic artery aneurysm is the most frequent visceral artery aneurysm and rupture of the aneurysm is associated with a high mortality rate. It is important to discriminate between a true aneurysm and a pseudoaneurysm that may be caused by pancreatitis, iatrogenic and postoperative causes, trauma and peptic ulcer disease. Multidetector-row CT angiography (MDCTA) allows detailed visualization of the vascular anatomy and may allow identification of aneurysms and pseudoaneurysms that affect the splenic artery. The objective of this article is to provide a review of the general characteristics of splenic artery aneurysms and pseudoaneurysms and to describe the findings of MDCTA

The multidetector computed tomography angiography (MDCTA) in the diagnosis of splenic artery aneurysm and pseudoaneurysm

Energy Technology Data Exchange (ETDEWEB)

Saba, Luca; Mallarini, Giorgio (Dept. of Radiology, Azienda Ospedaliero Universitaria (AOU), Cagliari (Italy)), email: lucasaba@tiscali.it; Anzidei, Michele; Lucatelli, Pierleone (Dept. of Radiological Sciences, Univ. of Rome La Sapienza, Rome (Italy))

2011-06-15

Splenic artery aneurysm is the most frequent visceral artery aneurysm and rupture of the aneurysm is associated with a high mortality rate. It is important to discriminate between a true aneurysm and a pseudoaneurysm that may be caused by pancreatitis, iatrogenic and postoperative causes, trauma and peptic ulcer disease. Multidetector-row CT angiography (MDCTA) allows detailed visualization of the vascular anatomy and may allow identification of aneurysms and pseudoaneurysms that affect the splenic artery. The objective of this article is to provide a review of the general characteristics of splenic artery aneurysms and pseudoaneurysms and to describe the findings of MDCTA

Growth of Murine Splenic Tissue Is Suppressed by Lymphotoxin β-Receptor Signaling (LTβR) Originating from Splenic and Non-Splenic Tissues

DEFF Research Database (Denmark)

Milićević, Novica M; Nohroudi, Klaus; Schmidt, Friederike

2016-01-01

LTβR signaling. Two-dimensional differential gel electrophoresis and subsequent mass spectrometry of stromal splenic tissue was applied to screen for potential factors mediating the LTβR dependent suppressive activity. Thus, LTβR dependent growth suppression is involved in regulating the size...

Prune belly syndrome, splenic torsion, and malrotation: a case report.

Science.gov (United States)

Tran, Sifrance; Grossman, Eric; Barsness, Katherine A

2013-02-01

An 18 year old male with a history of prune belly syndrome (PBS) presented with acute abdominal pain and palpable left upper quadrant mass. Computed tomography (CT) of the abdomen revealed a medialized spleen with a "whirl sign" in the splenic vessels, consistent with splenic torsion. Coincidentally, the small bowel was also noted to be on the right side of the abdomen, while the colon was located on the left, indicative of malrotation. Emergent diagnostic laparoscopy confirmed splenic torsion and intestinal malrotation. Successful laparoscopic reduction of the splenic torsion was achieved, however, conversion to an open procedure by a vertical midline incision was necessary owing to the patient's unique anatomy. Open splenopexy with a mesh sling and Ladd's procedure were subsequently performed. Malrotation and wandering spleen are known, rare associated anomalies in PBS; however, both have not been reported concurrently in a patient with PBS in the literature. In patients with PBS, acute abdominal pain, and an abdominal mass, high clinical suspicion for gastrointestinal malformations and prompt attention can result in spleen preservation and appropriate malrotation management. We present a case of a teenager who presented with a history of PBS, acute abdominal pain, and a palpable abdominal mass. The patient was found to have splenic torsion and intestinal malrotation. The clinical findings, diagnostic imaging, and surgical treatment options of splenic torsion are reviewed. Copyright © 2013 Elsevier Inc. All rights reserved.

MANAGEMENT OF SPLENIC INJURY AFTER BLUNT INJURY TO ABDOMEN

Directory of Open Access Journals (Sweden)

J. Bharath Prakash Reddy

2016-07-01

Full Text Available BACKGROUND The spleen is an important organ in the body’s immune system. It is the most frequently injured organ in blunt abdominal trauma. 1 Over the past several decades, diagnosis and management of splenic trauma has been evolved. The conservative, operative approach has been challenged by several reports of successful non-operative management aided by the power of modern diagnostic imaging. The aim of our prospective study was to compare non-operative management with surgery for cases of splenic injury. METHODS We conducted a prospective study of patients admitted with blunt splenic injury to our regional hospital over a three-year period (2012-2015. Haemodynamic status upon admission, FAST examination, computed tomography 2 grade of splenic tear, presence and severity of associated injuries have been taken into account to determine the treatment of choice. Therapeutic options were classified into non-operative and splenectomy. RESULTS Over a 3-year period, 24 patients were admitted with blunt splenic injury. Sixteen patients were managed operatively and eight patients non-operatively. 3,4 Non-operative management failed in one patient due to continued bleeding. The majority of grades I, II, and III splenic injuries were managed non-operatively and grades IV and V were managed operatively. Blood transfusion requirement was significantly higher among the operative group, but the operative group had a significantly longer hospital stay. Among those managed non-operatively (median age 24.5 years, a number of patients were followed up with CT scans with significant radiation exposure and unknown longterm consequences. CONCLUSION In our experience, NOM is the treatment of choice for grade I, II and III blunt splenic injuries. Splenectomy was the chosen technique in patients who met exclusion criteria for NOM, as well as for patients with grade IV and V injury.

Splenic artery aneurysm rupture in pregnancy

International Nuclear Information System (INIS)

Khan, H.R.; Low, S.; Selinger, M.; Nelson, N.

2004-01-01

Rupture of a splenic artery aneurysm, commonly associated with pregnancy is a rare and catastrophic event. We report here a case of a patient in her second pregnancy who presented with a short history of left hypochondriac and epigastric pain, followed by collapse at 32 weeks gestation. Sudden fetal distress lead to emergency caesarean delivery when splenic artery aneurysm rupture was diagnosed. With timely involvement of multidisciplinary personnel both mother and baby survived and had an uneventful recovery. (author)

Pseudoaneurysm of the splenic artery mimicking a solid lesion

Directory of Open Access Journals (Sweden)

Raffaele Pezzilli

2016-08-01

Full Text Available A 64-year-old man presented to the hospital because of hematemesis; on admission, he had weakness and pale skin, tachycardia and hypotension. Laboratory tests revealed severe anemia (hemoglobin 7.8 g/dL; liver, renal and pancreatic function tests were normal. An upper digestive endoscopy revealed a gastric ulcer of the cardia, treated with metallic clips and adrenalin injection. The patient was treated with fluids and was transfused with three units of red blood cells. In the previous two months, due to the presence of bloating and diarrhea, associated with abdominal distension, a colon-computed tomography (CT revealed a large retroperitoneal hypodense mass, 53x37 mm in size, without contrast enhancement localized between the body and the tail of the pancreas and the stomach, near the splenic artery and without signs of infiltration. To better define the mass, endoscopic ultrasound and biopsy were performed; however histopathology of multiple biopsies was not diagnostic, because of the presence of necrotic tissue and inflammatory cells. Since hematemesis recurred, the patient underwent a second upper digestive endoscopic examination, but no source of bleeding was found. Then a new contrast enhanced CT was performed that showed a size reduction of the mass, the presence of blood in the stomach and a small pseudoaneurysm of the splenic artery. Because of these findings an angiograpghic study was carried out; angiography confirmed a splenic artery pseudoaneurysm that was successfully embolized with metal microcoils.

Surgical management of splenic echinococcal disease

Directory of Open Access Journals (Sweden)

Meimarakis G

2009-04-01

Full Text Available Abstract Background Infection of the spleen with echinococcus is a rare clinical entity. Because the diagnosis of a splenic infestation with echinococcus is sometimes delayed, large hydatid cysts or pseudotumors may develop, demanding a differential surgical approach to cure the disease. Methods In a retrospective study 10 patients out of 250 with abdominal echinococcosis (4% were identified to have splenic infestation, either limited to the spleen (n = 4 or with synchronous involvement of the liver (n = 4, major omentum (n = 1, or the liver and lung (n = 1. Only one patient had alveolar echinococcosis whereas the others showed hydatid cysts of the spleen. Surgical therapy included splenectomy in 7 patients or partial cyst excision combined with omentoplasty in 3 patients. In case of liver involvement, pericystectomy was carried out simultaneously. Results There was no mortality. Postoperative complications were observed in 4 patients. Hospital stay and morbidity were not influenced when splenic procedures were combined with pericystectomies of the liver. Mean follow- up was 8.8 years and all of the patients are free of recurrence at this time. Conclusions Splenectomy should be the preferred treatment of hydatid cysts but partial cystectomy is suitable when the cysts are located at the margins of the spleen. Due to low morbidity rates, simultaneous treatment of splenic and liver hydatid cysts is recom mended.

Diagnostic problems with parasitic and non-parasitic splenic cysts

Directory of Open Access Journals (Sweden)

Adas Gokhan

2009-05-01

Full Text Available Abstract Background The splenic cysts constitute a very rare clinical entity. They may occur secondary to trauma or even being more seldom due to parasitic infestations, mainly caused by ecchinocccus granulosus. Literature lacks a defined concencus including the treatment plans and follow up strategies, nor long term results of the patients. In the current study, we aimed to evaluate the diagnosis, management of patients with parasitic and non-parasitic splenic cysts together with their long term follow up progresses. Methods Twenty-four patients with splenic cysts have undergone surgery in our department over the last 9 years. Data from eighteen of the twenty-four patients were collected prospectively, while data from six were retrospectively collected. All patients were assessed in terms of age, gender, hospital stay, preoperative diagnosis, additional disease, serology, ultrasonography, computed tomography (CT, cyst recurrences and treatment. Results In this study, the majority of patients presented with abdominal discomfort and palpable swelling in the left hypochondrium. All patients were operated on electively. The patients included 14 female and 10 male patients, with a mean age of 44.77 years (range 20–62. Splenic hydatid cysts were present in 16 patients, one of whom also had liver hydatid cysts (6.25%. Four other patients were operated on for a simple cyst (16% two patients for an epithelial cyst, and the last two for splenic lymphangioma. Of the 16 patients diagnosed as having splenic hydatit cysts, 11 (68.7% were correctly diagnosed. Only two of these patients were administered benzimidazole therapy pre-operatively because of the risk of multicystic disease The mean follow-up period was 64 months (6–108. There were no recurrences of splenic cysts. Conclusion Surgeons should keep in mind the possibility of a parasitic cyst when no definitive alternative diagnosis can be made. In the treatment of splenic hydatidosis, benzimidazole

Hepatic and splenic blush on computed tomography in children following blunt abdominal trauma: Is intervention necessary?

Science.gov (United States)

Ingram, Martha-Conley E; Siddharthan, Ragavan V; Morris, Andrew D; Hill, Sarah J; Travers, Curtis D; McKracken, Courtney E; Heiss, Kurt F; Raval, Mehul V; Santore, Matthew T

2016-08-01

There are no widely accepted guidelines for management of pediatric patients who have evidence of solid organ contrast extravasation ("blush") on computed tomography (CT) scans following blunt abdominal trauma. We report our experience as a Level 1 pediatric trauma center in managing cases with hepatic and splenic blush. All pediatric blunt abdominal trauma cases resulting in liver or splenic injury were queried from 2008 to 2014. Patients were excluded if a CT was unavailable in the medical record. The presence of contrast blush was based on final reports from attending pediatric radiologists. Correlations between incidence of contrast blush and major outcomes of interest were determined using χ and Wilcoxon rank-sum tests for categorical and continuous variables, respectively, evaluating statistical significance at p splenic or liver injury after blunt abdominal trauma, we report on 30 patients (9%) with solid organ blush, resulting in 18 cases of hepatic blush and 16 cases of splenic blush (four patients had extravasation from both organs). Blush was not found to correlate significantly with age, gender, or type of injury (liver vs. splenic) but was found to associate with higher grades of solid organ injury (p = 0.002) and higher ISS overall (p splenic or liver injury is associated with higher grade of injury. These patients receive intensive medical management but do not uniformly require invasive intervention. From our data, we suggest that a blush can safely be managed nonoperatively and that treatment should be dictated by change in physiology. Therapeutic study, level IV.

Criteria for nonoperative management of blunt splenic trauma

Directory of Open Access Journals (Sweden)

Sarmast Shoushtary MH

2009-02-01

Full Text Available "nBackground: Although nonoperative management is as an alternative method for surgery in the management of blunt splenic trauma, there are many contraversies in criteria for appropriate selection of the best method of management in patients. This study was conducted to find clinical and diagnostic criteria for selection of patients for surgery. "nMethods: One hundred and one patients with blunt splenic injury entered in our prospective observational and cross sectional study. Patients with unstable hemodyna-mics and obvious abdominal symptoms underwent emergency splenectomy was performed. In stable patients, abdominal and pelvic CT scan with IV contrast was performed. Patients with stable hemodynamics who lack obvious abdominal symptoms, admitted in ICU ward. Patients' demographics, blood pressure changes, hemoglobin concertration, severity of trauma with injury severity score (ISS scoring system, CT scan findings, amount of blood transfusion; Hospitalization time and mechanism of injury were recorded. "nResults: From 101 patients, 61(60.3% underwent early laparotomy. 40 patients were planned for conservative management. In 30 patients (29.7% nonoperative management was successful. In 10 patients (9.9% This management failed and they underwent surgery. Hypotension, hemoglobin concentration dropping more than one episode and blood transfusion requirement more than one time, increased the risk of operation. Higher ISS number and ISS≥16 had a direct relation with operative management. In patients who underwent early laparotomy CT grade of injury was higher. CT findings correlated well with laparotomy findings. "nConclusion: Nonoperative management was successful in 75% of selected patients. With correct selection of patients and concerning to homodynamic status, hemoglobin concentration changes and injury severity score in conjunction with CT findings, we can use this management in greater number of patients.

Infarto esplénico secundario a pancreatitis aguda Splenic infarction secondary to acute pancreatitis

Directory of Open Access Journals (Sweden)

J. J. Arenal Vera

2008-05-01

Full Text Available Fundamento y objetivo: la estrecha relación anatómica del páncreas con los vasos esplénicos y el bazo es responsable de complicaciones esplénicas en el curso de la pancreatitis aguda. El objetivo es presentar dos casos clínicos de pancreatitis aguda grave que sufrieron infarto esplénico como complicación de la enfermedad pancreática. Pacientes, participantes: en un periodo de tres meses, dos pacientes fueron diagnosticados de infarto esplénico secundario a pancreatitis aguda. En ambos casos el diagnóstico y seguimiento evolutivo del infarto esplénico se hizo a través de tomografía axial computerizada. Resultados: en el primer paciente, las imágenes muestran de forma inequívoca la afectación de la arteria esplénica por el proceso inflamatorio pancreático. En el segundo, no se pudo demostrar afectación de los vasos esplénicos, por lo que la única posible explicación etiológica es un incremento de coagulabilidad intravascular. Conclusiones: sería recomendable añadir las complicaciones esplénicas al conjunto de complicaciones graves extrapancreáticas de la pancreatitis aguda. La tomografía axial computerizada es de gran utilidad para la detección y seguimiento de las complicaciones esplénicas de la pancreatitis aguda.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

Recanalization of Splenic Artery Aneurysm After Transcatheter Arterial Embolization Using N-Butyl Cyanoacrylate

International Nuclear Information System (INIS)

Matsumoto, Keiji; Ushijima, Yasuhiro; Tajima, Tsuyoshi; Nishie, Akihiro; Hirakawa, Masakazu; Ishigami, Kousei; Yamaji, Yukiko; Honda, Hiroshi

2010-01-01

A 65-year-old woman who had been diagnosed as having microscopic polyangiitis developed sudden abdominal pain and entered a state of shock. Abdominal CT showed massive hemoperitoneum, and emergent angiography revealed a ruptured splenic artery aneurysm. After direct catheterization attempts failed due to tortuous vessels and angiospasm, transcatheter arterial embolization using an n-butyl cyanoacrylate (NBCA)-lipiodol mixture was successfully performed. Fifty days later, the patient developed sudden abdominal pain again. Repeated angiography demonstrated recanalization of the splenic artery and splenic artery aneurysm. This time, the recanalized aneurysm was embolized using metallic coils with the isolation method. Physicians should keep in mind that recanalization can occur after transcatheter arterial embolization using N-butyl cyanoacrylate, which has been used as a permanent embolic agent.

Late follow-up of patients submitted to subtotal splenectomy: late clinical, laboratory, imaging and functional with preservation of the upper splenic pole

Directory of Open Access Journals (Sweden)

Andy Petroianu

2008-09-01

Full Text Available objective: To evaluate the follow-up of patients submitted to splenectomy with preservation of the upper splenic pole. Methods: All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients submitted to this surgery were studied. The procedure was performed due to one of the following conditions: portal hypertension due to schistosomiasis (n = 43, trauma (n = 31, Gaucher’s disease (n = 4, myeloid hepatosplenomegaly due to myelofibrosis (n = 3, splenomegalic retarded growth and sexual development (n = 2, severe pain due to splenic ischemia (n = 2 and pancreatic cystadenoma (n = 1. All patients underwent hematologic tests, immunological assessment, abdominal ultrasonography, computed tomography (CT, scintigraphy and endoscopy. Rresults: Increased white blood cell and platelet counts were the only hematological abnormalities. No immune deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hypertension, but none had a re-bleeding event. The ultrasonography, tomography and scintigraphy confirmed the presence of functional splenic remnants without significant size alteration. Conclusions: Subtotal splenectomy seems to be a safe procedure that can be useful to treat conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time.

Reliability of injury grading systems for patients with blunt splenic trauma

NARCIS (Netherlands)

Olthof, D. C.; van der Vlies, C. H.; Scheerder, M. J.; de Haan, R. J.; Beenen, L. F. M.; Goslings, J. C.; van Delden, O. M.

2014-01-01

The most widely used grading system for blunt splenic injury is the American Association for the Surgery of Trauma (AAST) organ injury scale. In 2007 a new grading system was developed. This 'Baltimore CT grading system' is superior to the AAST classification system in predicting the need for

Muscular involvement by malignant lymphoma: CT and MR findings

International Nuclear Information System (INIS)

Kim, Baek Hyun

2000-01-01

To investigate the CT and MR findings of muscular involvement by malignant lymphoma. Thirteen patients with biopsy-proved muscular involvement by malignant lymphoma were included in this study. Two patients were primary muscle lymphoma and 11 patients were muscle lymphoma by secondary involvement of malignant lymphoma. CT of 10 patients (6 pre-contrast CT and 9 postcontrast CT) and MRI of 6 patients (all with pre a nd post-contrast studies) were retrospectively analyzed. In the majority of patients (84.6%, 11/13), the appearance of muscular involvement was the diffuse enlargement of several muscles as like as a group. The muscles involved by malignant lymphoma showed iso-attenuation (5/6) and homogeneity (6/6) on pre-contrast CT scan, and high attenuation (5/9) or iso-attenuation (4/9) and homogeneity (7/9) on post-contrast CT scan. The signal intensity of involved muscle showed slightly hyper- (4/6) or iso-intense (2/6) and homogeneous (6/6) on T1-weighted images, and hyper-intense (6/6) and homogeneous (4/6) on T2- and Gadolinium-enhanced T1-weighted images. Adjacent bone change was demonstrated in 69.2% (9/13), subcutaneous fat change in 61.5% (8/13), and neurovascular encasement within involved muscle in 53.8% (7/13). The CT and MR findings of muscular involvement by malignant lymphoma were diffuse enlargement of several muscles with homogeneous attenuation or signal intensity, and frequent changes in adjacent bones and subcutaneous fat, or neurovascular encasement. (author)

Iatrogenic splenic injury: review of the literature and medico-legal issues

Directory of Open Access Journals (Sweden)

Feola Alessandro

2016-01-01

Full Text Available Iatrogenic splenic injury is a recognized complication in abdominal surgery. The aim of this paper is to understand the medico-legal issues of iatrogenic splenic injuries. We performed a literature review on PubMed and Scopus using iatrogenic splenic or spleen injury and iatrogenic splenic rupture as keywords. Iatrogenic splenic injury cases were identified. Most cases were related to colonoscopy, but we also identified cases related to upper gastrointestinal procedures, colonic surgery, ERCP, left nephrectomy and/or adrenalectomy, percutaneous nephrolithotomy, vascular operations involving the abdominal aorta, gynecological operation, left lung biopsy, chest drain, very rarely spinal surgery and even cardiopulmonary resuscitation. There are several surgical procedures that can lead to a splenic injury. However, from a medico-legal point of view, it is important to assess whether the cause can be attributed to a technical error of the operator rather than being an unpredictable and unpreventable complication. It is important for the medico-legal expert to have great knowledge on iatrogenic splenic injuries because it is important to evaluate every step of the first procedure performed, how a splenic injury is produced, and whether the correct treatment for the splenic injury was administered in a judgment.

Radiological signs of extra nodal abdominal involvements in lymphoma

International Nuclear Information System (INIS)

Carro, A.I.; Alegre, N.; Cervera, J.L.; Montero, A.I.

1998-01-01

To assess abdominal CT images in lymphoma patients for the study of extra nodal abdominal involvement. Ninety-two patients diagnosed as having lymphoma were studied retrospectively. All the patients underwent abdominopelvic CT with oral and intravenous contrast (except in one patient who was allergic). In every case, the diagnosis was confirmed by biopsy or radiological follow-up after treatment had been completed. Fifty-two patients (56.5%) presented infiltration of extra nodal organs. The organs most frequently involved were liver and spleen, followed by the gastrointestinal tract, the musculoskeletal system and the genitourinary tract. The findings in this study coincide with those reported elsewhere with the exception of the splenic involvement the incidence of which was lower in the present series. (Author) 17 refs

Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience.

Science.gov (United States)

Jabbour, Gaby; Al-Hassani, Ammar; El-Menyar, Ayman; Abdelrahman, Husham; Peralta, Ruben; Ellabib, Mohammed; Al-Jogol, Hisham; Asim, Mohammed; Al-Thani, Hassan

2017-07-12

BACKGROUND Splenic injury is the leading cause of major bleeding after blunt abdominal trauma. We examined the clinical and radiological presentations, management, and outcome of blunt splenic injuries (BSI) in our institution. MATERIAL AND METHODS A retrospective study of BSI patients between 2011 and 2014 was conducted. We analyzed and compared management and outcome of different splenic injury grades in trauma patients. RESULTS A total of 191 BSI patients were identified with a mean (SD) age of 26.9 years (13.1); 164 (85.9%) were males. Traffic-related accident was the main mechanism of injury. Splenic contusion and hematoma (77.2%) was the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen (11.1%), blush (11.1%), and devascularization (0.6%). Repeated CT scan revealed 3 patients with pseudoaneurysm who underwent angioembolization. Nearly a quarter of patients were managed surgically. Non-operative management failed in 1 patient who underwent splenectomy. Patients with grade V injury presented with higher mean ISS and abdominal AIS, required frequent blood transfusion, and were more likely to be FAST-positive (p=0.001). The majority of low-grade (I-III) splenic injuries were treated conservatively, while patients with high-grade (IV and V) BSI frequently required splenectomy (p=0.001). Adults were more likely to have grade I, II, and V BSI, blood transfusion, and prolonged ICU stay as compared to pediatric BSI patients. The overall mortality rate was 7.9%, which is mainly association with traumatic brain injury and hemorrhagic shock; half of the deaths occurred within the first day after injury. CONCLUSIONS Most BSI patients had grade I-III injuries that were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan. Thorough clinical assessment and CT scan evaluation are crucial for

Embolization of a large, symptomatic splenic artery pseudoaneurysm

International Nuclear Information System (INIS)

Kukliński, Adam; Batycki, Krzysztof; Matuszewski, Wiesław; Ostrach, Andrzej; Kupis, Zbigniew; Łęgowik, Tomasz

2014-01-01

Splenic artery aneurysm is the third most common abdominal aneurysm. Most often it is due to pancreatitis. There were only 19 cases of aneurysms larger than 5 cm in diameter described in the literature. Management of splenic artery aneurysms depends on the size and symptoms. Invasive treatment modalities involve open procedures and interventional radiology methods (endovascular). A 44-years-old male with chronic pancreatitis, in a gradually worsening general condition due to a large splenic artery aneurysm, was subjected to the procedure. Blood flow through the aneurysm was cut-off by implanting a covered stent between celiac trunk and common hepatic artery. Patient’s general condition rapidly improved, allowing discharge home in good state soon after the procedure. Percutaneous embolization appears to be the best method of treatment of large splenic artery aneurysms. Complications of such treatment are significantly less dangerous than those associated with surgery

Endovascular treatment of ruptured splenic artery aneurysm

DEFF Research Database (Denmark)

Bjerring, Ole Steen

2008-01-01

Splenic artery aneurysms (SAA) are traditionally treated surgically, but endovascular techniques are becoming increasingly popular. A 64 year-old male with chest pain and low blood pressure was admitted under suspicion of AMI. A CT scan showed a 56 mm SAA with signs of rupture. The patient...... was treated with endovascular embolisation of the SAA with coils. Blood pressure and haemoglobin levels were stabilized and the patient was discharged. In the case of rupture the treatment of choice seems to be endovascular....

Contrast-enhanced ultrasound imaging of active bleeding associated with hepatic and splenic trauma.

Science.gov (United States)

Lv, F; Tang, J; Luo, Y; Li, Z; Meng, X; Zhu, Z; Li, T

2011-10-01

The aim of this study was to evaluate contrast-enhanced ultrasound (CEUS) imaging of active bleeding from hepatic and splenic trauma. Three hundred and ninety-two patients with liver or/and spleen trauma (179 liver and 217 spleen injuries), who underwent CEUS examinations following contrast-enhanced computed tomography (CT), were enrolled in this retrospective study over a period of >4 years. CEUS detected contrast medium extravasation or pooling in 16% (63/396) of liver or spleen lesions in 61 patients, which was confirmed by contrast-enhanced CT. Special attention was paid to observing the presence, location, and characteristics of the extravasated or pooled contrast medium. The CEUS detection rate for active bleeding was not different from that of contrast-enhanced CT (p=0.333). Information from surgery, minimally invasive treatment and conservative treatment was used as reference standard, and the sensitivities of the two techniques were not different (p=0.122). Of 63 lesions in 61 patients, CEUS showed that 74.6% (47/63) (21 liver lesions and 26 spleen lesions) presented contrast medium extravasation or pooling, both in the organ and out the capsule, in 14.3% (9/63) and only outside the capsule in 11.1% (7/63). CEUS imaging of active bleeding from hepatic and splenic trauma presented various characteristics, and the sizes and shapes of the active bleeding due to contrast medium extravasation or pooling were variable. CEUS can show the active bleeding associated with hepatic and splenic trauma with various imaging characteristics, thus making it possible to diagnose active bleeding using CEUS.

A novel method for the angiographic estimation of the percentage of spleen volume embolized during partial splenic embolization

International Nuclear Information System (INIS)

Ou, Ming-Ching; Chuang, Ming-Tsung; Lin, Xi-Zhang; Tsai, Hong-Ming; Chen, Shu-Yuan; Liu, Yi-Sheng

2013-01-01

Purpose: To evaluate the efficacy of estimating the volume of spleen embolized in partial splenic embolization (PSE) by measuring the diameters of the splenic artery and its branches. Materials and methods: A total of 43 liver cirrhosis patients (mean age, 62.19 ± 9.65 years) with thrombocytopenia were included. Among these, 24 patients underwent a follow-up CT scan which showed a correlation between angiographic estimation and measured embolized splenic volume. Estimated splenic embolization volume was calculated by a method based on diameters of the splenic artery and its branches. The diameters of each of the splenic arteries and branches were measured via 2D angiographic images. Embolization was performed with gelatin sponges. Patients underwent follow-up with serial measurement of blood counts and liver function tests. The actual volume of embolized spleen was determined by computed tomography (CT) measuring the volumes of embolized and non-embolized spleen two months after PSE. Results: PSE was performed without immediate major complications. The mean WBC count significantly increased from 3.81 ± 1.69 × 10 3 /mm 3 before PSE to 8.56 ± 3.14 × 10 3 /mm 3 at 1 week after PSE (P < 0.001). Mean platelet count significantly increased from 62.00 ± 22.62 × 10 3 /mm 3 before PSE to 95.40 ± 46.29 × 10 3 /mm 3 1 week after PSE (P < 0.001). The measured embolization ratio was positively correlated with estimated embolization ratio (Spearman's rho [ρ] = 0.687, P < 0.001). The mean difference between the actual embolization ratio and the estimated embolization ratio was 16.16 ± 8.96%. Conclusions: The method provides a simple method to quantitatively estimate embolized splenic volume with a correlation of measured embolization ratio to estimated embolization ratio of Spearman's ρ = 0.687

Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1. Liver and spleen

International Nuclear Information System (INIS)

Becker, C.D.; Terrier, F.; Mentha, G.

1998-01-01

Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of intra-abdominal hemorrhage and blunt hepatic and splenic injuries. Hepatic and splenic injuries can be detected by means of CT with a high accuracy. The vast majority of hepatic injuries can be successfully managed conservatively, even when CT demonstrates parenchymal damage of more than three segments and major hemoperitoneum. Delayed complications, e. g., formation of biloma or a false aneurysm, can be readily detected on repeat CT studies, although they are quite uncommon. The outcome of conservative treatment of splenic injuries remains unpredictable because delayed splenic rupture may occur even when initial CT shows only minor parenchymal lesions and little or no intraperitoneal hemorrhage. (orig.)

Asymptomatic appearance of splenic infarction in Wegeners granulomatosis

International Nuclear Information System (INIS)

Martusewicz-Boros, M.; Roszkowski-Sliz, K.; Wiatr, E.; Baranska, I.; Bestry, I.

2011-01-01

Splenic involvements in Wegeners granulomatosis (WG) are rarely diagnosed ante-mortem, while an autopsy is able to reveal a high rate of spleen lesions (78 - 100%). To date, there have been a few reported cases of splenic abnormalities in WG, including: splenomegaly, capsular adhesion, dysfunction and infarction. We reported a case of biopsy-verified WG with radiological evidence of diffuse spleen infarction despite the lack of any clinical symptoms. We concluded that due to a potential risk of severe hemorrhagic complications when anticoagulant therapy is necessary, radiological assessment of spleen should be performed regularly in this group of patients, particularly because spleen involvement can be asymptomatic. (authors)

The reevaluation of plain roentgenological study in isolated splenic injury

International Nuclear Information System (INIS)

Kang, Seong Ihn; Ko, Seung Sook; Kim, Kil Jeong; Oh, Jae Hee; Kim, Young Chul

1986-01-01

The spleen is the most common intraabdominal organ injured in blunt trauma. Although physical signs and symptoms, coupled with abdominal paracentesis and peritoneal lavage confirm intraabdominal injury, but isolated splenic injury especially delayed rupture, the diagnosis and clinical course is variable. We are reevaluation of plain roentgenologic findings for the light of early diagnosis of isolated splenic injury. 24 patients of the autopsy and surgically proven isolated splenic injury at Chosun University Hospital in the period from 1980 January to 1986 June were analyzed plain roentgenogram retrospectively. The results were as follows: 1. Male patients predominate, constitution 87.5%. Incidence has been greatest in second to fourth decade. 2. Mode of trauma causing isolated splenic injury is most common in motor vehicle accident and others are fall down, struck by fist, blow to object, uncertain blunt trauma. 3. Delayed rupture of spleen occurred in 2 cases (8.3%). 4. Common patterns of splenic injury is simple laceration that involves both the capsule and the parenchyma and a laceration that involves the splenic pedicle. 5. Plain chest roentgenographic findings were abnormal in 4 cases (16.7%). The most common plain abdominal roentgenographic findings was the evidence of intaabdominal fluid in 21 cases (87.5%). The others are included in order of frequency; gastric dilatation, prominent mucosal folds on greater curvature of the stomach, evidence of pelvic fluid, displacement of stomach to the right or downward, mass density in the region of spleen. 6. No relationship can be shown between patterns of injury, time lapse after trauma and plain roentgenological findings. But the evidence of intraabdominal fluid is most important in the light of early diagnosis. 7. Diagnosis of splenic injury may be most helpful that in combination with clinical history, clinical symptoms and signs and plain film findings. In delayed rupture, diagnostic value of serial examination

The reevaluation of plain roentgenological study in isolated splenic injury

Energy Technology Data Exchange (ETDEWEB)

Kang, Seong Ihn; Ko, Seung Sook; Kim, Kil Jeong; Oh, Jae Hee; Kim, Young Chul [Chosun University College of Medicine, Gwangju (Korea, Republic of)

1986-10-15

The spleen is the most common intraabdominal organ injured in blunt trauma. Although physical signs and symptoms, coupled with abdominal paracentesis and peritoneal lavage confirm intraabdominal injury, but isolated splenic injury especially delayed rupture, the diagnosis and clinical course is variable. We are reevaluation of plain roentgenologic findings for the light of early diagnosis of isolated splenic injury. 24 patients of the autopsy and surgically proven isolated splenic injury at Chosun University Hospital in the period from 1980 January to 1986 June were analyzed plain roentgenogram retrospectively. The results were as follows: 1. Male patients predominate, constitution 87.5%. Incidence has been greatest in second to fourth decade. 2. Mode of trauma causing isolated splenic injury is most common in motor vehicle accident and others are fall down, struck by fist, blow to object, uncertain blunt trauma. 3. Delayed rupture of spleen occurred in 2 cases (8.3%). 4. Common patterns of splenic injury is simple laceration that involves both the capsule and the parenchyma and a laceration that involves the splenic pedicle. 5. Plain chest roentgenographic findings were abnormal in 4 cases (16.7%). The most common plain abdominal roentgenographic findings was the evidence of intaabdominal fluid in 21 cases (87.5%). The others are included in order of frequency; gastric dilatation, prominent mucosal folds on greater curvature of the stomach, evidence of pelvic fluid, displacement of stomach to the right or downward, mass density in the region of spleen. 6. No relationship can be shown between patterns of injury, time lapse after trauma and plain roentgenological findings. But the evidence of intraabdominal fluid is most important in the light of early diagnosis. 7. Diagnosis of splenic injury may be most helpful that in combination with clinical history, clinical symptoms and signs and plain film findings. In delayed rupture, diagnostic value of serial examination

Multiple splenic abscesses

Directory of Open Access Journals (Sweden)

Harish Kumar

2015-01-01

Full Text Available Splenic abscess is a rare clinical entity with poor prognosis. But owing to imaging technique, diagnosis and prognosis have improved nowadays. Most patients who are presented with splenic abscess are immunocompromised due to predisposing risk factors like diabetes mellitus, intravenous drug abuse, trauma, bacterial endocarditis, human immunodeficiency virus (HIV, chemotherapy, or steroids. Here, we are presenting a rarer case of multiple splenic abscesses with its complication in an immunocompetent healthy adult male without any risk factor.

System immune response to vaccination on FDG-PET/CT

Energy Technology Data Exchange (ETDEWEB)

Mingos, Mark; Howard, Stephanie; Giaclone, Micholas; Kozono, David; Jacene, Heather [Brigham and Women' s Hospital, Boston (United States)

2016-12-15

A patient with newly diagnosed right lung cancer had transient 18F-fluorodeoxyglucose (FDG)-avid left axillary lymph nodes and intense splenic FDG uptake on positron emission tomography (PET)/computed tomography (CT). History revealed that the patient received a left-sided influenza vaccine 2-3 days before the examination. Although inflammatory FDG uptake in ipsilateral axillary nodes is reported, to our knowledge, this is the first report of visualization of the systemic immune response in the spleen related to the influenza vaccination on FDG-PET/CT. The history, splenic uptake and time course on serial FDG-PET/CT helped to avoid a false-positive interpretation for progressing lung cancer and alteration of the radiation therapy plan.

System immune response to vaccination on FDG-PET/CT

International Nuclear Information System (INIS)

Mingos, Mark; Howard, Stephanie; Giaclone, Micholas; Kozono, David; Jacene, Heather

2016-01-01

A patient with newly diagnosed right lung cancer had transient 18F-fluorodeoxyglucose (FDG)-avid left axillary lymph nodes and intense splenic FDG uptake on positron emission tomography (PET)/computed tomography (CT). History revealed that the patient received a left-sided influenza vaccine 2-3 days before the examination. Although inflammatory FDG uptake in ipsilateral axillary nodes is reported, to our knowledge, this is the first report of visualization of the systemic immune response in the spleen related to the influenza vaccination on FDG-PET/CT. The history, splenic uptake and time course on serial FDG-PET/CT helped to avoid a false-positive interpretation for progressing lung cancer and alteration of the radiation therapy plan

Standardization of MIP technique in three-dimensional CT portography: usefulness in evaluation of portosystemic collaterals in cirrhotic patients

International Nuclear Information System (INIS)

Kim, Jong Gi; Kim, Yong; Kim, Chang Won; Lee, Jun Woo; Lee, Suk Hong

2003-01-01

To assess the usefulness of three-dimensional CT portography using a standardized maximum intensity projection (MIP) technique for the evaluation of portosystemic collaterals in cirrhotic patients. In 25 cirrhotic patients with portosystemic collaterals, three-phase CT using a multide-tector-row helical CT scanner was performed to evaluate liver disease. Late arterial-phase images were transferred to an Advantage Windows 3.1 workstation (Gener Electric). Axial images were reconstructed by means of three-dimensional CT portography, using both a standardized and a non-standardized MIP technique, and the respective reconstruction times were determined. Three-dimensional CT portography with the standardized technique involved eight planes, namely the spleno-portal confluence axis (coronal, lordotic coronal, lordotic coronal RAO 30 .deg. C, and lordotic coronal LAO 30 .deg. C), the left renal vein axis (lordotic coronal), and axial MIP images (lower esophagus level, gastric fundus level and splenic hilum). The eight MIP images obtained in each case were interpreted by two radiologists, who reached a consensus in their evaluation. The portosystemic collaterals evaluated were as follows: left gastric vein dilatation; esophageal, paraesophageal, gastric, and splenic varix; paraumbilical vein dilatation; gastro-renal, spleno-renal, and gastro-spleno-renal shunt; mesenteric, retroperitoneal, and omental collaterals. The average reconstruction time using the non-standardized MIP technique was 11 minutes 23 seconds, and with the standardized technique, the time was 6 minutes 5 seconds. Three-dimensional CT portography with the standardized technique demonstrated left gastric vein dilatation (n=25), esophageal varix (n=18), paraesophageal varix (n=13), gastric varix (n=4), splenic varix (n=4), paraumbilical vein dilatation (n=4), gastro-renal shunt (n=3), spleno-renal shunt (n=3), and gastro-spleno-renal shunt (n=1). Using three-dimensional CT protography and the non

Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1. Liver and spleen

Energy Technology Data Exchange (ETDEWEB)

Becker, C.D.; Terrier, F. [Department of Radiology, Division of Diagnostic and Interventional Radiology, Geneva University Hospital, Geneva (Switzerland); Mentha, G. [Department of Surgery, Division of Abdominal Surgery, Geneva University Hospital, Geneva (Switzerland)

1998-05-01

Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of intra-abdominal hemorrhage and blunt hepatic and splenic injuries. Hepatic and splenic injuries can be detected by means of CT with a high accuracy. The vast majority of hepatic injuries can be successfully managed conservatively, even when CT demonstrates parenchymal damage of more than three segments and major hemoperitoneum. Delayed complications, e. g., formation of biloma or a false aneurysm, can be readily detected on repeat CT studies, although they are quite uncommon. The outcome of conservative treatment of splenic injuries remains unpredictable because delayed splenic rupture may occur even when initial CT shows only minor parenchymal lesions and little or no intraperitoneal hemorrhage. (orig.) With 11 figs., 5 tabs., 64 refs.

Embolisation of the splenic artery

Energy Technology Data Exchange (ETDEWEB)

Essler, G; Duex, A

1982-09-01

In bleeding of oesophageal varices with resistance to common treatment embolisation of the splenic artery causes depression of the portal hypertension by forty per cent. Thrombosis of the splenic or portal vein as in splenectomies are not to be expected. The splenic vein remains open for later spleno-renal anastomosis. By occlusion of the splenic artery we were successful in stopping oesophageal bleeding. In a patient with dominant hypersplenism in portal hypertension the severity of the syndrome decreased after embolisation of the splenic artery. Thrombocytes, leukocytes and gammaglobulin increased.

Splenic torsion, a challenging diagnosis: Case report and review of literature.

Science.gov (United States)

Viana, C; Cristino, H; Veiga, C; Leão, P

2018-01-01

Wandering spleen is an unusual condition characterized by hypermobility of the spleen. This is a rare clinical entity and it's more common in childhood under 1 year of age and in third decade of life. In this second peak, it's more frequent in females. Clinical manifestations can vary from asymptomatic to abdominal emergency. Treatment is often surgical. We presented a case report of splenic torsion from our hospital and a review of cases described in literature. This is a 40 year-old woman with complaints of upper abdominal pain associated with nausea and vomiting. A marked tenderness and a palpable abdominal mass on left hypochondrium were found as well as a slight increase in inflammatory parameters. A CT was performed and demonstrated findings compatible with splenic torsion. Surgery was performed doing laparoscopic splenectomy; Review of literature was made using the keyword combination: "wandering spleen". The research resulted in 451 articles. The physical examination and CT are fundamental for diagnosis. Surgery was performed and laparoscopic splenectomy was made because infarcted spleen; about the review of literature, the majority of patients were female and the average age at the time of diagnosis was 25.2 years. 69.5% needed splenectomy and 78.6% of surgeries were laparotomic. Splenic torsion is a rare but important differential diagnosis in patients presenting with acute abdomen. Diagnosis should be made promptly before development of life-threatening complications. Surgery is often necessary and splenopexy or splenectomy can be done. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Splenic trauma: three pronged diagnosis

International Nuclear Information System (INIS)

Owens, M.L.; Brantigan, J.; Chang, F.

1975-01-01

Peritoneal lavage, splenic scan, and splenic arteriography can vastly increase the speed and accuracy of patient evaluation when splenic injury is suspected. Although certain pitfalls exist, their wider use is advocated

Isolated metachronous splenic metastasis from synchronous colon cancer

Directory of Open Access Journals (Sweden)

Aker Fugen

2006-07-01

Full Text Available Abstract Background Isolated splenic metastases from colorectal cancer are very rare and there are only 13 cases reported in the English literature so far. Most cases are asymptomatic and the diagnosis is usually made by imaging studies during the evaluation of rising CEA level postoperatively. Case presentation A 76-year-old man underwent an extended left hemicolectomy for synchronous colon cancers located at the left flexure and the sigmoid colon. The tumors were staged as IIIC (T3N2M0 clinically and the patient received adjuvant chemotherapy. During the first year follow-up period, the patient remained asymptomatic with normal levels of laboratory tests including CEA measurement. However, a gradually rising CEA level after the 14th postoperative month necessitated further imaging studies including computed tomography of the abdomen which revealed a mass in the spleen that was subsequently confirmed by 18FDG- PET scanning to be an isolated metastasis. The patient underwent splenectomy 17 months after his previous cancer surgery. Histological diagnosis confirmed a metastatic adenocarcinoma with no capsule invasion. After an uneventful postoperative period, the patient has been symptom-free during the one-year of follow-up with normal blood CEA levels, although he did not accept to receive any further adjuvant therapy. To the best of our knowledge, this 14th case of isolated splenic metastasis from colorectal carcinoma is also the first reported case of splenic metastasis demonstrated preoperatively by 18FDG PET-CT fusion scanning which revealed its solitary nature as well. Conclusion Isolated splenic metastasis is a rare finding in the follow-up of colorectal cancer patients and long-term survival can be achieved with splenectomy.

A novel method for the angiographic estimation of the percentage of spleen volume embolized during partial splenic embolization

Energy Technology Data Exchange (ETDEWEB)

Ou, Ming-Ching; Chuang, Ming-Tsung [Department of Diagnostic Radiology, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China); Lin, Xi-Zhang [Department of Internal Medicine, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China); Tsai, Hong-Ming; Chen, Shu-Yuan [Department of Diagnostic Radiology, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China); Liu, Yi-Sheng, E-mail: taicheng100704@yahoo.com.tw [Department of Diagnostic Radiology, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China)

2013-08-15

Purpose: To evaluate the efficacy of estimating the volume of spleen embolized in partial splenic embolization (PSE) by measuring the diameters of the splenic artery and its branches. Materials and methods: A total of 43 liver cirrhosis patients (mean age, 62.19 ± 9.65 years) with thrombocytopenia were included. Among these, 24 patients underwent a follow-up CT scan which showed a correlation between angiographic estimation and measured embolized splenic volume. Estimated splenic embolization volume was calculated by a method based on diameters of the splenic artery and its branches. The diameters of each of the splenic arteries and branches were measured via 2D angiographic images. Embolization was performed with gelatin sponges. Patients underwent follow-up with serial measurement of blood counts and liver function tests. The actual volume of embolized spleen was determined by computed tomography (CT) measuring the volumes of embolized and non-embolized spleen two months after PSE. Results: PSE was performed without immediate major complications. The mean WBC count significantly increased from 3.81 ± 1.69 × 10{sup 3}/mm{sup 3} before PSE to 8.56 ± 3.14 × 10{sup 3}/mm{sup 3} at 1 week after PSE (P < 0.001). Mean platelet count significantly increased from 62.00 ± 22.62 × 10{sup 3}/mm{sup 3} before PSE to 95.40 ± 46.29 × 10{sup 3}/mm{sup 3} 1 week after PSE (P < 0.001). The measured embolization ratio was positively correlated with estimated embolization ratio (Spearman's rho [ρ] = 0.687, P < 0.001). The mean difference between the actual embolization ratio and the estimated embolization ratio was 16.16 ± 8.96%. Conclusions: The method provides a simple method to quantitatively estimate embolized splenic volume with a correlation of measured embolization ratio to estimated embolization ratio of Spearman's ρ = 0.687.

Splenic function after angioembolization for splenic trauma in children and adults: A systematic review

NARCIS (Netherlands)

Schimmer, J. A. G.; van der Steeg, A. F. W.; Zuidema, W. P.

2016-01-01

Splenic artery embolization (SAE), proximal or distal, is becoming the standard of care for traumatic splenic injury. Theoretically the immunological function of the spleen may be preserved, but this has not yet been proven. A parameter for measuring the remaining splenic function must therefore be

Splenic function after angioembolization for splenic trauma in children and adults: A systematic review.

Science.gov (United States)

Schimmer, J A G; van der Steeg, A F W; Zuidema, W P

2016-03-01

Splenic artery embolization (SAE), proximal or distal, is becoming the standard of care for traumatic splenic injury. Theoretically the immunological function of the spleen may be preserved, but this has not yet been proven. A parameter for measuring the remaining splenic function must therefore be determined in order to decide whether or not vaccinations and/or antibiotic prophylaxis are necessary to prevent an overwhelming post-splenectomy infection (OPSI). A systematic review of the literature was performed July 2015 by searching the Embase and Medline databases. Articles were eligible if they described at least two trauma patients and the subject was splenic function. Description of procedure and/or success rate of SAE was not necessary for inclusion. Two reviewers independently assessed the eligibility and the quality of the articles and performed the data extraction. Twelve studies were included, eleven with adult patients and one focusing on children. All studies used different parameters to assess splenic function. None of them reported a OPSI after splenic embolization. Eleven studies found a preserved splenic function after SAE, in both adults and children. All but one studies on the long term effects of SAE indicate a preserved splenic function. However, there is still no single parameter or test available which can demonstrate that unequivocally. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Treatment practice in patients with isolated blunt splenic injuries. A survey of Swiss traumatologists].

Science.gov (United States)

Schnüriger, B; Martens, F; Eberle, B M; Renzulli, P; Seiler, C A; Candinas, D

2013-01-01

The non-operative management (NOM) of blunt splenic injuries has gained widespread acceptance. However, there are still many controversies regarding follow-up of these patients. The purpose of this study was to survey active members of the Swiss Society of General and Trauma Surgery (SGAUC) to determine their practices regarding the NOM of isolated splenic injuries. A survey of active SGAUC members with a written questionnaire was carried out. The questionnaire was designed to elicit information about personal and facility demographics, diagnostic practices, in-hospital management, preferred follow-up imaging and return to activity. Out of 165 SGAUC members 52 (31.5%) completed the survey and 62.8% of all main trauma facilities in Switzerland were covered by the sample. Of the respondents 14 (26.9%) have a protocol in place for treating patients with splenic injuries. For initial imaging in hemodynamically stable patients 82.7% of respondents preferred ultrasonography (US). In cases of suspected splenic injury 19.2% of respondents would abstain from further imaging. In cases of contrast extravasation from the spleen half of the respondents would take no specific action. For low-grade injuries 86.5% chose to admit patients for an average of 1.6 days (range 0-4 days) with a continuously monitored bed. No differences in post-discharge activity restrictions between moderate and high-grade splenic injuries were found. The present survey showed considerable practice variation in several important aspects of the NOM of splenic injuries. Not performing further CT scans in patients with suspected splenic injuries and not intervening in cases of a contrast extravasation were the most important discrepancies to the current literature. Standardization of the NOM of splenic injuries may be of great benefit for both surgeons and patients.

Overview of Nonoperative Blunt Splenic Injury Management with Associated Splenic Artery Pseudoaneurysm.

Science.gov (United States)

Morrison, Chet A; Gross, Brian W; Kauffman, Matthew; Rittenhouse, Katelyn J; Rogers, Frederick B

2017-06-01

The delayed development of splenic artery pseudoaneurysm (SAP) can complicate the nonoperative management of splenic injuries. We sought to determine the utility of repeat imaging in diagnosing SAP in patients managed nonoperatively without angioembolization. We hypothesized that a significant rate of SAPs would be found in this population on repeat imaging. Patients undergoing nonoperative splenic injury management from January 2011 to June 2015 were queried from the trauma registry. Rates of repeat imaging, angioembolization, readmission, and SAP development were analyzed. Further, subanalyses investigating the incidence of SAP in patients managed nonoperatively without angioembolization were conducted. A total of 133 patients met inclusion criteria. Repeat imaging rate was 40 per cent, angioembolization rate was 26 per cent, and readmission rate was 6 per cent. Within the study population, nine SAPs were found (8/9 in patients with splenic injury grade ≥III). Of these nine SAPs, three (33%) were identified on initial scans and embolized, whereas six (67%) were found on repeat imaging in patients not initially receiving angioembolization. Splenic injuries are typically managed nonoperatively without serious complications. Our results suggest patients with splenic injuries grade ≥III managed nonoperatively without angioembolization should have repeat imaging within 48 hours to rule out the possibility of SAP.

Analysis of the value of imaging as part of the follow-up of splenic injury in children

Energy Technology Data Exchange (ETDEWEB)

Huebner, S. [Dept. of Radiology, Helath Sciences Centre, Winnipeg, MB (Canada); Reed, M.H. [Pediatric Radiology, Children' s Hospital, Winnipeg, Man. (Canada)

2001-12-01

Objective: A recent article suggested that routine follow-up imaging is still frequently used in the conservative management of splenic trauma in children. The purpose of this study was to use decision analysis to assess the value of routine imaging as part of the long-term follow-up of splenic injury in children managed nonoperatively. Methods: A literature review (1970-1999) on the management of blunt splenic trauma in children was performed. Data, including the use of follow-up imaging and the occurrence of delayed splenic rupture and death, on those patients managed nonoperatively were collected. The data were used to construct a decision tree. A Poisson distribution was used to determine the risk of delayed splenic rupture. Results: Information was extracted from 26 cohort studies. Nineteen of these studies were retrospective and six were prospective. One study had both retrospective and prospective arms. The study population consisted of 1,083 children. Of these patients, 920 (85 %) underwent routine follow-up imaging (US, CT, or scintigraphy). Follow-up imaging was either not performed or selectively performed in 163 patients (15 %). No cases of post-discharge splenic rupture or death were encountered in any of these groups. The maximum risk of delayed splenic rupture in the entire group was 0.3 % (0-3.7 cases). Conclusion:. The risk of delayed splenic rupture following blunt injury in children is very low, and is apparently unaffected by imaging protocols. No deaths, even in cases of delayed presentation, were identified in our study. These findings do not support the use of routine follow-up imaging of children with blunt splenic trauma. (orig.)

Analysis of the value of imaging as part of the follow-up of splenic injury in children

International Nuclear Information System (INIS)

Huebner, S.; Reed, M.H.

2001-01-01

Objective: A recent article suggested that routine follow-up imaging is still frequently used in the conservative management of splenic trauma in children. The purpose of this study was to use decision analysis to assess the value of routine imaging as part of the long-term follow-up of splenic injury in children managed nonoperatively. Methods: A literature review (1970-1999) on the management of blunt splenic trauma in children was performed. Data, including the use of follow-up imaging and the occurrence of delayed splenic rupture and death, on those patients managed nonoperatively were collected. The data were used to construct a decision tree. A Poisson distribution was used to determine the risk of delayed splenic rupture. Results: Information was extracted from 26 cohort studies. Nineteen of these studies were retrospective and six were prospective. One study had both retrospective and prospective arms. The study population consisted of 1,083 children. Of these patients, 920 (85 %) underwent routine follow-up imaging (US, CT, or scintigraphy). Follow-up imaging was either not performed or selectively performed in 163 patients (15 %). No cases of post-discharge splenic rupture or death were encountered in any of these groups. The maximum risk of delayed splenic rupture in the entire group was 0.3 % (0-3.7 cases). Conclusion:. The risk of delayed splenic rupture following blunt injury in children is very low, and is apparently unaffected by imaging protocols. No deaths, even in cases of delayed presentation, were identified in our study. These findings do not support the use of routine follow-up imaging of children with blunt splenic trauma. (orig.)

Massive Upper Gastrointestinal Bleeding from a Splenic Artery Pseudoaneurysm Caused by a Penetrating Gastric Ulcer: Case Report and Review of Literature

International Nuclear Information System (INIS)

Sawicki, Marcin; Marlicz, Wojciech; Czapla, Norbert; Łokaj, Marek; Skoczylas, Michał M.; Donotek, Maciej; Kołaczyk, Katarzyna

2015-01-01

Splenic artery aneurysm and pseudoaneurysm are rare pathologies. True aneurysms are usually asymptomatic. Aneurysm rupture occurring in 2–3% of cases results in bleeding into the lesser sack, peritoneal space or adjacent organs typically presenting as abdominal pain and hemodynamic instability. In contrast, pseudoaneurysms are nearly always symptomatic carrying a high risk of rupture of 37–47% and mortality rate of 90% if untreated. Therefore, prompt diagnosis and treatment are essential in the management of patients with splenic artery pseudoaneurysm. Typical causes include pancreatitis and trauma. Rarely, the rupture of a pseudoaneurysm presents as upper gastrointestinal (UGI) bleeding. Among causes, peptic ulcer is the casuistic one. This report describes a very rare case of recurrent UGI bleeding from a splenic artery pseudoaneurysm caused by a penetrating gastric ulcer. After negative results of endoscopy and ultrasound, the diagnosis was established in CT angiography. The successful treatment consisted of surgical ligation of the bleeding vessel and suture of the ulcer with preservation of the spleen and pancreas, which is rarely tried in such situations. The most important factor in identifying a ruptured splenic artery pseudoaneurysm as a source of GI bleeding is considering the diagnosis. UGI hemorrhage from splenic artery pseudoaneurysm can have a relapsing course providing false negative results of endoscopy and ultrasound if performed between episodes of active bleeding. In such cases, immediate CT angiography is useful in establishing diagnosis and in application of proper therapy before possible recurrence

CT perfusion imaging of the liver and the spleen in patients with cirrhosis: Is there a correlation between perfusion and portal venous hypertension?

International Nuclear Information System (INIS)

Talakic, Emina; Schoellnast, Helmut; Schaffellner, Silvia; Kniepeiss, Daniela; Mueller, Helmut; Stauber, Rudolf; Quehenberger, Franz

2017-01-01

To correlate hepatic and splenic CT perfusion parameters with hepatic venous pressure gradient (HVPG) measurements in patients with cirrhosis. Twenty-one patients with cirrhosis (males, 17; females, 4; mean ± SD age, 57 ± 7 years) underwent hepatic and splenic perfusion CT on a 320-detector row volume scanner as well as invasive measurement of HVPG. Different CT perfusion algorithms (maximum slope analysis and Patlak plot) were used to measure hepatic arterial flow (HAF), portal venous flow (PVF), hepatic perfusion index (HPI), splenic arterial flow (SAF), splenic blood volume (SBV) and splenic clearance (SCL). Hepatic and splenic perfusion parameters were correlated with HVPG, and sensitivity and specificity for detection of severe portal hypertension (≥12 mmHg) were calculated. The Spearman correlation coefficient was -0.53 (p < 0.05) between SAF and HVPG, and -0.68 (p < 0.01) between HVPG and SCL. Using a cut-off value of 125 ml/min/100 ml for SCL, sensitivity for detection of a HVPG of ≥12 mmHg was 94%, and specificity 100%. There was no significant correlation between hepatic perfusion parameters and HVPG. CT perfusion in patients with cirrhosis showed a strong correlation between SCL and HVPG and may be used for detection of severe portal hypertension. (orig.)

CT perfusion imaging of the liver and the spleen in patients with cirrhosis: Is there a correlation between perfusion and portal venous hypertension?

Energy Technology Data Exchange (ETDEWEB)

Talakic, Emina; Schoellnast, Helmut [Medical University of Graz, Division of General Radiology, Department of Radiology, Graz (Austria); Schaffellner, Silvia; Kniepeiss, Daniela; Mueller, Helmut [Medical University of Graz, Department of Surgery, Division of Transplantation Surgery, Graz (Austria); Stauber, Rudolf [Medical University of Graz, Department of Internal Medicine, Division of Gastoenterology and Hepatology, Graz (Austria); Quehenberger, Franz [Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, Graz (Austria)

2017-10-15

To correlate hepatic and splenic CT perfusion parameters with hepatic venous pressure gradient (HVPG) measurements in patients with cirrhosis. Twenty-one patients with cirrhosis (males, 17; females, 4; mean ± SD age, 57 ± 7 years) underwent hepatic and splenic perfusion CT on a 320-detector row volume scanner as well as invasive measurement of HVPG. Different CT perfusion algorithms (maximum slope analysis and Patlak plot) were used to measure hepatic arterial flow (HAF), portal venous flow (PVF), hepatic perfusion index (HPI), splenic arterial flow (SAF), splenic blood volume (SBV) and splenic clearance (SCL). Hepatic and splenic perfusion parameters were correlated with HVPG, and sensitivity and specificity for detection of severe portal hypertension (≥12 mmHg) were calculated. The Spearman correlation coefficient was -0.53 (p < 0.05) between SAF and HVPG, and -0.68 (p < 0.01) between HVPG and SCL. Using a cut-off value of 125 ml/min/100 ml for SCL, sensitivity for detection of a HVPG of ≥12 mmHg was 94%, and specificity 100%. There was no significant correlation between hepatic perfusion parameters and HVPG. CT perfusion in patients with cirrhosis showed a strong correlation between SCL and HVPG and may be used for detection of severe portal hypertension. (orig.)

Higher incidence of major complications after splenic embolization for blunt splenic injuries in elderly patients.

Science.gov (United States)

Wu, Shih-Chi; Fu, Chih-Yuan; Chen, Ray-Jade; Chen, Yung-Fang; Wang, Yu-Chun; Chung, Ping-Kuei; Yu, Shu-Fen; Tung, Cheng-Cheng; Lee, Kun-Hua

2011-02-01

Nonoperative management (NOM) of blunt splenic injuries has been widely accepted, and the application of splenic artery embolization (SAE) has become an effective adjunct to NOM. However, complications do occur after SAE. In this study, we assess the factors leading to the major complications associated with SAE. Focusing on the major complications after SAE, we retrospectively studied patients who received SAE and were admitted to 2 major referral trauma centers under the same established algorithm for management of blunt splenic injuries. The demographics, angiographic findings, and factors for major complications after SAE were examined. Major complications were considered to be direct adverse effects arising from SAE that were potentially fatal or were capable of causing disability. There were a total of 261 patients with blunt splenic injuries in this study. Of the 261 patients, 53 underwent SAE, 11 (21%) of whom were noted to have 12 major complications: 8 cases of postprocedural bleeding, 2 cases of total infarction, 1 case of splenic abscess, and 1 case of splenic atrophy. Patients older than 65 years were more susceptible to major complications after SAE. Splenic artery embolization is considered an effective adjunct to NOM in patients with blunt splenic injuries. However, risks of major complications do exist, and being elderly is, in part, associated with a higher major complication incidence. Copyright © 2011 Elsevier Inc. All rights reserved.

Splenic abscess: a rare presentation

Directory of Open Access Journals (Sweden)

Mohit Bhatia

2015-01-01

Full Text Available Splenic abscess is a rare clinical entity with an incidence of 0.2-0.7% in autopsy-based studies. When untreated, splenic abscess is associated with nearly 100% mortality; in treated patients, the mortality rate is 16.6% during the first 90 days. It mostly occurs in patients with neoplasia, immunodeficiency, trauma, diabetes or splenic infarct. The incidence of splenic abscess is thought to be growing because of the increase in the number of immunocompromised patients who are particularly at risk for this disease and also because of the widespread use of diagnostic modalities. However, the optimal treatment for this remains unclear. We present a case of a 42-year-old man diagnosed with multiloculated splenic abscess and was subjected to splenectomy.

Massive splenic infarction in children with sickle cell anemia and the role of splenectomy.

Science.gov (United States)

Al-Salem, Ahmed H

2013-03-01

Massive splenic infarction (MSI) is a very rare condition. Few reports of splenic infarction of various etiologies including hematological and non-hematological causes have been published. On the other hand, MSI in patients with sickle cell anemia (SCA) is extremely rare. This report describes our experience with 15 children with SCA and MSI outlining aspects of presentation, diagnosis and management. The records of all children with MSI were retrospectively reviewed for age at diagnosis, sex, clinical features, precipitating factors, investigations, management and outcome. 15 children (11 M: 4 F) with SCA were treated for MSI. Their mean age was 10.9 years (6-17 years). All presented with severe left upper quadrant abdominal pain. In nine, this was associated with nausea and vomiting. Three were febrile and all had a tender splenomegaly. Their mean hemoglobin was 8.2 g/dl (5.7-11.3 g/dl), mean WBC was 10.97 × 10(3) mm(-3) (3.6 × 10(3)-22.3 × 10(3) mm(-3)) and mean platelet count was 263.3 × 10(3) mm(-3) (40 × 10(3)-660 × 10(3) mm(-3)). In seven, there was a precipitating cause including high altitude in two, acute chest syndrome in two, septicemia in two and severe vasooclusive crisis in one. Abdominal ultrasound and CT scan confirmed the diagnosis of MSI which involved more than half of the spleen in 12 and whole spleen in 3. All were treated with IV fluids, analgesia and blood transfusion where appropriate. Eleven had splenectomy because of persistent abdominal pain, three developed splenic abscess and underwent splenectomy and one settled on conservative treatment. Histology confirmed the diagnosis of splenic infarction in 11 and infarction with abscess in the remaining 3. MSI is extremely rare in children with SCA. It can develop spontaneously or precipitated by other factors namely high altitude, acute chest syndrome and severe stress. Most reported cases of splenic infarction are small in size, focal and can be treated conservatively. MSI, on the other

Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients

Energy Technology Data Exchange (ETDEWEB)

Wang, Qi, E-mail: wqtjmu@gmail.com; Xiong, Bin, E-mail: herrxiong@126.com; Zheng, ChuanSheng, E-mail: hqzcsxh@sina.com; Liang, Ming, E-mail: whliangming@163.com; Han, Ping, E-mail: cjr.hanping@vip.163.com [Huazhong University of Science and Technology, Department of Radiology, Union Hospital, Tongji Medical College (China)

2016-03-15

ObjectiveThis retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding.MethodsFrom August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization. Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). The patients were clinically followed.ResultsIn 14 patients, splenic arterial embolization was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up.ConclusionsSplenic arterial embolization, particularly the two-step method, proved feasible and effective for the treatment of SPH patients with gastric varices or gastric variceal bleeding.

Embolization Therapy for Traumatic Splenic Lacerations

Energy Technology Data Exchange (ETDEWEB)

Dasgupta, Niloy; Matsumoto, Alan H., E-mail: ahm4d@virginia.edu; Arslan, Bulent; Turba, Ulku C.; Sabri, Saher; Angle, John F. [University of Virginia Health System, Division of Vascular and Interventional Radiology, Department of Radiology (United States)

2012-08-15

Purpose: This study was designed to evaluate the clinical success, complications, and transfusion requirements based on the location of and agents used for splenic artery embolization in patients with splenic trauma. Methods: A retrospective study was performed of patients with splenic trauma who underwent angiography and embolization from September 2000 to January 2010 at a level I trauma center. Electronic medical records were reviewed for demographics, imaging data, technical aspects of the procedure, and clinical outcomes. Results: Fifty patients were identified (34 men and 16 women), with an average age of 48 (range, 16-80) years. Extravasation was seen on initial angiography in 27 (54%) and was absent in 23 (46%). All 27 patients with extravasation were embolized, and 18 of 23 (78.2%) without extravasation were embolized empirically. Primary clinical success was similar (>75%) across all embolization locations, embolic agents, and grades of laceration treated. Of 45 patients treated, 9 patients (20%) were embolized in the main splenic artery, 34 (75.6%) in the splenic hilum, and 2 (4.4%) were embolized in both locations. Partial splenic infarctions developed in 47.3% treated in the splenic hilum compared with 12.5% treated in the main splenic artery. There were four (8.9%) mortalities: two occurred in patients with multiple critical injuries and two from nonbleeding etiologies. Conclusions: Embolization of traumatic splenic artery injuries is safe and effective, regardless of the location of treatment. Embolization in splenic hilar branches may have a higher incidence of infarction. The grade of laceration and agents used for embolotherapy did not impact the outcomes.

Embolization Therapy for Traumatic Splenic Lacerations

International Nuclear Information System (INIS)

Dasgupta, Niloy; Matsumoto, Alan H.; Arslan, Bulent; Turba, Ulku C.; Sabri, Saher; Angle, John F.

2012-01-01

Purpose: This study was designed to evaluate the clinical success, complications, and transfusion requirements based on the location of and agents used for splenic artery embolization in patients with splenic trauma. Methods: A retrospective study was performed of patients with splenic trauma who underwent angiography and embolization from September 2000 to January 2010 at a level I trauma center. Electronic medical records were reviewed for demographics, imaging data, technical aspects of the procedure, and clinical outcomes. Results: Fifty patients were identified (34 men and 16 women), with an average age of 48 (range, 16–80) years. Extravasation was seen on initial angiography in 27 (54%) and was absent in 23 (46%). All 27 patients with extravasation were embolized, and 18 of 23 (78.2%) without extravasation were embolized empirically. Primary clinical success was similar (>75%) across all embolization locations, embolic agents, and grades of laceration treated. Of 45 patients treated, 9 patients (20%) were embolized in the main splenic artery, 34 (75.6%) in the splenic hilum, and 2 (4.4%) were embolized in both locations. Partial splenic infarctions developed in 47.3% treated in the splenic hilum compared with 12.5% treated in the main splenic artery. There were four (8.9%) mortalities: two occurred in patients with multiple critical injuries and two from nonbleeding etiologies. Conclusions: Embolization of traumatic splenic artery injuries is safe and effective, regardless of the location of treatment. Embolization in splenic hilar branches may have a higher incidence of infarction. The grade of laceration and agents used for embolotherapy did not impact the outcomes.

Radiological characteristics of splenic lesions: how to distinguish them?

International Nuclear Information System (INIS)

Leao, Alberto Ribeiro de Souza; Freire Filho, Edison de Oliveira; Szejnfeld, Jacob; D'Ippolito, Giuseppe

2005-01-01

The spleen is often overlooked in studies of the upper abdomen probably due to the low frequency in which it occurs when compared to other abdominal solid organs. In this study we describe the main forms of splenic involvement by malignant or benign neoplasms, vascular, inflammatory and traumatic lesions, as well as congenital anomalies and variants of normality. We aimed to evaluate some characteristics and radiological aspects that permit the definition of the nature of splenic changes with considerable precision in order to allow an accurate diagnosis and increase radiologist's confidence on different situations. (author)

CT perfusion imaging of the liver and the spleen in patients with cirrhosis: Is there a correlation between perfusion and portal venous hypertension?

Science.gov (United States)

Talakić, Emina; Schaffellner, Silvia; Kniepeiss, Daniela; Mueller, Helmut; Stauber, Rudolf; Quehenberger, Franz; Schoellnast, Helmut

2017-10-01

To correlate hepatic and splenic CT perfusion parameters with hepatic venous pressure gradient (HVPG) measurements in patients with cirrhosis. Twenty-one patients with cirrhosis (males, 17; females, 4; mean ± SD age, 57 ± 7 years) underwent hepatic and splenic perfusion CT on a 320-detector row volume scanner as well as invasive measurement of HVPG. Different CT perfusion algorithms (maximum slope analysis and Patlak plot) were used to measure hepatic arterial flow (HAF), portal venous flow (PVF), hepatic perfusion index (HPI), splenic arterial flow (SAF), splenic blood volume (SBV) and splenic clearance (SCL). Hepatic and splenic perfusion parameters were correlated with HVPG, and sensitivity and specificity for detection of severe portal hypertension (≥12 mmHg) were calculated. The Spearman correlation coefficient was -0.53 (p portal hypertension. • SAF and SCL are statistically significantly correlated with HVPG • SCL showed stronger correlation with HVPG than SAF • 125 ml/min/100 ml SCL-cut-off yielded 94 % sensitivity, 100 % specificity for severe PH • HAF, PVF and HPI showed no statistically significant correlation with HVPG.

Rare case of isolated splenic metastases from gastric cancer detected with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography

International Nuclear Information System (INIS)

Kamaleshwaran, Koramadai Karuppusamy; Shibu, Deepu; Sugunan Shinto, Ajit; Sivanesan, Balasubramanian

2013-01-01

We report a rare case of isolated splenic metastasis from gastric cancer detected with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT). A 55-year-old man with gastric cancer 1 year post surgery, evaluated with PET/CT showed focal, intense uptake in the spleen, with no other abnormal findings. On splenectomy, the lesion was confirmed as metastasis from gastric cancer pathologically. (author)

Meningoencephalitis, pancytopenia, pulmonary insufficiency and splenic abscess in a patient with brucellosis

International Nuclear Information System (INIS)

Cokca, F.; Yilmaz-Bozkurt, G.; Azap, A.; Memikoglu, O.; Takeli, E.

2006-01-01

A complicated case of brucellosis with some rare features is reported. Brucellosis is a multisystematic disease. However, disseminated brucellosis with cerebral, pulmonary, hematopoietic and splenic involvement in an otherwise healthy patient is a rare event. In this article, we report a case of disseminated brucellosis who was initially diagnosed as myeldoplastic syndrome (MDS) and meningoencephalitis, pulmonary symptoms, and splenic abscess formation occurred thereafter. (author)

Escherichia coli clearance after splenic autotransplants

International Nuclear Information System (INIS)

Marques, R.G.; Petroianu, A.; Oliveira, M.B.N.; Bernardo-Filho, M.; Portela, M.C.

2002-01-01

Background: Splenic autotransplantation seems to be the only alternative for preservation of splenic tissue, after total splenectomy. The present study was carried out to analyze Escherichia coli depuration by mononuclear phagocyte system organs after total splenectomy and splenic autotransplantation. Methods: We utilized an experimental model including young and adult Wistar rats, of both sexes, submitted to total splenectomy and splenic autotransplantation. The evaluation method was intravenous inoculation of a suspension of Escherichia coli labeled with technetium-99m. We analyzed bacteria uptake by mononuclear phagocyte system organs and bacteria remnant in the bloodstream. Results: There was no difference between young and adult animals in bacteria uptake by mononuclear phagocyte system organs. In the comparison of groups, it was found out that the mean percent uptake by spleen and liver of animals in the control group was higher than that observed for animals with splenic implants. However, bacteria uptake in the lung was higher in the splenic implant group than in the control group. Although spleen bacteria uptake in the control group animals has been higher than that of animals in the splenic implant group, the remnant bacteria in the bloodstream was similar. Animals submitted to isolated total splenectomy showed higher bacteria remnant in the bloodstream than animals of the control group or the group submitted to total splenectomy combined with splenic autotransplantation. Conclusion: Our results indicate that autogenous splenic implant is efficacious in bacteria depuration in rats, by means of their macrophages phagocytosis. In addition, it does not modify bacteria removal function of liver and lung

CT and pathologic studies in detecting hepatic involvement of malignant lymphoma

International Nuclear Information System (INIS)

Okazaki, Atsushi; Niibe, Hideo; Mitsuhashi, Norio

1985-01-01

In order to determine the value of CT in detecting lymphomatous involvement of the liver, 57 autopsied cases (48 cases of non-Hodgkin lymphoma and 9 of Hodgkin's disease) were analyzed in detail. Additionally, 90 recent cases of abdominal CT with liver study in the initial staging were reviewed and 6 cases in which the liver had been examined within 2 weeks before autopsy were compared for macroscopic and pathologic findings. The following results were obtained. 1) Autopsy findings in 57 cases of malignant lymphoma. (1) Hepatic involvement was demonstrated in 56% of the patients with non-Hodgkin lymphoma and in 67% of those with Hodgkin's disease. (2) Of these patients with hepatic involvement, intrahepatic nodular lesions over 1.0cm in diameter were macroscopically identified in 22% of the cases of non-Hodgkin lymphoma and 33% of those with Hodgkin's disease. (3) Lymphomatous involvements were seen in many organs in the cases of hepatic involvement. 2) CT examinations of 90 cases for the initial staging showed no significant abnormality in the liver or spleen. 3) Of the 6 cases in which the liver was examined by CT within about 2 weeks before autopsy, lymphomatous involvemet was pathologically diagnosed in 5. Of these, only one having multiple nodules larger than the tip of a thumb was correctly diagnosed by CT. 4) Hepatic involvement of lymphoma was thought to be the end stage, and minimal or early disease was detected in the region of Glisson's capsule. The above findings indicate that early hepatic involvement is not likely to be detected by CT at the present time. (author)

CT arterial portography and CT arteriography with a triple-lumen balloon catheter

International Nuclear Information System (INIS)

Murakami, T.; Oi, H.; Hori, M.; Kim, T.; Takahashi, S.; Matsushita, M.; Narumi, Y.; Nakamura, H.

1997-01-01

Purpose: To evaluate the usefulness of the triple-lumen balloon catheter in the serial performance of CT arterial portography (CT-AP) and CT arteriography (CT-A). Material and Methods: A combined CT-AP and CT-A examination of 58 patients was carried out in which a cobra-type triple-lumen balloon catheter was used. CT-AP was performed by injecting contrast medium either into the splenic artery through a side-hole in the catheter proximal to the balloon inflated in the common hepatic artery, or into the superior mesentric artery through an end-hole in the catheter. Then CT-A was serially performed by delivering contrast medium either to the common hepatic artery or the proper hepatic artery from the end-hole, or to the accessory right hepatic artery through a side-hole proximal to the inflated balloon. Results: Sufficient CT-APs were obtained in 53 of the 58 patients (91%), CT-A in 42 (72%), and both in 42 (72%). Incomplete CT-AP was due to technical failure or anatomical anomaly, as was incomplete CT-A. No complications were seen. (orig.)

Multiple foci of splenic tissue autotransplantation: Splenosis in diagnostic imaging

International Nuclear Information System (INIS)

Laskowska, K.; Burzynska-Makuch, M.; Drewa, S.; Lasek, W.; Pilecki, S.; Junik, R.

2005-01-01

Splenosis is usually defined as an autotransplantation of lienal tissue in the abdomen or cest following trauma to the spleen and/or splenectomy. The authors present the case of patient 15 years after a splenectomy performed because of extensive abdominal trauma. A new computed tomographic (CT) scan of the abdomen revealed multiple homogenous nodules, different in size, spread in the abdomen. Their density was characteristic of spleen. Ultrasound examination revealed only the largest tumors, located close to the liver and apparently isoechogenic to it. Static scintigraphy and SPECT were performed to prove the presence of splenosis. After treating the patient with colloid sulfide, multiple foci of increased radioisotope accumulation were identified in the abdomen, extrahepatic at the same locations as the masses visible on the CT scans, which were comparable to splenic tissue. Nodules revealed during CT or abdominal US in patients previously treated by splenectomy require further imaging with static scintigraphy of the liver and spleen in order to confirm or exclude splenosis. (author)

Tortuosity and calcification of the splenic artery. More than an additional finding

International Nuclear Information System (INIS)

Golder, W.A.

2008-01-01

Tortuosity of the splenic artery and calcification of the vessel wall are typical additional findings on plain abdominal x-ray. The combination of both anomalies is common in elderly persons presenting without symptoms of splenic ischemia. Its pathogenesis is thought to be multifactorial. In infancy and childhood, the splenic artery is stretched in its entire course. A growing difference between the length of the vessel and the distance between its origin and the splenic hilum gives rise to tortuosity. The artery's proximal segment is involved more frequently and more severely than the distal one. The tortuous route of the vessel is accentuated by the direction of its major branches, which is roughly perpendicular to the main trajectory. Neither tortuosity nor calcification should be taken to be risk factors for the comparatively common splenic artery aneurysm. Calcific deposits are not confined to the media but are also detected in the intima of the vascular wall. Critical narrowings of the lumen arising on the calcium deposits are not observed. Calcifying atherosclerosis of the splenic artery is comparable to medial sclerosis of the peripheral arteries frequently noticed in diabetics and dialysis patients. Only the less important calcification of the intima may be attributed to mechanisms of the hydrohemodynamic theory of atherosclerosis. The spleen's blood storage capacity may contribute to the characteristic age-dependent alterations of the shape and course of the splenic artery. (orig.) [de

CT of the congenital and spleen acquired abnormalities; TC de las anomalias congenitas y adquiridas del bazo

Energy Technology Data Exchange (ETDEWEB)

Gil, A.; Ibarburen, C.; Anton, E.; Temprano, C.; Salgado, F. M.; Davila, J. [Hospital de Mostoles. Madrid (Spain)

2000-07-01

This study aims to review the X-ray characteristics of the different entities that can affect the spleen by illustrating the semiology that is seen in the Computed tomography (CT). We review 239 cases of splenic pathology that occurred during a period of 15 years (1985-1999). All of the patients underwent a CT with and without i. v. contrast. Most of the patients were submitted to a splenectomy and histological correlation was performed. The CT is the imaging technique of choice in the diagnosis of splenic diseases since the ultrasonography, although a very sensitive technique, is very inspecific. (Author) 36 refs.

Splenic irradiation for hairy cell leukaemia

Energy Technology Data Exchange (ETDEWEB)

Al-Moundhri, A.; Graham, P.H. [St George Hospital, Kogarah, NSW, (Australia). Department of Radiation Oncology

1997-11-01

Splenic irradiation in the management of hairy cell leukaemia is previously unreported. A case is presented here to illustrate that splenic irradiation may be a useful addition to systemic therapies. It achieved local splenic and blood picture response and remission similar to splenectomy without any significant toxicity. (authors). 7 refs., 2 figs.

Operative management of splenic injury in a patient with proteus syndrome

Directory of Open Access Journals (Sweden)

Umashankkar Kannan

2014-01-01

Full Text Available A 20-year-old female with Proteus syndrome sustained splenic injury after fall from a bike. She was initially managed non-operatively at a different hospital for three days and was then referred to our level I trauma center in view of increasing abdominal pain and distention. On admission in the Emergency Department (ED, her pulse rate was 120 per minute and blood pressure was 108/68 mm Hg. Clinical examination showed a distended abdomen with left hypochondrial pain. Ultrasonogram (USG and Computed Tomography (CT of the abdomen showed splenomegaly and grade III splenic injury with significant hemoperitoneum. Her hemoglobin was 2.9 g/dl with packed cell volume (PCV of 12%. In view of low hemoglobin and possibility of pathologic spleen, splenectomy was done. Microscopic examination of the spleen showed hemangiolymphangioma. The patient was discharged on the 5 th post-operative day and is doing well at 6 months of follow-up.

Automated detection and volumetric segmentation of the spleen in CT scans; Automatische Detektion und volumetrische Segmentierung der Milz in CT-Untersuchungen

Energy Technology Data Exchange (ETDEWEB)

Hammon, M.; Dankerl, P.; Janka, R.; Uder, M.; Cavallaro, A. [Universitaetsklinikum Erlangen (Germany). Radiologisches Inst.; Kramer, M.; Seifert, S.; Tsymbal, A.; Costa, M.J. [Siemens AG, Erlangen (Germany). Corporate Technology

2012-08-15

To introduce automated detection and volumetric segmentation of the spleen in spiral CT scans with the THESEUS-MEDICO software. The consistency between automated volumetry (aV), estimated volume determination (eV) and manual volume segmentation (mV) was evaluated. Retrospective evaluation of the CAD system based on methods like ''marginal space learning'' and ''boosting algorithms''. 3 consecutive spiral CT scans (thoraco-abdominal; portal-venous contrast agent phase; 1 or 5 mm slice thickness) of 15 consecutive lymphoma patients were included. The eV: 30 cm{sup 3} + 0.58 (width x length x thickness of the spleen) and the mV as the reference standard were determined by an experienced radiologist. The aV could be performed in all CT scans within 15.2 ({+-} 2.4) seconds. The average splenic volume measured by aV was 268.21 {+-} 114.67 cm{sup 3} compared to 281.58 {+-} 130.21 cm{sup 3} in mV and 268.93 {+-} 104.60 cm{sup 3} in eV. The correlation coefficient was 0.99 (coefficient of determination (R{sup 2}) = 0.98) for aV and mV, 0.91 (R{sup 2} = 0.83) for mV and eV and 0.91 (R{sup 2} = 0.82) for aV and eV. There was an almost perfect correlation of the changes in splenic volume measured with the new aV and mV (0.92; R{sup 2} = 0.84), mV and eV (0.95; R{sup 2} = 0.91) and aV and eV (0.83; R{sup 2} = 0.69) between two time points. The automated detection and volumetric segmentation software rapidly provides an accurate measurement of the splenic volume in CT scans. Knowledge about splenic volume and its change between two examinations provides valuable clinical information without effort for the radiologist. (orig.)

CT in pancreatic involvement of non-Hodgkin lymphoma

International Nuclear Information System (INIS)

Prayer, L.; Schurawitzki, H.; Mallek, R.; Mostbeck, G.

1992-01-01

In an attempt to evaluate characteristic CT features of primary pancreatic involvement in non-Hodgkin lymphoma (NHL), scans of 10 patients were reviewed retrospectively and compared to 50 patients with histologically proved different neoplasms of the pancreas. Setting the correct diagnosis of NHL would be essential for planning of treatment and prognosis. CT findings of NHL were characteristic but not specific. Nevertheless, the presence of a homogeneous pancreatic mass with a diameter of 7 cm or more, infiltrating surrounding tissue accompanied by retroperitoneal and/or mesenteric lymphadenopathy strongly suggests NHL. CT-guided needle biopsy can help to establish the diagnosis of pancreatic NHL. (orig.)

CT in pancreatic involvement of non-Hodgkin lymphoma

Energy Technology Data Exchange (ETDEWEB)

Prayer, L.; Schurawitzki, H.; Mallek, R.; Mostbeck, G. (Allgemeines Krankenhaus, Vienna (Austria). Dept. of Radiology)

1992-03-01

In an attempt to evaluate characteristic CT features of primary pancreatic involvement in non-Hodgkin lymphoma (NHL), scans of 10 patients were reviewed retrospectively and compared to 50 patients with histologically proved different neoplasms of the pancreas. Setting the correct diagnosis of NHL would be essential for planning of treatment and prognosis. CT findings of NHL were characteristic but not specific. Nevertheless, the presence of a homogeneous pancreatic mass with a diameter of 7 cm or more, infiltrating surrounding tissue accompanied by retroperitoneal and/or mesenteric lymphadenopathy strongly suggests NHL. CT-guided needle biopsy can help to establish the diagnosis of pancreatic NHL. (orig.).

[A Case of Gastric Cancer with Splenic Artery Aneurysm, Intraoperative ICG Fluorography Is Useful in Evaluating the Blood Flow of Stomach and Spleen].

Science.gov (United States)

Usui, Kenji; Sakamoto, Kaoru; Akabane, Kentaro; Hayasaka, Kazuki; Mizuki, Toru; Yagi, Yutaka; Shirahata, Yasuhiro; Ichikawa, Hiroshi; Hanyu, Takaaki; Ishikawa, Takashi; Kameyama, Hitoshi; Suzuki, Satoshi; Saito, Kiyohiro; Wakai, Toshifumi

2017-11-01

An 81-year-oldwoman with advancedgastric cancer was referredto our hospital. Preoperative contrast-enhancedCT revealeda roundcalcification of the splenic hilum with 15mm in diameter as a splenic artery aneurysm. She underwent transcatheter arterial embolization(TAE)for the splenic artery aneurysm. Celiac artery angiography showedcollateral arterial network of the spleen from left gastric artery. Surgery for the gastric cancer was performed1 4 days after TAE. We cut the right gastric andbilateral epigastric arteries. After the left gastric artery clamping, we performedintraoperative indocyanine green(ICG)fluorography. ICG fluorography confirmedthat the bloodflow of the upper thirdof the stomach andspleen were maintained. We safely performed distal gastrectomy, and the postoperative course was uneventful.

Changing patterns in the management of splenic trauma: the impact of nonoperative management.

Science.gov (United States)

Pachter, H L; Guth, A A; Hofstetter, S R; Spencer, F C

1998-01-01

OBJECTIVE: The recognition that splenectomy renders patients susceptible to lifelong risks of septic complications has led to routine attempts at splenic conservation after trauma. In 1990, the authors reported that over an 11-year study period involving 193 patients, splenorrhaphy was the most common splenic salvage method (66% overall) noted, with nonoperative management employed in only 13% of blunt splenic injuries. This report describes changing patterns of therapy in 190 consecutive patients with splenic injuries seen during a subsequent 6-year period (1990 to 1996). An algorithmic approach for patient management and pitfalls to be avoided to ensure safe nonoperative management are detailed. METHODS: Nonoperative management criteria included hemodynamic stability and computed tomographic examination without shattered spleen or other injuries requiring celiotomy. RESULTS: Of 190 consecutive patients, 102 (54%) were managed nonoperatively: 96 (65%) of 147 patients with blunt splenic injuries, which included 15 patients with intrinsic splenic pathology, and 6 hemodynamically stable patients with isolated stab wounds (24% of all splenic stab wounds). Fifty-six patients underwent splenectomy (29%) and 32 splenorrhaphy (17%). The mean transfusion requirement was 6 units for splenectomy survivors and 0.8 units for nonoperative therapy (85% received no transfusions). Fifteen of the 16 major infectious complications that occurred followed splenectomy. Two patients failed nonoperative therapy (2%) and underwent splenectomy, and one patient required splenectomy after partial splenic resection. There no missed enteric injuries in patients managed nonoperatively. The overall mortality rate was 5.2%, with no deaths following nonoperative management. CONCLUSIONS: Nonoperative management of blunt splenic injuries has replaced splenorrhaphy as the most common method of splenic conservation. The criteria have been extended to include patients previously excluded from this form

Splenic trauma: Is splenectomy redundant?

Directory of Open Access Journals (Sweden)

S Tandon

2013-01-01

Full Text Available 41 year old male, serving air warrior sustained blunt abdominal trauma, CECT revealed grade III splenic injury. He was managed conservatively with good clinical outcome. Conservatism is the new approach to splenic trauma.

Determinants of splenectomy in splenic injuries following blunt ...

African Journals Online (AJOL)

Introduction. The management of splenic injuries has shifted from splenectomy to splenic preservation owing to the risk of overwhelming post-splenectomy infection (OPSI). This study aimed to identify the factors that determine splenectomy in patients with isolated splenic injuries, with a view to increasing the rate of splenic ...

Splenic Rupture Diagnosed with Bedside Ultrasound in a Patient with Shock in the Emergency Department Following Colonoscopy

Directory of Open Access Journals (Sweden)

William Mulkerin

2015-10-01

Full Text Available A 64-year-old male presented to the emergency department (ED with near syncope and worsening left flank and shoulder pain. He had undergone a difficult colonoscopy two days prior due to a tortuous colon. Initial vital signs were normal. He looked uncomfortable and had significant left upper quadrant abdominal tenderness with guarding. Thirty minutes after ED arrival, his blood pressure dropped to 73/59 mmHg, requiring aggressive fluid resuscitation. Bedside focused assessment with sonography in trauma (FAST exam demonstrated free fluid in the abdomen with mixed echogenicity of the spleen, suggestive of splenic injury. Computed tomography (CT demonstrated a large subcapsular splenic hematoma with active extravasation and surrounding intraperitoneal free fluid (Figure, Video. He was admitted to the surgical intensive care unit. Hemorrhage continued after interventional radiology performed embolization of the splenic artery. He then required laparoscopic splenectomy on hospital day 2 to control bleeding. He subsequently did well and was discharged on hospital day 10.

Giant-cell arteritis. Concordance study between aortic CT angiography and FDG-PET/CT in detection of large-vessel involvement

International Nuclear Information System (INIS)

Boysson, Hubert de; Dumont, Anael; Boutemy, Jonathan; Maigne, Gwenola; Martin Silva, Nicolas; Sultan, Audrey; Bienvenu, Boris; Aouba, Achille; Liozon, Eric; Ly, Kim Heang; Lambert, Marc; Aide, Nicolas; Manrique, Alain

2017-01-01

The purpose of our study was to assess the concordance of aortic CT angiography (CTA) and FDG-PET/CT in the detection of large-vessel involvement at diagnosis in patients with giant-cell arteritis (GCA). We created a multicenter cohort of patients with GCA diagnosed between 2010 and 2015, and who underwent both FDG-PET/CT and aortic CTA before or in the first ten days following treatment introduction. Eight vascular segments were studied on each procedure. We calculated concordance between both imaging techniques in a per-patient and a per-segment analysis, using Cohen's kappa concordance index. We included 28 patients (21/7 women/men, median age 67 [56-82]). Nineteen patients had large-vessel involvement on PET/CT and 18 of these patients also presented positive findings on CTA. In a per-segment analysis, a median of 5 [1-7] and 3 [1-6] vascular territories were involved on positive PET/CT and CTA, respectively (p = 0.03). In qualitative analysis, i.e., positivity of the procedure suggesting a large-vessel involvement, the concordance rate between both procedures was 0.85 [0.64-1]. In quantitative analysis, i.e., per-segment analysis in both procedures, the global concordance rate was 0.64 [0.54-0.75]. Using FDG-PET/CT as a reference, CTA showed excellent sensitivity (95%) and specificity (100%) in a per-patient analysis. In a per-segment analysis, sensitivity and specificity were 61% and 97.9%, respectively. CTA and FDG-PET/CT were both able to detect large-vessel involvement in GCA with comparable results in a per-patient analysis. However, PET/CT showed higher performance in a per-segment analysis, especially in the detection of inflammation of the aorta's branches. (orig.)

Giant-cell arteritis. Concordance study between aortic CT angiography and FDG-PET/CT in detection of large-vessel involvement

Energy Technology Data Exchange (ETDEWEB)

Boysson, Hubert de; Dumont, Anael; Boutemy, Jonathan; Maigne, Gwenola; Martin Silva, Nicolas; Sultan, Audrey; Bienvenu, Boris; Aouba, Achille [Caen University Hospital, Department of Internal Medicine, Caen (France); Liozon, Eric; Ly, Kim Heang [Limoges University Hospital, Department of Internal Medicine, Limoges (France); Lambert, Marc [Lille University Hospital, Department of Internal Medicine, Lille (France); Aide, Nicolas [Caen University Hospital, Department of Nuclear Medicine, Caen (France); INSERM U1086 ' ' ANTICIPE' ' , Francois Baclesse Cancer Centre, Caen (France); Manrique, Alain [Caen University Hospital, Department of Nuclear Medicine, Caen (France); Normandy University, Caen (France)

2017-12-15

The purpose of our study was to assess the concordance of aortic CT angiography (CTA) and FDG-PET/CT in the detection of large-vessel involvement at diagnosis in patients with giant-cell arteritis (GCA). We created a multicenter cohort of patients with GCA diagnosed between 2010 and 2015, and who underwent both FDG-PET/CT and aortic CTA before or in the first ten days following treatment introduction. Eight vascular segments were studied on each procedure. We calculated concordance between both imaging techniques in a per-patient and a per-segment analysis, using Cohen's kappa concordance index. We included 28 patients (21/7 women/men, median age 67 [56-82]). Nineteen patients had large-vessel involvement on PET/CT and 18 of these patients also presented positive findings on CTA. In a per-segment analysis, a median of 5 [1-7] and 3 [1-6] vascular territories were involved on positive PET/CT and CTA, respectively (p = 0.03). In qualitative analysis, i.e., positivity of the procedure suggesting a large-vessel involvement, the concordance rate between both procedures was 0.85 [0.64-1]. In quantitative analysis, i.e., per-segment analysis in both procedures, the global concordance rate was 0.64 [0.54-0.75]. Using FDG-PET/CT as a reference, CTA showed excellent sensitivity (95%) and specificity (100%) in a per-patient analysis. In a per-segment analysis, sensitivity and specificity were 61% and 97.9%, respectively. CTA and FDG-PET/CT were both able to detect large-vessel involvement in GCA with comparable results in a per-patient analysis. However, PET/CT showed higher performance in a per-segment analysis, especially in the detection of inflammation of the aorta's branches. (orig.)

[Automated detection and volumetric segmentation of the spleen in CT scans].

Science.gov (United States)

Hammon, M; Dankerl, P; Kramer, M; Seifert, S; Tsymbal, A; Costa, M J; Janka, R; Uder, M; Cavallaro, A

2012-08-01

To introduce automated detection and volumetric segmentation of the spleen in spiral CT scans with the THESEUS-MEDICO software. The consistency between automated volumetry (aV), estimated volume determination (eV) and manual volume segmentation (mV) was evaluated. Retrospective evaluation of the CAD system based on methods like "marginal space learning" and "boosting algorithms". 3 consecutive spiral CT scans (thoraco-abdominal; portal-venous contrast agent phase; 1 or 5 mm slice thickness) of 15 consecutive lymphoma patients were included. The eV: 30 cm³ + 0.58 (width × length × thickness of the spleen) and the mV as the reference standard were determined by an experienced radiologist. The aV could be performed in all CT scans within 15.2 (± 2.4) seconds. The average splenic volume measured by aV was 268.21 ± 114.67 cm³ compared to 281.58 ± 130.21 cm³ in mV and 268.93 ± 104.60 cm³ in eV. The correlation coefficient was 0.99 (coefficient of determination (R²) = 0.98) for aV and mV, 0.91 (R² = 0.83) for mV and eV and 0.91 (R² = 0.82) for aV and eV. There was an almost perfect correlation of the changes in splenic volume measured with the new aV and mV (0.92; R² = 0.84), mV and eV (0.95; R² = 0.91) and aV and eV (0.83; R² = 0.69) between two time points. The automated detection and volumetric segmentation software rapidly provides an accurate measurement of the splenic volume in CT scans. Knowledge about splenic volume and its change between two examinations provides valuable clinical information without effort for the radiologist. © Georg Thieme Verlag KG Stuttgart · New York.

Automated detection and volumetric segmentation of the spleen in CT scans

International Nuclear Information System (INIS)

Hammon, M.; Dankerl, P.; Janka, R.; Uder, M.; Cavallaro, A.; Kramer, M.; Seifert, S.; Tsymbal, A.; Costa, M.J.

2012-01-01

To introduce automated detection and volumetric segmentation of the spleen in spiral CT scans with the THESEUS-MEDICO software. The consistency between automated volumetry (aV), estimated volume determination (eV) and manual volume segmentation (mV) was evaluated. Retrospective evaluation of the CAD system based on methods like ''marginal space learning'' and ''boosting algorithms''. 3 consecutive spiral CT scans (thoraco-abdominal; portal-venous contrast agent phase; 1 or 5 mm slice thickness) of 15 consecutive lymphoma patients were included. The eV: 30 cm 3 + 0.58 (width x length x thickness of the spleen) and the mV as the reference standard were determined by an experienced radiologist. The aV could be performed in all CT scans within 15.2 (± 2.4) seconds. The average splenic volume measured by aV was 268.21 ± 114.67 cm 3 compared to 281.58 ± 130.21 cm 3 in mV and 268.93 ± 104.60 cm 3 in eV. The correlation coefficient was 0.99 (coefficient of determination (R 2 ) = 0.98) for aV and mV, 0.91 (R 2 = 0.83) for mV and eV and 0.91 (R 2 = 0.82) for aV and eV. There was an almost perfect correlation of the changes in splenic volume measured with the new aV and mV (0.92; R 2 = 0.84), mV and eV (0.95; R 2 = 0.91) and aV and eV (0.83; R 2 = 0.69) between two time points. The automated detection and volumetric segmentation software rapidly provides an accurate measurement of the splenic volume in CT scans. Knowledge about splenic volume and its change between two examinations provides valuable clinical information without effort for the radiologist. (orig.)

Detection of active intraabdominal hemorrhage after blunt trauma: value of delayed CT scanning

Energy Technology Data Exchange (ETDEWEB)

Sivit, C.J. [Department of Radiology, Rainbow Babies and Children' s Hospital of the University Hospitals of Cleveland and Case Western Reserve School of Medicine, 11100 Euclid Avenue, Cleveland, OH (United States)

2000-02-01

Active hemorrhage is a rare finding at CT following blunt abdominal trauma. The time interval between IV contrast administration and scanning the abdomen may impact on the ability to visualize active hemorrhage at CT. We report a case of active hemorrhage associated with splenic injury that was identified only at delayed CT scanning. (orig.)

Detection of active intraabdominal hemorrhage after blunt trauma: value of delayed CT scanning

International Nuclear Information System (INIS)

Sivit, C.J.

2000-01-01

Active hemorrhage is a rare finding at CT following blunt abdominal trauma. The time interval between IV contrast administration and scanning the abdomen may impact on the ability to visualize active hemorrhage at CT. We report a case of active hemorrhage associated with splenic injury that was identified only at delayed CT scanning. (orig.)

X-ray CT evaluation of pulmonary involvements of sarcoidosis

International Nuclear Information System (INIS)

Nishimura, Koichi; Izumi, Takateru; Kitaichi, Masanori

1987-01-01

We evaluated high resolution CT in 60 patients with histologically diagnosed pulmonary sarcoidosis and, also, studied the relationship between CT and findings in open lung biopsy specimens in 2 cases. The CT findings were as follows: (1) thickening of bronchial wall shadows (27 out of 60 cases, 45.0 %), (2) irregular enlargement of pulmonary vascular shadows (39 cases, 65.0 %), (3) small or large nodular shadows (24 cases, 40.0 %), (4) local volume loss (14 cases, 23.3 %), (5) slightly increased density of localized lung field areas (24 cases, 40.0 %), (6) pleural or subpleural involvement (27 cases, 45.0 %), (7) lymph node enlargement (59 cases, 98.3 %). X-ray CT in 7 patients revealed no evidence of lung field involvement in patients with histologicall confirmed epithelioid cell granuloma in transbronchial lung biopsy specimens. Lesions located within vessels or in the vascular wall, perivascular sheath or alveoli surrounding blood vessels might cause pulmonary vascular shadows to appear swollen on CT. In a comparative study, we found irregular dilatation of pulmonary vascular shadows corresponding to granulomas in the connective tissue sheath of blood vessels. Also, thickening of bronchial wall shadows corresponded to granulomas in and around the bronchial wall. From the point of histopathological view epithelioid cell granulomas in the bronchovascular sheath were most marked in sarcoidosis, and they apperaed on CT as an irregular enlargement of pulmonary vascular shadows and thickening of the bronchial wall. On the other hand, we reported that collapse of alveoli and fibrosis surrounding blood vessels could cause irregular enlargement of pulmonary vascular shadows on CT in idiopathic pulmonary fibrosis (IPF). Such shadows were seen on CT in both sarcoidosis and IPF but the mechanism of their appearance differed. (J.P.N.)

Case report on the role of radiofrequency-assisted spleen-preserving surgery for splenic metastasis in the era of check-point inhibitors.

Science.gov (United States)

Mudan, Satvinder; Kumar, Jayant; Mafalda, Neves C; Kusano, Tomokazu; Reccia, Isabella; Zanallato, Artur; Dalgleish, Angus; Habib, Nagy

2017-12-01

An isolated splenic metastasis is a rare phenomenon noted in advanced stage melanoma. We report the role of radiofrequency (RF) -based splenic-preserving splenectomy in a patient with a solitary splenic metastasis from advanced stage melanoma that was managed with checkpoint inhibitors. We report a case of a 60-year-old man who presented with multiple lung metastases and a solitary splenic metastasis with advanced stage melanoma following excision of primary from his trunk 2.3 years back. Considering the diagnosis of advanced stage melanoma with multiple lung metastases and a solitary splenic metastasis, and its ongoing progressive nature. This case was discussed in the tumour board meeting. A decision was made to commence treatment with immunotherapy in the form of PD-1 inhibitor (programmed cell death 1 receptor) pembrolizumab. Follow-up restaging computer tomography (CT) scan of the abdomen and chest showed a significant reduction in the lung and chest wall lesions, but the splenic lesion remained unchanged. Given the lack of response to treatment in the splenic metastasis and the significant decrease in lung metastases, the multidisciplinary team decided that a partial splenectomy combined with continued immunotherapy treatment would be appropriate as the success of immunotherapy was imminent within the splenic preservation. The postoperative recovery was smooth and the patient was discharged from hospital on the sixth postoperative day with normal platelets and white blood cells. The histopathological analysis of the resected specimen showed a metastatic melanoma with negative margins.At 10-month follow-up after the splenic resection the patient had not experienced further tumour recurrences. Spleen-preserving resection for an isolated, solitary splenic metastasis of melanoma is a feasible approach as it not only preserves the ongoing efficacy of checkpoint inhibitors by preserving the physiological T cell milieu, but the immunomodulation properties of RF can

Comparison of gray-scale contrast-enhanced ultrasonography with contrast-enhanced computed tomography in different grading of blunt hepatic and splenic trauma: an animal experiment.

Science.gov (United States)

Tang, Jie; Li, Wenxiu; Lv, Faqin; Zhang, Huiqin; Zhang, Lihai; Wang, Yuexiang; Li, Junlai; Yang, Li

2009-04-01

To compare the diagnostic value of contrast-enhanced ultrasonography (CEUS) with contrast-enhanced computed tomography (CECT) for the detection of different grading of solid organ injuries in blunt abdominal trauma in animals. A self-made miniature tools were used as models to simulate a blunt hepatic or splenic trauma in 16 and 14 anesthetized dogs, respectively. Baseline ultrasound, CEUS and CECT were used to detect traumatic injuries of livers and spleens. The degree of injuries was determined by CEUS according to the American Association for the Surgery of Trauma (AAST) scale and the results compared with injury scale based on CECT evaluation. CEUS showed 22 hepatic injury sites in 16 animals and 17 splenic injury sites in other 14 animals. According to AAST scale, 2 grade I, 4 grade II, 3 grade III, 5 grade IV and 2 grade V hepatic lesions were present in 16 animals; 2 grade I, 4 grade II, 6 grade III and 2 grade IV splenic lesions in 14 animals. On CECT scan, 21 hepatic and 17 splenic injuries were demonstrated. According to Becker CT scaling for hepatic injury, 1 grade I, 2 grade II, 4 grade III, 5 grade IV and 2 grade V hepatic injuries were present. On the basis of Buntain spleen scaling, 2 grade I, 5 grade II, 5 grade III, 2 grade IV splenic injuries were showed. After Spearman rank correlation analysis, the agreement of CEUS with CECT on the degree of hepatic and splenic injury is 93.3% and 92.9%, respectively. CT is currently considered as the reference method for grading blunt abdominal trauma, according to experiment results, CEUS grading showed high levels of concordance with CECT. CEUS can accurately determine the degree of injury and will play an important role in clinical application.

Impact of Splenic Artery Embolization on the Success Rate of Nonoperative Management for Blunt Splenic Injury

International Nuclear Information System (INIS)

Vlies, C. H. van der; Hoekstra, J.; Ponsen, K. J.; Reekers, J. A.; Delden, O. M. van; Goslings, J. C.

2012-01-01

Introduction: Nonoperative management (NOM) has become the treatment of choice for hemodynamically stable patients with blunt splenic injury. Results of outcome after NOM are predominantly based on large-volume studies from level 1 trauma centers in the United States. This study was designed to assess the results of NOM in a relatively low-volume Dutch level 1 trauma center. Methods: An analysis of a prospective trauma registry was performed for a 6-year period before (period 1) and after the introduction and implementation of splenic artery embolization (SAE) (period 2). Primary outcome was the failure rate of initial treatment. Results: A total of 151 patients were reviewed. An increased use of SAE and a reduction of splenic operations during the second period was observed. Compared with period 1, the failure rate after observation in period 2 decreased from 25% to 10%. The failure rate after SAE in period 2 was 18%. The splenic salvage rate (SSR) after observation increased from 79% in the first period to 100% in the second period. During the second period, all patients with failure after observation were successfully treated with SAE. The SSR after SAE in periods 1 and 2 was respectively 100% and 86%. Conclusions: SAE of patients with blunt splenic injuries is associated with a reduction in splenic operations. The failure and splenic salvage rates in this current study were comparable with the results from large-volume studies of level 1 trauma centers. Nonoperative management also is feasible in a relatively low-volume level 1 trauma center outside the United States.

Radiation-induced splenic atrophy in patients with Hodgkin's disease and non-Hodgkin's lymphomas

International Nuclear Information System (INIS)

Dailey, M.O.; Coleman, C.N.; Kaplan, H.S.

1980-01-01

Effective treatment of Hodgkin's disease requires the determination of the extent of the disease. This usually involves staging laparotomy, which includes splenectomy and biopsies of the para-aortic lymph nodes, liver, and bone marrow. Absence of the spleen predisposes a person to fulminant septicemia from encapsulated bacteria, a risk even greater in patients undergoing treatment for Hodgkin's disease. For this reason, some investigators have suggested that spleens not be removed for diagnosis but, rather, that they be included within the fields of radiation, which would preserve normal splenic function. We present a case of fatal spontaneous pneumococcal sepsis in a patient with splenic atrophy; the sepsis occurred 12 years after successful treatment of Hodgkin's disease by total nodal and splenic irradiation. A retrospective study of patients treated for Hodgkin's and non-Hodgkin's lymphomas indicated that atrophy and functional asplenia may be an important sequela of splenic irradiation

Literature Review of the Role of Ultrasound, Computed Tomography, and Transcatheter Arterial Embolization for the Treatment of Traumatic Splenic Injuries

Science.gov (United States)

van Delden, Otto M.; Punt, Bastiaan J.; Ponsen, Kees J.; Reekers, Jim A.; Goslings, J. Carel

2010-01-01

Introduction The spleen is the second most frequently injured organ following blunt abdominal trauma. Trends in management have changed over the years. Traditionally, laparotomy and splenectomy was the standard management. Presently, nonoperative management (NOM) of splenic injury is the most common management strategy in hemodynamically stable patients. Splenic injuries can be managed via simple observation (OBS) or with angiography and embolization (AE). Angio-embolization has shown to be a valuable alternative to observational management and has increased the success rate of nonoperative management in many series. Diagnostics Improved imaging techniques and advances in interventional radiology have led to a better selection of patients who are amenable to nonoperative management. Despite this, there is still a lot of debate about which patients are prone to NOM. Angiography and Embolization The optimal patient selection is still a matter of debate and the role of CT and angio-embolization has not yet fully evolved. We discuss the role of sonography and CT features, such as contrast extravasation, pseudoaneurysms, arteriovenous fistulas, or hemoperitoneum, to determine the optimal patient selection for angiography and embolization. We also review the efficiency, technical considerations (proximal or selective embolization), logistics, and complication rates of AE for blunt traumatic splenic injuries. PMID:20668852

Literature Review of the Role of Ultrasound, Computed Tomography, and Transcatheter Arterial Embolization for the Treatment of Traumatic Splenic Injuries

International Nuclear Information System (INIS)

Vlies, Cornelis H. van der; Delden, Otto M. van; Punt, Bastiaan J.; Ponsen, Kees J.; Reekers, Jim A.; Goslings, J. Carel

2010-01-01

IntroductionThe spleen is the second most frequently injured organ following blunt abdominal trauma. Trends in management have changed over the years. Traditionally, laparotomy and splenectomy was the standard management. Presently, nonoperative management (NOM) of splenic injury is the most common management strategy in hemodynamically stable patients. Splenic injuries can be managed via simple observation (OBS) or with angiography and embolization (AE). Angio-embolization has shown to be a valuable alternative to observational management and has increased the success rate of nonoperative management in many series.DiagnosticsImproved imaging techniques and advances in interventional radiology have led to a better selection of patients who are amenable to nonoperative management. Despite this, there is still a lot of debate about which patients are prone to NOM.Angiography and EmbolizationThe optimal patient selection is still a matter of debate and the role of CT and angio-embolization has not yet fully evolved. We discuss the role of sonography and CT features, such as contrast extravasation, pseudoaneurysms, arteriovenous fistulas, or hemoperitoneum, to determine the optimal patient selection for angiography and embolization. We also review the efficiency, technical considerations (proximal or selective embolization), logistics, and complication rates of AE for blunt traumatic splenic injuries.

Macrophages support splenic erythropoiesis in 4T1 tumor-bearing mice.

Directory of Open Access Journals (Sweden)

Min Liu

Full Text Available Anemia is a common complication of cancer; a role of spleen in tumor-stress erythropoiesis has been suggested. However, the molecular mechanisms involved in the splenic erythropoiesis following tumor maintenance remain poorly understood. Here we show that tumor development blocks medullar erythropoiesis by granulocyte colony-stimulating factor (G-CSF and then causes anemia in murine 4T1 breast tumor-bearing mice. Meanwhile, tumor-stress promotes splenic erythropoiesis. Splenectomy worsened tumor-induced anemia, and reduced tumor volume and tumor weight, indicating the essential role of spleen in tumor-stress erythropoiesis and tumor growth. Tumor progression of these mice led to increased amounts of bone morphogenetic protein 4 (BMP4 in spleen. The in vivo role of macrophages in splenic erythropoiesis under tumor-stress conditions was investigated. Macrophage depletion by injecting liposomal clodronate decreased the expression of BMP4, inhibited splenic erythropoiesis, aggravated the tumor-induced anemia and suppressed tumor growth. Our results provide insight that macrophages and BMP4 are positive regulators of splenic erythropoiesis in tumor pathological situations. These findings reveal that during the tumor-stress period, the microenvironment of the spleen is undergoing changes, which contributes to adopt a stress erythropoietic fate and supports the expansion and differentiation of stress erythroid progenitors, thereby replenishing red blood cells and promoting tumor growth.

Littoral cell angioma of the spleen: CT and MR imaging appearance

Energy Technology Data Exchange (ETDEWEB)

Schneider, G.; Uder, M.; Altmeyer, K.; Gruber, M.; Kramann, B. [Univ. Hospital Saarland University, Homburg/Saar (Germany). Dept. of Diagnostic Radiology; Bonkhoff, H. [Department of Pathology, University Hospital, Saarland University, D-66421 Homburg/Saar (Germany)

2000-09-01

We report a case of littoral cell angioma (LCA) of the spleen, a recently described splenic pathology, which imaging characteristics and pathologic morphology have been discussed only by a few authors. The imaging findings in unenhanced and contrast-enhanced MRI and CT as well as histologic specimen are presented. Diagnosis was made after elective splenectomy. Differential diagnosis of splenic tumors as well as the imaging findings in this particular case are discussed. (orig.)

Splenic trauma management in relation to mode and grade

International Nuclear Information System (INIS)

Gangat, S.A.; Khaskhali, A.A.; Memon, I.A.

2008-01-01

To study the prevalence and management of splenic trauma in relation to its mode and grade. All cases admitted in emergency with abdominal trauma and splenic injury. The data of all the patients who had splenic trauma was entered on a proforma and analyzed. A total of 44 patients with ages between 20-40 years presented with splenic injury; 32(72.7%) were male. The commonest mode of splenic trauma was blunt abdominal injury (50%), and most (47%) patients had Grade- III injury. Splenectomy was carried out in 84% patients, while 9% underwent splenic salvage. Seven (15.9%) patients with splenectomy died in the series. Splenic injury was mostly caused by blunt abdominal trauma. Proper assessment of the grade of injury at the time of laparotomy resulted in more splenic salvage procedures with decreased risk of complications. (author)

The unexpected finding of a splenic infarction in a patient with infectious mononucleosis due to Epstein-Barr virus.

Science.gov (United States)

Machado, Catarina; Melo Salgado, Joana; Monjardino, Leonor

2015-11-25

The authors present a case of a 24-year-old man with infectious mononucleosis (IM) due to Epstein-Barr virus (EBV). Among his symptoms, he reported abdominal pain in the upper left quadrant. An abdominal ultrasound and CT revealed an extensive splenic infarction. During the acute stage of this disease, the thrombophilic screening revealed reduced free protein S and elevated factor VIII, with normalisation on re-evaluation 6 weeks later. Splenic infarction is a very rare complication of IM due to EBV but should be considered in patients presenting abdominal pain. A hypercoagulability state should be investigated. To our knowledge, this is the first described case of a splenic infarction in a patient with IM due to EBV associated with a transient reduction of protein S and elevation of factor VIII. Thus, this work promotes the importance of including these factors in the thrombophilic screening conducted during the investigation of similar cases. 2015 BMJ Publishing Group Ltd.

Large primary splenic cyst: A laparoscopic technique.

LENUS (Irish Health Repository)

Geraghty, M

2009-01-01

Splenic cysts are rare lesions with around 800 cases reported in the world literature. Traditionally splenectomy was the treatment of choice. However, with the recognition of the important immunological function of the spleen, new techniques to preserve splenic function have been developed. This case emphasizes that in selected cases splenic preservation is appropriate.

Safety and effectiveness of percutaneous biopsy of focal splenic lesions under ultrasonographic guidance

Energy Technology Data Exchange (ETDEWEB)

Han, Hyun Young; Kim, Joo Heon [Eulji University College of Medicine, Taejeon (Korea, Republic of); Shin, Kyung Sook [Chungnam National University College of Medicine, Taejeon (Korea, Republic of)

2002-06-15

To evaluate the diagnostic yield and safety of ultrasound (US)-guided percutaneous needle biopsy for the diagnosis of focal splenic lesions. US guided, automated needle biopsy using an 18-gauge cutting needle was performed in 11 patients, consisted of nine men and two women (mean age=49 years), with focal splenic lesions detected on the CT or US. Six patients (55%) had multiple lesions while five (45%) had a single lesion. Two of eleven patients had splenomegaly. None of 11 patients had the prior diagnosis of extrasplenic or hematopoietic malignancies. The biopsy was considered successful if a specific pathological diagnosis was possible. The diagnostic yield and frequency of complication were retrospectively analyzed. Tissue adequate for histological diagnosis was obtained in nine (82%) of 11 patients, and no complications other than mild, localized discomfort occurred. Multifocal splenic lesions without splenomegaly in five patients were confirmed as Hodgkin's disease (n=2), tuberculosis (n=1), infarction (n=1), and hemangioma (n=1). All single lesion in four patients were proven as benign conditions including hamartoma (n=2), lymphangioma (n=1) and chronic organizing abscess (n=1), and only of them with a large hamartoma received splenectomy while others did not receive further treatment. Although in two (18%) patients with multiple lesions and splenomegaly, no specific diagnosis was established by US-guided biopsy, malignant lymphoma and Hodgkin's disease were confirmed by surgery. US-guided automated needle biopsy is a safe and valuable procedure that can provides a specific diagnosis in patients with splenic lesions.

Laparoscopic splenic biopsy in dogs and cats: 15 cases (2006-2008).

Science.gov (United States)

Radhakrishnan, Anant; Mayhew, Philipp D

2013-01-01

This retrospective study describes a technique and evaluates outcome associated with laparoscopic splenic biopsy in dogs and cats. Medical records of dogs (n = 10) and cats (n = 5) that had a laparoscopic splenic biopsy performed as part of their diagnostic evaluation for systemic disease were evaluated. Splenic biopsies were performed with the patient in dorsal recumbency using a two-portal approach. In some cases, concurrent organ biopsy was also performed. A pair of 5 mm cup biopsy forceps was used for biopsy collection, and an absorbable gelatin hemostatic sponge was placed at the biopsy site to aid in hemostasis. All patients recovered without major complications. Conversion to an open surgical approach was not required. Median survival time was 180 days, and nine patients were alive at the time of manuscript preparation. Four patients were diagnosed with neoplasia; however, only one had neoplasia involving the spleen. Median survival time for the nonneoplasia group (n = 11) was 300 days. Eight of those patients were alive at time of manuscript preparation. Minimal morbidity was observed in this cohort of clinical patients. Histopathology may be preferred over cytology in some clinical situations, and laparoscopic splenic biopsy provides a minimally invasive diagnostic option.

Management of splenic trauma--changing concepts.

Science.gov (United States)

Reihneŕ, E; Brismar, B

1995-03-01

During the last two decades the reported risk of overwhelming postsplenectomy infection (OPSI) has resulted in a conservative approach to splenic trauma, with the aim of splenic salvage. The appropriateness of this strategy is now questioned. The risk of OPSI varies with age and indication for splenectomy from less than 1% in adults to more than 4% in children. Pneumococcus is the causative agent in about 60% of cases. A prerequisite for splenic preservation procedures should be a haemodynamically stable patient without other intraabdominal injuries. The benefits derived from non-operative treatment of splenic salvage procedures may be overshadowed by the potential risk of transfusion-related bacterial and viral diseases. Polyvalent pneumococcal vaccines given early after splenectomy appear to reduce the incidence of OPSI substantially.

Hypereosinophilic syndrome: CT findings in patients with hepatic lobar or segmental involvement

Energy Technology Data Exchange (ETDEWEB)

Lim, Jae Hoon; Lee, Won Jae [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Lee, Dong Ho [Kyunghee University Hospital, Seoul (Korea, Republic of); Nam, Kyung Jin [Donga University College of Medicine, Pusan (Korea, Republic of)

2000-06-01

The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved. Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation. CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis. Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis.

Hypereosinophilic syndrome: CT findings in patients with hepatic lobar or segmental involvement

International Nuclear Information System (INIS)

Lim, Jae Hoon; Lee, Won Jae; Lee, Dong Ho; Nam, Kyung Jin

2000-01-01

The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved. Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation. CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis. Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis

Isolated Splenic Metastasis from Renal Cell Carcinoma: Case Report and Review

Directory of Open Access Journals (Sweden)

J.A.G. Moir

2011-04-01

Full Text Available This report presents the case of a 70-year-old woman with a previous history of a left nephrectomy for renal cell carcinoma (RCC, who developed general malaise and fatigue. Abdominal computed tomography demonstrated an enhancing 6 × 7 cm necrotic lesion in the lower pole of the spleen suggestive of a metastasis. Given the highly suspicious nature of the lesion we proceeded to splenectomy. The tumour did not breach the splenic capsule, and there was no local diaphragmatic involvement. The mass was concluded to be a true metastasis of the original RCC rather than local recurrence of the disease. The causes of isolated solid splenic lesions are wide and varied, however a past or present history of malignancy should lead to a high index of suspicion for a splenic metastasis. We report an extremely unusual case of spread from a RCC.

Splenic Infarction: An Under-recognized Complication of Infectious Mononucleosis?

Science.gov (United States)

Li, Yan; George, Ann; Arnaout, Sami; Wang, Jennifer P; Abraham, George M

2018-03-01

Splenic infarction is a rare complication of infectious mononucleosis. We describe 3 cases of splenic infarction attributed to infectious mononucleosis that we encountered within a 2-month period. We underscore the awareness of this potential complication of infectious mononucleosis and discuss the differential diagnosis of splenic infarction, including infectious etiologies. While symptomatic management is usually sufficient for infectious mononucleosis-associated splenic infarction, close monitoring for other complications, including splenic rupture, is mandated.

Scintigraphic evaluation of traumatic splenic lesions in children

International Nuclear Information System (INIS)

Erasmie, U.; Mortensson, W.; Persson, U.; Laennergren, K.; St. Goerans Children's Hospital, Stockholm

1988-01-01

Ninety-eight children with recent blunt abdominal trauma which initially evoked clinical suspicion of splenic injury were examined with colloid scintigraphy of the spleen and the liver using multiple imaging views and with abdominal survey. Nineteen children were, in addition, examined with tomographic scintigraphy. The clinical findings and the course of the disorder were reanalysed. Scintigraphy indicated splenic injury in 56 children and hepatic injury in another 5 children. The left lateral and the left oblique were the optimum imaging views for detecting splenic ruptures. Tomographic scintigraphy did not improve the diagnostic yield. Abdominal survey failed to indicate almost every second case of splenic rupture and provided no additional information of significance. The clinical review agreed with the scintigraphic diagnosis of splenic lesions but, in addition, it suggested possible splenic lesions in another 10 children with normal scintigraphy. This discrepancy cannot be explained as surgery was not employed; the occurrence of splenic lesions too small to become detectable at scintigraphy or to provoke clinically evident symptoms may be supposed. (orig.)

Splenectomy for solitary splenic metastasis of ovarian cancer

International Nuclear Information System (INIS)

Koh, Yang Seok; Kim, Jung Chul; Cho, Chol Kyoon

2004-01-01

Splenic metastases occur in rare cases with a few case reports of patients in the literature. Generally, splenic metastases mean late dissemination of a disease. Solitary splenic metastases from solid tumors are extremely unusual. We report a case of a patient with ovarian mucinous cystadenocarcinoma who underwent splenectomy for isolated parenchymal metastasis. Ovarian epithelial tumors comprised most of isolated splenic metastases from gynecologic tumor. When isolated splenic recurrence is suspected on image studies and serum tumor markers, intraabdominal gross findings should be examined to exclude peritoneal carcinomatosis. If only spleen was under suspicion of recurrence of ovarian cancer, splenectomy may play a therapeutic role

Emergency CT for assessment and management of blunt traumatic splenic injuries at a Level 1 Trauma Center: 13-year study.

Science.gov (United States)

Margari, Sergio; Garozzo Velloni, Fernanda; Tonolini, Massimo; Colombo, Ettore; Artioli, Diana; Allievi, Niccolò Ettore; Sammartano, Fabrizio; Chiara, Osvaldo; Vanzulli, Angelo

2018-05-12

To determine the relationship between multidetector computed tomography (MDCT) findings, management strategies, and ultimate clinical outcomes in patients with splenic injuries secondary to blunt trauma. This Institutional Review Board-approved study collected 351 consecutive patients admitted at the Emergency Department (ED) of a Level I Trauma Center with blunt splenic trauma between October 2002 and November 2015. Their MDCT studies were retrospectively and independently reviewed by two radiologists to grade splenic injuries according to the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) and to detect intraparenchymal (type A) or extraparenchymal (type B) active bleeding and/or contained vascular injuries (CVI). Clinical data, information on management, and outcome were retrieved from the hospital database. Statistical analysis relied on Student's t, chi-squared, and Cohen's kappa tests. Emergency multiphase MDCT was obtained in 263 hemodynamically stable patients. Interobserver agreement for both AAST grading of injuries and vascular lesions was excellent (k = 0.77). Operative management (OM) was performed in 160 patients (45.58% of the whole cohort), and high-grade (IV and V) OIS injuries and type B bleeding were statistically significant (p trauma event, without significant increase of mortality. Both intraparenchymal and extraparenchymal active bleeding were predictive of NOM failure (p splenic traumas and contributes to the shift toward NOM in hemodynamically stable patients.

Type A aortic dissection: Are there CT signs suggestive of valvular involvement?

Energy Technology Data Exchange (ETDEWEB)

Platon, Alexandra, E-mail: alexandra.platon@hcuge.ch [Department of Radiology, Emergency Radiology Unit, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva (Switzerland); Bernard, Stephane; Perrin, Nils [Department of Radiology, Emergency Radiology Unit, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva (Switzerland); Murith, Nicolas [Division of Cardiovascular Surgery, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva (Switzerland); John, Gregor [Department of Internal medicine/Geriatrics and Rehabilitation, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva (Switzerland); Department of Internal Medicine, Hôpital neuchâtelois, 2300 La Chaux-de-Fonds (Switzerland); Perneger, Thomas [Division of Clinical Epidemiology, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva (Switzerland); Rutschmann, Olivier T. [Division of Emergency Medicine, University Hospitals of Geneva and School of Medicine, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva (Switzerland); Poletti, Pierre-Alexandre [Department of Radiology, Emergency Radiology Unit, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva (Switzerland)

2016-11-15

Highlights: • Non-ECG gated CT rarely shows valve involvement in type A aortic dissection. • Diameters of the aortic root in type A aortic dissection were measured on initial CT. • Sinus of Valsalva diameter >45 mm is 100% specific to predict aortic valve involvement. - Abstract: Aim: To identify the predictive signs of aortic valve involvement on the non-electrocardiogram (ECG)-gated admission computed tomography (CT) of patients with Type A aortic dissection (AD) according to the Stanford classification. Materials and methods: We retrospectively analyzed the non-ECG-gated CT examinations of patients admitted to the emergency department who underwent surgery for Type A AD over a period of 4 years. The diameter of the following structures was calculated as the mean of the smallest and largest diameters (mm) measured in two different planes: aortic annulus, sinus of Valsalva, sinotubular junction, and proximal ascending aorta. These parameters were compared against operative reports in order to determine whether they were predictive of aortic valve involvement. Results: In total, 20 patients (13 men and 7 women) of a mean age of 59.5 years (29–80) were included, 55% of patients (11/20) having surgically proven valvular involvement. The mean diameters (in mm) of the aortic annulus, sinus of Valsalva, sinotubular junction and proximal ascending aorta in the group with (and without, respectively) valvular involvement was 27.7 (26.7), 44.3 (38.1), 42.6 (36.6), and 47.8 (45.9). Only the measurement of the mean diameter of the sinuses of Valsalva was significantly predictive (p = 0.02) of aortic valve involvement. Conclusion: Our findings suggest that measuring the diameter of the sinuses of Valsalva on non-ECG-gated admission CT examinations allows for predicting aortic valve involvement in Type A AD patients.

Type A aortic dissection: Are there CT signs suggestive of valvular involvement?

International Nuclear Information System (INIS)

Platon, Alexandra; Bernard, Stephane; Perrin, Nils; Murith, Nicolas; John, Gregor; Perneger, Thomas; Rutschmann, Olivier T.; Poletti, Pierre-Alexandre

2016-01-01

Highlights: • Non-ECG gated CT rarely shows valve involvement in type A aortic dissection. • Diameters of the aortic root in type A aortic dissection were measured on initial CT. • Sinus of Valsalva diameter >45 mm is 100% specific to predict aortic valve involvement. - Abstract: Aim: To identify the predictive signs of aortic valve involvement on the non-electrocardiogram (ECG)-gated admission computed tomography (CT) of patients with Type A aortic dissection (AD) according to the Stanford classification. Materials and methods: We retrospectively analyzed the non-ECG-gated CT examinations of patients admitted to the emergency department who underwent surgery for Type A AD over a period of 4 years. The diameter of the following structures was calculated as the mean of the smallest and largest diameters (mm) measured in two different planes: aortic annulus, sinus of Valsalva, sinotubular junction, and proximal ascending aorta. These parameters were compared against operative reports in order to determine whether they were predictive of aortic valve involvement. Results: In total, 20 patients (13 men and 7 women) of a mean age of 59.5 years (29–80) were included, 55% of patients (11/20) having surgically proven valvular involvement. The mean diameters (in mm) of the aortic annulus, sinus of Valsalva, sinotubular junction and proximal ascending aorta in the group with (and without, respectively) valvular involvement was 27.7 (26.7), 44.3 (38.1), 42.6 (36.6), and 47.8 (45.9). Only the measurement of the mean diameter of the sinuses of Valsalva was significantly predictive (p = 0.02) of aortic valve involvement. Conclusion: Our findings suggest that measuring the diameter of the sinuses of Valsalva on non-ECG-gated admission CT examinations allows for predicting aortic valve involvement in Type A AD patients.

Non-operative management for penetrating splenic trauma : how far can we go to save splenic function?

NARCIS (Netherlands)

Spijkerman, Roy; Teuben, Michel Paul Johan; Hoosain, Fatima; Taylor, Liezel Phyllis; Hardcastle, Timothy Craig; Blokhuis, Taco Johan; Warren, Brian Leigh; Leenen, Luke Petrus Hendrikus

2017-01-01

BACKGROUND: Selective non-operative management (NOM) for the treatment of blunt splenic trauma is safe. Currently, the feasibility of selective NOM for penetrating splenic injury (PSI) is unclear. Unfortunately, little is known about the success rate of spleen-preserving surgical procedures. The aim

Transcatheter Splenic Artery Occlusion for Treatment of Splenic Artery Steal Syndrome After Orthotopic Liver Transplantation

International Nuclear Information System (INIS)

Uflacker, Renan; Selby, J. Bayne; Chavin, Kenneth; Rogers, Jeffrey; Baliga, Prabhakar

2002-01-01

Purpose: To review some aspects of the problem of splenic artery steal syndrome as cause of ischemia in transplanted livers and treatment by selective splenic artery occlusion. Materials and Methods: Eleven liver transplant patients from a group of 350 patients, nine men and two women,ranging in age from 40 years to 61 years (mean 52 years), presented with biochemical evidences of liver ischemia and failure, ranging from one to 60 days following orthotopic liver transplantation. Diagnosis of splenic artery steal syndrome was suspected by elevated enzymes, Doppler ultrasound and confirmed by celiac angiogram. Patients with confirmed hepatic artery thrombosis before angiography were excluded from the study. Embolization with Gianturco coils was performed. Results: All patients were treated by splenic artery embolization with Gianturco coils. The 11 patients improved clinically within 24 hours of the procedure with significant change in the biochemical and clinical parameters. Followup ranged from one month to two years. One of the 11 patient initially improved, but developed hepatic artery thrombosis within 24 hours of the embolic treatment,requiring surgical repair. Conclusion: Splenicartery steal syndrome following liver transplantation surgery can be diagnosed by celiac angiography, and effectively treated by splenic artery embolization with coils. Embolization is one of the treatments available, it is minimally invasive, and leads to immediate clinical improvement. Hepatic artery thrombosis is a possible complication of the procedure

CT evaluation of abdominal trauma

International Nuclear Information System (INIS)

Huang Ruiting

2004-01-01

Objective: An evaluation of CT diagnosis of abdominal trauma. Methods: CT appearance of abdominal trauma was analyzed retrospectively in 95 cases. thirty-three patients were cured by operation, and the other 59 patients received conservative treatment. Fifty-one patients out of 59 were seen healed or improved by a follow up CT scan after the conservative treatment. Results: The study included: 31 cases of splenic contusion, accompanying with hemoperitoneum in 25 cases; 3 cases of hepatic laceration; 33 cases of liver and spleen compound trauma accompanying with hemoperitoneum; 18 cases of renal contusion, with subcapsular hemorrhage in 12 cases; 4 cases of midriff colic; 3 cases of mesentery breach; 3 cases of digestive tract perforation. Conclusion: CT is sensitive and precise in evaluating abdominal trauma, providing important information for treatment. (author)

[The organ-preserving surgical treatment of the splenic rupture after the blunt abdominal trauma].

Science.gov (United States)

Alimov, A N; Zubarev, A R; Priamikov, A D; Alimov, V A; Sukiasian, A A; Murashina, I V; Safronov, É P; Kim, Iu E

2013-01-01

The outcomes of 383 cases of heavy combined traumas (n=273) and isolated (n=110) closed injuries of the abdomen with spleen damage were analyzed. The overall mortality was 11.74% (n=45), whereas the mortality rate during the first day after admission was 7.83% (n=30). Removal of a spleen was executed at 228 patients. The spleen-preserving operation with ligation of splenic artery, was performed in 155 patients. The optimal level of the splenic artery ligation proved to be in its proximal and median parts. The postoperative CT-angiogarphy and Doppler US scanning together with the three-dimensional reconstruction confirmed that blood supply of the body and tail of the pancreas was satisfactory thanks to the natural collateral blood circulation. The dramatic decrease in lethality and of postoperative complication rates allows to consider spleen-preserving resections to be a good alternative to spleenectomy.

Determinants of splenectomy in splenic injuries following blunt abdominal trauma.

Science.gov (United States)

Akinkuolie, A A; Lawal, O O; Arowolo, O A; Agbakwuru, E A; Adesunkanmi, A R K

2010-02-01

The management of splenic injuries has shifted from splenectomy to splenic preservation owing to the risk of overwhelming post-splenectomy infection (OPSI). This study aimed to identify the factors that determine splenectomy in patients with isolated splenic injuries, with a view to increasing the rate of splenic preservation. Files of 55 patients managed for isolated splenic injuries from blunt abdominal trauma between 1998 and 2007 were retrospectively analysed using a pro forma. Management options were classified into nonoperative, operative salvage and splenectomy. The majority of patients suffered splenic injury as a result of motor vehicle accident (MVA) trauma or falls. Splenectomy was undertaken in 33 (60%) patients, 12 (22%) had non-operative management, and operative salvage was achieved in 10 (18%) patients. Significant determinants of splenectomy were grade of splenic injury, hierarchy of the surgeon, and hierarchy of the assistant. MVA injury and falls accounted for the vast majority of blunt abdominal trauma in this study. The rate and magnitude of energy transferred versus splenic protective mechanisms at the time of blunt abdominal trauma seems to determine the grade of splenic injury. Interest in splenic salvage surgery, availability of technology that enables splenic salvage surgery, and the experience of the surgeon and assistant appear to determine the surgical management. Legislation on vehicle safety and good parental control may reduce the severity of splenic injury in blunt abdominal trauma. When surgery is indicated, salvage surgery should be considered in intermediate isolated splenic injury to reduce the incidence of OPSI.

Splenic injuries in athletes: a review.

Science.gov (United States)

Gannon, Elizabeth H; Howard, Thomas

2010-01-01

Splenic injuries can be challenging to the sports medicine physician. While these injuries are not common among athletes, they can have serious, potentially fatal consequences if not properly diagnosed and managed in a prompt and timely fashion. Currently, there are no evidence-based guidelines on returning athletes to previous levels of activity after sustaining a splenic injury. In addition, there is no consensus on follow-up imaging after injury. This article discusses the evaluation of athletes with blunt abdominal trauma for splenic injury, including the imaging, management, and current return-to-play guidelines.

Ectopic Splenic Tissue in the Testis: A Case Report

African Journals Online (AJOL)

Ectopic SplENic tiSSUE iN thE tEStiS associated with bilateral cryptorchidism and hypospadias4. Brasch et al. reported a case involving the right testis5. Ultrasonography, scintigraphy (with technetium-99m) and single positron emission computerized tomography are considered the best diagnostic tools for this condition2,3.

Partial splenic embolization in patients with idiopathic portal hypertension

Energy Technology Data Exchange (ETDEWEB)

Romano, Maurizio E-mail: maurizio.romano@ibb.cnr.it; Giojelli, Angela; Capuano, Gaetano; Pomponi, Domenico; Salvatore, Marco

2004-03-01

Purpose: To evaluate the effectiveness of partial splenic embolization (PSE) in patients with idiopathic portal hypertension (IPH) in reducing variceal bleeding episodes, splenomegaly and thrombocytopenia. Materials and methods: Six patients (2M, 4F, mean age 30.3 years) with IPH presenting with splenomegaly, thrombocytopenia and recurrent variceal bleeding were treated with PSE using gelatin sponge (four patients) or Contour particles (two patients) as embolization material. Results: PSE was performed successfully in all cases; 3F coaxial microcatheters were necessary in two patients due to extreme splenic artery tortuosity. The average amount of devascularized parenchyma at CT 1 week after PSE was 71%. Splenomegaly and thrombocytopenia improved in all cases, with a mean platelet count increase of 120000/mm{sup 3} and an average 68% reduction of spleen volume at follow up. Variceal bleeding did not recur after PSE. Esophageal or gastroesophageal varices disappeared (one patient) or significantly reduced (five patients) at endoscopic controls. No significant complications were noted. The follow up was of at least 18 months in all patients; mean follow up was 28.2 months. Conclusion: In patients with IPH PSE can be effective in preventing variceal bleedings, in reducing spleen volume and in significantly increasing platelet count; therapeutic results were durable in our population.

Ultrasonographic and CT findings of hepatosplenic tuberculosis

International Nuclear Information System (INIS)

Moon, Un Hyeon; Lee, Jeong Seok; Ko, Kang Seok; Park, Byung Ran; Yang, Dong Cheol; Im, Ju Hyeon; Kang, In Young

1998-01-01

To evaluate the ultrasonographic and CT findings of hepatosplenic tuberculosis Materials and Methods: We retrospectively reviewed the ultrasonographic and CT findings of confirmed hepatosplenic tuberculosis in 12 patients. Six were men and six were women ; their average age was 41, and most were in their twenties. Lesions of the liver and spleen, as well as associated findings such as abdominal tuberculosis and other organ involvement of tuberculosis were analyzed. Results : There were three cases of hepatic tuberculosis, seven of splenic tuberculosis, and two of hepatosplenic involvement of tuberculosis. On the basis of the ultrasonographic and CT findings, hepatosplenic tuberculosis was classified as one of two patterns : miliary or micronodular, ormacronodular. The micronodular type was more common (9/12 cases) being characterized by innumerable micronodules,and with easy coalescence in the liver and spleen in five of the nine cases. The macronodular type of low density mass was noted in the other three patients. Splenomegaly was noted in 12 cases and hepatomegaly in ten. Pulmonary tuberculosis-including the miliary type(n=5)-was noted in eight patients. Associated abdominal tuberculosis such as lymphadenopathy with central low density and peripheral rim enhancement (n=6), tuberculous peritonitis(n=3),highly attenuated ascites(n=6), adrenal tuberculosis(n=1), renal tuberculosis(n=1), ovarian abscess(n=1), psoasabscess(n=1), and systemic tuberculosis such as central nervous system tuberculoma(n=2), cervical lymphadenopathy(n=4) and tuberculous spondylitis(n=1) were noted. Conclusion : Ultrasonography and CT were valuable in the detection and diagnosis of hepatosplenic tuberculosis

Ultrasonographic and CT findings of hepatosplenic tuberculosis

Energy Technology Data Exchange (ETDEWEB)

Moon, Un Hyeon; Lee, Jeong Seok; Ko, Kang Seok; Park, Byung Ran; Yang, Dong Cheol; Im, Ju Hyeon [Kwangju Christian Hospital, Kwangju (Korea, Republic of); Kang, In Young [Kwangju Green Cross Hospital, Kwangju (Korea, Republic of)

1998-08-01

To evaluate the ultrasonographic and CT findings of hepatosplenic tuberculosis Materials and Methods: We retrospectively reviewed the ultrasonographic and CT findings of confirmed hepatosplenic tuberculosis in 12 patients. Six were men and six were women ; their average age was 41, and most were in their twenties. Lesions of the liver and spleen, as well as associated findings such as abdominal tuberculosis and other organ involvement of tuberculosis were analyzed. Results : There were three cases of hepatic tuberculosis, seven of splenic tuberculosis, and two of hepatosplenic involvement of tuberculosis. On the basis of the ultrasonographic and CT findings, hepatosplenic tuberculosis was classified as one of two patterns : miliary or micronodular, ormacronodular. The micronodular type was more common (9/12 cases) being characterized by innumerable micronodules,and with easy coalescence in the liver and spleen in five of the nine cases. The macronodular type of low density mass was noted in the other three patients. Splenomegaly was noted in 12 cases and hepatomegaly in ten. Pulmonary tuberculosis-including the miliary type(n=5)-was noted in eight patients. Associated abdominal tuberculosis such as lymphadenopathy with central low density and peripheral rim enhancement (n=6), tuberculous peritonitis(n=3),highly attenuated ascites(n=6), adrenal tuberculosis(n=1), renal tuberculosis(n=1), ovarian abscess(n=1), psoasabscess(n=1), and systemic tuberculosis such as central nervous system tuberculoma(n=2), cervical lymphadenopathy(n=4) and tuberculous spondylitis(n=1) were noted. Conclusion : Ultrasonography and CT were valuable in the detection and diagnosis of hepatosplenic tuberculosis.

Splenic abscess in cancer chemotherapy.

Science.gov (United States)

Ismail, Essadi; El Barni, Rachid; Lahkim, Mohamed; Rokhsi, Redouane; Atmane, Elmehdi; El Fikri, Abdelghani; Bouchama, Rachid; Achour, Abdessamad; Zyani, Mohamed

2015-11-11

Splenic abcess is an uncommon complication for cancer treatment. It occurs more frequently in immunocompromised patients. They are characterized by high mortality. The classic triad (fever, pain of the left hypochondrium, and sensitive mass left) is only present in one-third of cases the clinical spectrum ranging from no symptoms to events such as fever, nausea, vomiting, weight loss, abdominal pain left, splenomegaly. Treatment options are limited, but must be discussed and adapted to the patient profile. We report the case of a 62-year-old Arabic male, diagnosed with metastatic lung adenocarcinoma, who, after several cycles of chemotherapy, presented symptoms and signs of splenic abcess. Splenic abcess is rare situation, which must be actively researched, to have access to an optimal therapeutic approach.

[A case of infectious mononucleosis with splenic infarction].

Science.gov (United States)

Kobe, Daisuke; Nakatani, Toshiya; Fujinaga, Yukihisa; Seki, Kenichiro; Saikawa, Soichiro; Sawada, Yasuhiko; Sato, Yoshiki; Nagamatsu, Shinsaku; Matsuo, Hideki; Kikuchi, Eiryo

2013-08-01

A 22-year-old man complaining of persisting high fever and right hypochondralgia was admitted to our hospital for infectious mononucleosis with splenic infarction detected by computed tomography. The splenic infarction deteriorated with a marked elevation of inflammatory parameters. This necessitated the commencement of methylprednisolone pulse therapy, resulting in prompt amelioration of inflammation and a reduction in cytokine levels. Including our case, only 9 cases of mononucleosis with splenic infarction have been reported to date; however, splenic infarction should be considered because it is a significant complication of infectious mononucleosis.

Adrenal pseudomasses due to varices: angiographic-CT-MRI-pathologic correlations

International Nuclear Information System (INIS)

Brady, T.M.; Gross, B.H.; Glazer, G.M.; Williams, D.M.

1985-01-01

Periadrenal and adrenal portosystemic collaterals are a recently reported cause of adrenal pseudotumor on computed tomography (CT). Nine patients with this left adrenal pseudotumor illustrate its typical position and appearance on CT, angiography, CT-angiography, and magnetic resonance imaging (MRI). The anatomic basis for variceal adrenal pseudotumors is the left inferior phrenic vein, which passes immediately anterior to the left adrenal gland and which serves as a collateral pathway from splenic to left renal vein in portal hypertension. Thus, unlike previously described adrenal pseudotumors, these venous collaterals are not anatomically distinguishable from the adrenal gland on CT. Bolus dynamic CT is usually diagnostic, but in equivocal cases, MRI may prove useful

Adrenal pseudomasses due to varices: angiographic-CT-MRI-pathologic correlations

Energy Technology Data Exchange (ETDEWEB)

Brady, T.M.; Gross, B.H.; Glazer, G.M. Williams, D.M.

1985-08-01

Periadrenal and adrenal portosystemic collaterals are a recently reported cause of adrenal pseudotumor on computed tomography (CT). Nine patients with this left adrenal pseudotumor illustrate its typical position and appearance on CT, angiography, CT-angiography, and magnetic resonance imaging (MRI). The anatomic basis for variceal adrenal pseudotumors is the left inferior phrenic vein, which passes immediately anterior to the left adrenal gland and which serves as a collateral pathway from splenic to left renal vein in portal hypertension. Thus, unlike previously described adrenal pseudotumors, these venous collaterals are not anatomically distinguishable from the adrenal gland on CT. Bolus dynamic CT is usually diagnostic, but in equivocal cases, MRI may prove useful.

Idiopathic hypereosinophilic syndrome involving the liver: CT features vs. peripheral eosinophilia

Energy Technology Data Exchange (ETDEWEB)

Kim, Kyung Sook; Lee, Moon Gyu; Won, Young Chul; Lee, Eun Hye; Noh, Han Na; Ha, Hyun Kwon; Kim, Pyo Nyun; Auh, Yong Ho [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of)

1997-10-01

To correlate CT features with peripheral eosinophilia in patients with idiopathic hypereosinophilic syndrome involving the liver. During the last three years, features of liver involvement in nine of 20 patients with idiopathic hypereosinophilic syndrome were evaluated on CT. The shape and distribution of intrahepatic low densities and the presence of hepatomegaly and/or splenomegaly were reviewed on CT, and the percentage of eosinophils in peripheral blood was also determined. In seven cases, interval change in hepatic lesion and the percentage of eosinophils were reviewed on follow-up examination. On initial CT, varying low-density patterns were seen in the liver in all cases; hepatomegaly was seen in four cases, and hepatosplenomegaly in two. The percentage of eosinophils was 89% in a case with diffuse patch low densities in the liver, 65-85% in three cases with numerous nodular low density lesions, 12-29% in four cases with multiple (below ten) nodular or small geographic hypodense lesions, and 24% in a case with a single nodular hypodense lesion. On follow-up CT, seven patients showed a decrease in the percentage of eosinophils, and in six, improved intrahepatic low densities were seen. On CT, intrahepatic low densities were seen in patients with idiopathic hypereosinophilic syndrome, and these were distributed more extensively when peripheral eosinophilia was more severe. With improvement in peripheral eosinophilia, the low densities also improved.

Idiopathic hypereosinophilic syndrome involving the liver: CT features vs. peripheral eosinophilia

International Nuclear Information System (INIS)

Kim, Kyung Sook; Lee, Moon Gyu; Won, Young Chul; Lee, Eun Hye; Noh, Han Na; Ha, Hyun Kwon; Kim, Pyo Nyun; Auh, Yong Ho

1997-01-01

To correlate CT features with peripheral eosinophilia in patients with idiopathic hypereosinophilic syndrome involving the liver. During the last three years, features of liver involvement in nine of 20 patients with idiopathic hypereosinophilic syndrome were evaluated on CT. The shape and distribution of intrahepatic low densities and the presence of hepatomegaly and/or splenomegaly were reviewed on CT, and the percentage of eosinophils in peripheral blood was also determined. In seven cases, interval change in hepatic lesion and the percentage of eosinophils were reviewed on follow-up examination. On initial CT, varying low-density patterns were seen in the liver in all cases; hepatomegaly was seen in four cases, and hepatosplenomegaly in two. The percentage of eosinophils was 89% in a case with diffuse patch low densities in the liver, 65-85% in three cases with numerous nodular low density lesions, 12-29% in four cases with multiple (below ten) nodular or small geographic hypodense lesions, and 24% in a case with a single nodular hypodense lesion. On follow-up CT, seven patients showed a decrease in the percentage of eosinophils, and in six, improved intrahepatic low densities were seen. On CT, intrahepatic low densities were seen in patients with idiopathic hypereosinophilic syndrome, and these were distributed more extensively when peripheral eosinophilia was more severe. With improvement in peripheral eosinophilia, the low densities also improved

Symptomatic splenic hamartoma with renal, cutaneous, and hematological abnormalities

International Nuclear Information System (INIS)

Kassarjian, A.; Patenaude, Y.G.; Bernard, C.; Bell, L.

2001-01-01

Background. There is a rare association between splenic hamartomas and hematological abnormalities with, to our knowledge, only 24 reported cases in the English literature. Patients and methods. We report a case of a splenic hamartoma in a 14-year-old boy associated with membranoproliferative glomerulonephritis, multiple lobular capillary hemangiomas of the skin, hypertension, and anemia. Following imaging with ultrasonography, MRI, and nuclear scans, a hamartoma was suspected, but malignancy could not be excluded. The lesion was removed by partial splenectomy, and pathological examination confirmed the presence of a red pulp splenic hamartoma. Results. The renal, hematological, and dermatological abnormalities resolved following removal of the splenic hamartoma. This is the first reported case of a splenic hamartoma associated with renal, cutaneous, and hematological abnormalities and only the second reported case of a symptomatic splenic hamartoma treated by partial splenectomy. (orig.)

Symptomatic splenic hamartoma with renal, cutaneous, and hematological abnormalities

Energy Technology Data Exchange (ETDEWEB)

Kassarjian, A.; Patenaude, Y.G. [Dept. of Medical Imaging, Montreal Children' s Hospital, PQ (Canada); Bernard, C. [Dept. of Pathology, Montreal Children' s Hospital, PQ (Canada); Bell, L. [Dept. of Nephrology, Montreal Children' s Hospital, PQ (Canada)

2001-02-01

Background. There is a rare association between splenic hamartomas and hematological abnormalities with, to our knowledge, only 24 reported cases in the English literature. Patients and methods. We report a case of a splenic hamartoma in a 14-year-old boy associated with membranoproliferative glomerulonephritis, multiple lobular capillary hemangiomas of the skin, hypertension, and anemia. Following imaging with ultrasonography, MRI, and nuclear scans, a hamartoma was suspected, but malignancy could not be excluded. The lesion was removed by partial splenectomy, and pathological examination confirmed the presence of a red pulp splenic hamartoma. Results. The renal, hematological, and dermatological abnormalities resolved following removal of the splenic hamartoma. This is the first reported case of a splenic hamartoma associated with renal, cutaneous, and hematological abnormalities and only the second reported case of a symptomatic splenic hamartoma treated by partial splenectomy. (orig.)

CT of pancreatitis

International Nuclear Information System (INIS)

Fukuda, Toshio

1990-01-01

One hundred and two cases of acute and chronic pancreatitis were studied by computed tomography. Fluid collection was detected by CT in 45 cases, and the common extrapancreatic sites of involvement included the lesser sac (13 cases), anterior pararenal space (9 cases), transverse mesocolon (7 cases) and posterior pararenal space (5 cases). Ten cases of spontaneous resolution of pancreatic pseudocysts were encountered. Cystojejunostomy was done on 6 patients. A 4-to-6-weeks time interval has been currently accepted as necessary for pseudocyst wall maturation. However, the surgery was not possible in two patients in this series since the cyst wall was too thin. It is considered that the time over 3 months is required for surgical anastomosis of the cyst to the gastrointestinal tract. Pancreatic abscess has become the most common cause of death from pancreatitis. In this series pancreatic abscess occurred in 8 patients. Gas collection in the pancreas was observed in only one patient. In the other patients, pseudocysts had become infected and converted to abscesses. The CT number of 4 infected pseudocysts was less than 15 HU. Thus, it was not possible to distinguish infected from noninfected pseudocysts by CT. The author studied 9 patients with focal inflammatory mass of the pancreas with histologically proved severe fibrosis. All masses were small. Angiography showed occlusion or marked stenosis of the splenic vein in 3 cases. The postcontract CT (after intravenous bolus injection) in 7 cases of focal inflammatory mass demonstrated almost equal enhanced effect of the mass as compared with the adjacent normal pancreatic parenchyma. This finding is considered to be useful in distinguishing inflammatory mass from pancreatic carcinoma. (author)

Importance of MRI in the diagnosis of vertebral involvement in generalized cystic lymphangiomatosis

Energy Technology Data Exchange (ETDEWEB)

Renjen, Pooja; Kovanlikaya, Arzu; Brill, Paula W. [New York Presbyterian Hospital/Weill Cornell Medical Center, Department of Radiology, New York, NY (United States); Narula, Navneet [New York Presbyterian Hospital/Weill Cornell Medical Center, Department of Pathology, New York, NY (United States)

2014-11-15

A 9-year-old boy presented with the sudden onset of pleuritic chest pain and on CT was found to have a large pleural effusion, mediastinal fluid, splenic lesions and multiple apparently sclerotic vertebral bodies. Subsequent MRI showed that those vertebral bodies that appeared sclerotic were in fact normal, and the vertebral bodies initially interpreted as normal had an abnormal T1 and T2 hyperintense signal on MRI and were relatively lucent on CT. MRI also demonstrated abnormal heterogeneous T2 hyperintense paraspinal tissue and several multicystic soft tissue masses. Biopsy of two adjacent vertebral bodies, one relatively sclerotic and one lucent, demonstrated findings of bony remodeling without a specific diagnosis. Biopsy of an infiltrative mediastinal mass confirmed the diagnosis of generalized cystic lymphangiomatosis. MRI should be included in the assessment of vertebral involvement in this condition because CT and biopsy findings may be nonspecific. (orig.)

Laparoscopic splenic hilar lymphadenectomy for advanced gastric cancer.

Science.gov (United States)

Hosogi, Hisahiro; Okabe, Hiroshi; Shinohara, Hisashi; Tsunoda, Shigeru; Hisamori, Shigeo; Sakai, Yoshiharu

2016-01-01

Laparoscopic distal gastrectomy has recently become accepted as a surgical option for early gastric cancer in the distal stomach, but laparoscopic total gastrectomy (LTG) has not become widespread because of technical difficulties of esophagojejunal anastomosis and splenic hilar lymphadenectomy. Splenic hilar lymphadenectomy should be employed in the treatment of advanced proximal gastric cancer to complete D2 dissection, but laparoscopically it is technically difficult even for skilled surgeons. Based on the evidence that prophylactic combined resection of spleen in total gastrectomy increased the risk of postoperative morbidity with no survival impact, surgeons have preferred laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) for advanced tumors without metastasis to splenic hilar nodes or invasion to the greater curvature of the stomach, and reports with LSPL have been increasing rather than LTG with splenectomy. In this paper, recent reports with laparoscopic splenic hilar lymphadenectomy were reviewed.

Complicated congenital splenic cyst: Saved by a splenunculus

Directory of Open Access Journals (Sweden)

Karia Nina

2011-01-01

Full Text Available A 12-year-old girl presented with a large congenital splenic cyst complicated by Salmonella organisms. After failure of conservative management and percutaneous drainage, a splenectomy was performed. An incidental splenunculus was preserved. On follow up the splenunculus had increased to normal splenic size and there was no evidence of Howell-Jolly bodies, suggesting normal splenic function.

Splenic mass with remote trauma history: a management dilemma.

LENUS (Irish Health Repository)

McCarthy, C J

2012-02-01

BACKGROUND: Delayed presentation of splenic trauma is a well described entity. METHOD: We report two patients who presented with splenic abnormality found incidentally on imaging for other medical problems. A remote history of splenic trauma was elicited during clinical evaluation; 18 months in one patient and 11 years in the second patient. Both patients underwent surgical exploration. CONCLUSIONS: Radiological investigations could not reassure us that the splenic abnormalities were benign, and their management was the subject of some debate.

Initial thoracic involvement in lymphoma. CT assessment; Afectacion toracica inicial en el linfom. Valoracion con TC

Energy Technology Data Exchange (ETDEWEB)

Bustos, A.; Corredoira, J.; Ferreiros, J.; Cabeza, B.; Jorquera, M.; Pedrosa, I.; Martinez, R.; Fernandez, C. [Hospital Clinico San Carlos. Madrid (Spain)

2002-07-01

To analyze the initial thoracic involvement by CT in a consecutive series of patients with lymphoma. A retrospective analysis was made of thoracic CT studies made at the time of diagnosis of 259 patients with lymphoma. Mediastinal pulmonary, pleural, pericardial and chest wall involvement was assessed by CT. Of 259 patients (129 men y 130 women), 56 had Hodgkin's disease (HD) and 203 had non-Hodgkin lymphoma (NHL). Forty-two percent (42.5%, 110/259) of the patients had chest involvement on CT: 33 of 56 patients with HD (58.9%) and 77 of 203 patients with NHL (37.9%). All the patients with thoracic HD and 71.4% of patients with thoracic NHL, had mediastinal lymph node involvement. of the patients with thoracic involvement 12.1% (4/33) of the patient with HD and 23.3% (18/77) of the patients with NHL had pulmonary involvement. Thoracic involvement on CT was more frequent in HD. Mediastinal lymph node involvement was the most common finding fundamentally in HD. Pulmonary disease always occurred in the presence of mediastinal lymph node involvement in HD but could occur as an isolated finding in NHL. (Author) 24 refs.

Delayed splenic rupture presenting 70 days following blunt abdominal trauma.

Science.gov (United States)

Resteghini, Nancy; Nielsen, Jonpaul; Hoimes, Matthew L; Karam, Adib R

2014-01-01

Delayed splenic rupture following conservative management of splenic injury is an extremely rare complication. We report a case of an adult patient who presented with delayed splenic rupture necessitating splenectomy, 2 months following blunt abdominal trauma. Imaging at the initial presentation demonstrated only minimal splenic contusion and the patient was discharge following 24 hours of observation. © 2014.

Splenic infarction at low altitude in a child with hemoglobin S-C disease.

Science.gov (United States)

Alvarado, C S; Wyly, B; Buchanan, I; Fajman, W A

1988-08-01

We describe a 15-year-old black boy with hemoglobin S-C disease living in Atlanta (altitude 1,034 ft), with no prior history of aircraft or mountain travel, who developed splenic infarction. The clinical picture was characterized by severe left upper quadrant abdominal pain, fever, splenomegaly, and hematologic and scintigraphic evidence of functional asplenia. The diagnosis was suggested by liver/spleen scintigraphy and further confirmed by ultrasonography and computerized tomography (CT) of the spleen. Treatment consisted of analgesics, intravenous fluids, and short-term antibiotic therapy. The child recovered without sequelae.

Resection of tumors of the neck of the pancreas with venous invasion: the "Whipple at the Splenic Artery (WATSA)" procedure.

Science.gov (United States)

Strasberg, Steven M; Sanchez, Luis A; Hawkins, William G; Fields, Ryan C; Linehan, David C

2012-05-01

Tumors of the neck of the pancreas may involve the superior mesenteric and portal veins as well as the termination of the splenic vein. This presents a difficult problem since the pancreas cannot be transected through the neck as is standard in a Whipple procedure. Here, we present our method of resecting such tumors, which we term "Whipple at the Splenic Artery (WATSA)". The superior mesenteric and portal veins are isolated below and above the pancreas, respectively. The pancreas and splenic vein are divided just to the right of the point that the splenic artery contacts the superior border of the pancreas. This plane of transection is approximately 2 cm to the left of the pancreatic neck and away from the tumor. The superior mesenteric artery is cleared from the left side of the patient. With the specimen remaining attached only by the superior mesenteric and portal veins, these structures are clamped and divided. Reconstruction is performed with or without a superficial femoral vein graft. The splenic vein is not reconstructed. Ten cases have been performed to date without mortality. We have previously shown that the pattern of venous collateral development following occlusion of the termination of the splenic vein in the manner described is not similar to that of cases of sinistral (left sided) portal hypertension. Whipple at the splenic artery (WATSA) is a safe method for resection of tumors of the neck of the pancreas with vein involvement. It should be performed in high-volume pancreatic surgery centers.

Examination of hepatic contrast-enhanced CT monitored by Smart Prep

International Nuclear Information System (INIS)

Kakizaki, Dai; Saito, Kazuhiro; Sakurada, Toru; Abe, Kimihiko; Suzuki, Kenji

1999-01-01

The aim of the present study is to obtain the time density curves of the contrast-enhanced CT of hepatic portal vein, hepatic and splenic parenchyma, and to examine the relation with age, body weight, type of liver dysfunction. Subjects were 32 patients with liver tumors or liver diseases. For this purpose, the procedure of hepatic CT was monitored by Smart Prep and the images of whole liver was taken when the level of the contrast at the hepatic portal vein reached to the enhancement threshold. The contrast medium used was Iomeprol 300. The adverse reactions by Iomeprol 300 were mild and any treatment did not need. There was no correlation age and weight with enhancement threshold at the hepatic portal vein and peak time at the splenic parenchyma. The enhancement threshold at the hepatic portal vein was various in patients with chrrhosis and chronic hepatitis, and tended to be delayed in patients with chrrhosis. The peak time of the splenic parenchyma was up to 52 seconds in all patients with chronic hepatitis. The shortage of the enhancement threshold and the increase in blood flow at arterial early phase were observed in the patients with advanced acute hepatitis. This method should be examined more cases with various hepatic diseases. (K.H.)

Splenic irradiation in HIV-related thrombocytopenia

International Nuclear Information System (INIS)

Leung, J.T.; Kuan, R.

1996-01-01

Splenic irradiation has been used in patients with HIV-related thrombocytopenia. This retrospective review deals with four patients treated with low dose splenic irradiation. All patients had an increase in platelet count and tolerated the treatment without side effects. However, the treatment response lasted for several months only. 9 refs., 1 tab

Splenic mass with remote trauma history: a management dilemma.

LENUS (Irish Health Repository)

McCarthy, C J

2011-03-02

BACKGROUND: Delayed presentation of splenic trauma is a well described entity. METHOD: We report two patients who presented with splenic abnormality found incidentally on imaging for other medical problems. A remote history of splenic trauma was elicited during clinical evaluation; 18 months in one patient and 11 years in the second patient. Both patients underwent surgical exploration. CONCLUSIONS: Radiological investigations could not reassure us that the splenic abnormalities were benign, and their management was the subject of some debate.

Symptomatic heterotopic suprarenal splenic tissue

International Nuclear Information System (INIS)

Heider, J.; Kreft, B.; Winter, P.

1998-01-01

We report on a 33-year-old man with symptomatic heterotopic suprarenal splenic tissue. Heterotopic splenic tissue can often be found after posttraumatic splenectomy. It is a result of autotransplantation induced by trauma (splenosis). Additionally it can grow during embryogenic development. Such an accessory spleen is found in 10-44% of all autopsies. In this case report the patient was treated by resection due to increasing flank pain and suspected neoplasm. (orig.) [de

Bacterial phagocytosis by macrophage of autogenous splenic implant

Directory of Open Access Journals (Sweden)

Marques R. G.

2003-01-01

Full Text Available Autogenous splenic implant seems to be the only alternative for preservation of splenic tissue after total splenectomy. This work was carried out to analyze the morphologic regeneration of autotransplanted splenic tissue in Wistar rats and to determine the bacterial phagocytic function of their macrophages. We utilized an experimental model with thirty-two rats, of both sexes, submitted to total splenectomy combined with autotransplantation in greater omentum of slices of the whole spleen mass. The animals were divided into two groups: I - young rats weighing 100 to 150 g; and II - adult rats weighing 250 to 300 g. Sixteen weeks later animals were intravenously inoculated with a suspension of Escherichia coli AB1157. Twenty minutes after inoculation, the animals were sacrificed and the splenic autotransplants were removed for morphological study. There was regeneration of autotransplanted splenic tissue in all animals. A similar morphological aspect among all animals was observed, with splenic tissue showing red and white pulps, lymphoid follicles, and marginal zone, with a moderate architectural disarrangement. Macrophages containing gram-negative bacterial aggregates as well as macrophages with hemosiderin pigments within the cytoplasm were observed. Blood vessels showed preserved walls, with no signs of vasculitis or thrombosis. The present results suggest that autogenous splenic implants in the greater omentum of the rat acquire the macro- and microscopic architecture of a normal spleen, with reduced dimensions, and preserve bacterial phagocyte function.

Transcatheter Embolization for Delayed Hemorrhage Caused by Blunt Splenic Trauma

International Nuclear Information System (INIS)

Krohmer, Steven J.; Hoffer, Eric K.; Burchard, Kenneth W.

2010-01-01

Although the exact benefit of adjunctive splenic artery embolization (SAE) in the nonoperative management (NOM) of patients with blunt splenic trauma has been debated, the role of transcatheter embolization in delayed splenic hemorrhage is rarely addressed. The purpose of this study was to evaluate the effectiveness of SAE in the management of patients who presented at least 3 days after initial splenic trauma with delayed hemorrhage. During a 24-month period 4 patients (all male; ages 19-49 years) presented with acute onset of pain 5-70 days after blunt trauma to the left upper quadrant. Two had known splenic injuries that had been managed nonoperatively. All had computed axial tomography evidence of active splenic hemorrhage or false aneurysm on representation. All underwent successful SAE. Follow-up ranged from 28 to 370 days. These cases and a review of the literature indicate that SAE is safe and effective for NOM failure caused by delayed manifestations of splenic arterial injury.

Acute Gastric Volvulus Causing Splenic Avulsion and Hemoperitoneum

Directory of Open Access Journals (Sweden)

Yana Cavanagh

2018-01-01

Full Text Available Gastric volvulus is an abnormal, potentially life-threatening, torsion of the stomach. The presence of complications such as hemoperitoneum increases the diagnostic urgency; however it can also mask the presentation of gastric volvulus. We encountered a 66-year-old female who presented with symptomatic gastric outlet obstruction and was found to have hemoperitoneum and splenic avulsion on imaging. In our case, hemoperitoneum was a clinical red herring as initial imaging concentrated on the presence of hemoperitoneum and was nondiagnostic of gastric volvulus. Interestingly, our patient experienced complete resolution of her presenting symptomatology following placement of a nasogastric tube. Furthermore, endoscopic evaluation revealed no overt pathology to explain outlet obstruction. In light of these findings, gastric torsion was strongly suspected. A repeat CT scan was confirmatory, elucidated reduction of the stomach to its anatomic position, retroactively diagnosing a gastric volvulus. This case is unusual in its presentation and setting. The patient presented with two rare complications of gastric volvulus, hemoperitoneum and splenic avulsion. Additionally, ten years prior to this presentation the patient had a temporary gastrostomy tube. Gastropexy with a gastrostomy is the treatment for gastric volvulus and should have been preventative of her presentation with torsion. Furthermore, the gastric volvulus was not initially recognized radiographically due to the presence of masking radiographic findings. This case serves to highlight the utility of clinical acumen and maintain a high index of suspicion for gastric volvulus in all cases presenting with Borchardt’s triad.

Drainage of Splenic Abscess: A Case Report | Kombo | Nigerian ...

African Journals Online (AJOL)

... and was managed by tube drainage. His post operative recovery was uneventful. Conclusion: Tube drainage of the splenic abscess is encouraged if there is easy access to the abscess and there is evidence of residual splenic tissue in the critically ill patient. Key Word: Tube drainage, splenic abscess, splenectomy.

Functional hyposplenia after splenic irradiation for Hodgkin's disease

International Nuclear Information System (INIS)

Coleman, C.N.; McDougall, I.R.; Dailey, M.O.; Ager, P.; Bush, S.; Kaplan, H.S.

1982-01-01

We previously reported a patients who developed fulminant pneumococcal sepsis 12 years after successful treatment for Hodgkin's disease, which included splenic irradiation. We have since evaluated splenic size and function in 25 patients who had received splenic irradiation 5 to 16 years previously either for Hodgkin's disease (n . 19) or non-Hodgkin's lymphoma (n . 6). Mean maximum splenic diameter as measured on a 99mTc-sulfur colloid liver-spleen scan was 6.2 cm in the irradiated group and 9.7 cm in a control group (p less than 0.001). The mean percentage of erythrocytes containing pits when observed with interference phase microscopy was 13.0% in the irradiated group, which was significantly different (p less than 0.001) from the levels found in each of the control groups: normal subjects, 0.9%; unstaged and untreated lymphoma patients, 0.6%; and patients after splenectomy, 33.7%. Patients who have had splenic irradiation should be considered at risk of developing overwhelming pneumococcal sepsis

CNS Involvement in Hemophagocytic Lymphohistiocytosis: CT and MR Findings

International Nuclear Information System (INIS)

Chung, Tae Woong

2007-01-01

Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder that is characterized by proliferation of benign histiocytes, and this commonly involves the liver, spleen, lymph nodes, bone marrow and central nervous system (CNS). We report here on the CT and MR imaging findings in a case of CNS HLH that showed multiple ring enhancing masses mimicking abscess or another mass on the CT and MR imaging. emophagocytic lymphohistiocytosis (HLH) is a rare disorder that is characterized by nonmalignant diffuse infiltration of multiple organs, including the central nervous system (CNS), by lymphocytes and histiocytes (1). Many radiologic reports describing diffuse white matter infiltrations, parenchymal atrophy and calcification have been published, but the characteristics of these findings remain non-specific, especially in immunocompromised patients. We present here a case of HLH in a 3-year-old boy who presented with multiple ring enhancing lesions involving the brain. In conclusion, although the CT and MRI findings of HLH with ring enhancing parenchymal lesions are nonspecific and mimic abscess, and especially in the immunosuppressed patients, increased diffusion at the center on DWI may be a finding of HLH to differentiate it from abscess, which has restricted diffusion at the center. However, the pathologic correlation with DWI according to the lesion stage certainly needs further study with a larger number of patients

Management and treatment of splenic trauma in children.

Science.gov (United States)

Arslan, Serkan; Guzel, Mahmut; Turan, Cuneyt; Doğanay, Selim; Kopru, Mehmet

2015-01-01

To assess types of splenic traumas, accompanying injuries, their management and results. We studied the reports of 90 patients (64 boys, 26 girls) who were treated for splenic injuries as a result of blunt abdominal trauma between 2005-2012. Age, sex, hospitalization time, mechanisms of traumas, accompanying injuries and management methods were recorded. Causes of trauma were falls from height (46 patients, 51%), pedestrian traffic accidents (17 patients, 19%), passenger traffic accidents (11 patients, 12%), bicycle accidents (10 patients, 11%) and falling objects from height (6 patients, 6.6%). Splenic injury alone was observed in 57 patients (63.3%) and other organ injuries together with splenic injury in 33 patients (36.7%). Splenectomy was performed in six patients (6.6%) due to hemodynamic instability and small intestine repair due to small intestine injury in one patient (1.1%). None of these patients died from their injuries. A large proportion of splenic injuries recover with conservative therapy. Some of the advantages of conservative therapy include short hospitalization time, less need for blood transfusion, and less morbidity and mortality. Falls from height and traffic accidents are important factors in etiology. The possibility of other organ injuries together with splenic injuries should be considered.

The contemporary management of penetrating splenic injury.

Science.gov (United States)

Berg, Regan J; Inaba, Kenji; Okoye, Obi; Pasley, Jason; Teixeira, Pedro G; Esparza, Michael; Demetriades, Demetrios

2014-09-01

Selective non-operative management (NOM) is standard of care for clinically stable patients with blunt splenic trauma and expectant management approaches are increasingly utilised in penetrating abdominal trauma, including in the setting of solid organ injury. Despite this evolution of clinical practice, little is known about the safety and efficacy of NOM in penetrating splenic injury. Trauma registry and medical record review identified all consecutive patients presenting to LAC+USC Medical Center with penetrating splenic injury between January 2001 and December 2011. Associated injuries, incidence and nature of operative intervention, local and systemic complications and mortality were determined. During the study period, 225 patients experienced penetrating splenic trauma. The majority (187/225, 83%) underwent emergent laparotomy. Thirty-eight clinically stable patients underwent a deliberate trial of NOM and 24/38 (63%) were ultimately managed without laparotomy. Amongst patients failing NOM, 3/14 (21%) underwent splenectomy while an additional 6/14 (42%) had splenorrhaphy. Hollow viscus injury (HVI) occurred in 21% of all patients failing NOM. Forty percent of all NOM patients had diaphragmatic injury (DI). All patients undergoing delayed laparotomy for HVI or a splenic procedure presented symptomatically within 24h of the initial injury. No deaths occurred in patients undergoing NOM. Although the vast majority of penetrating splenic trauma requires urgent operative management, a group of patients does present without haemodynamic instability, peritonitis or radiologic evidence of hollow viscus injury. Management of these patients is complicated as over half may remain clinically stable and can avoid laparotomy, making them potential candidates for a trial of NOM. HVI is responsible for NOM failure in up to a fifth of these cases and typically presents within 24h of injury. Delayed laparotomy, within this limited time period, did not appear to increase

Splenic CD11clowCD45RBhigh dendritic cells derived from endotoxin-tolerant mice attenuate experimental acute liver failure

Science.gov (United States)

Zhang, Sai-Nan; Yang, Nai-Bin; Ni, Shun-Lan; Dong, Jin-Zhong; Shi, Chun-Wei; Li, Shan-Shan; Zhang, Sheng-Guo; Tang, Xin-Yue; Lu, Ming-Qin

2016-01-01

Endotoxin tolerance (ET) is suggested to attenuate the severity of acute liver failure (ALF) in mice, possibly through both innate and adaptive immunity. However, the involvement of regulatory dendritic cells (DCregs) in ET has not been fully elucidated. In this study, their effect on ALF in mice was investigated. Splenic DCregs from ET-exposed mice (ET-DCregs) showed lower expression levels of CD40, CD80, and MHC-II markers and stronger inhibition of allogenic T cells and regulation of IL-10 and IL-12 secretion than splenic DCregs from normal mice (nDCregs). Moreover, the mRNA and protein levels of TNF-α and P65 in splenic ET-DCregs were significantly lower than those in the splenic nDCregs. The survival rate was significantly increased and liver injury was mitigated in mice with ALF treated with splenic ET-DCregs. In addition, A20 expression was decreased in the liver of ALF mice, but elevated after infusion of splenic nDCregs and ET-DCregs, and a much higher elevation was observed after infusing the latter cells. The functionality of splenic DCregs was altered after ET exposure, contributing to protection of the livers against D-GalN/LPS-induced ALF. PMID:27625297

Twenty-years of splenic preservation at a level 1 pediatric trauma center.

Science.gov (United States)

Bairdain, Sigrid; Litman, Heather J; Troy, Michael; McMahon, Maria; Almodovar, Heidi; Zurakowski, David; Mooney, David P

2015-05-01

Splenic preservation is the standard of care for hemodynamically stable children with splenic injuries. We report a 20-year single-institutional series of children with splenic injuries managed without a splenectomy. Children evaluated and treated for blunt splenic injury at Boston Children's Hospital from 1994 to 2014 were extracted from the trauma registry. Demographics, clinical characteristics, complications, and outcomes were reviewed. Three time-periods were evaluated based upon the development and modification of splenic injury clinical pathway guidelines (CPGs). Survival was defined as being discharged from the hospital alive. 502 suffered isolated splenic injuries. The median AAST grade of splenic injury increased across the three CPG time periods (psplenic-injury related mortalities occurred. Hospital length of stay decreased significantly secondary to splenic injury CPGs (psplenic injury, no patient died or underwent splenectomy. Hospital length of stay decreased across time, despite an increase in the severity of splenic injuries encountered. Splenectomy has become so unusual in the management of hemodynamically stable children with a splenic injury that it may no longer be a legitimate outcome marker. Copyright © 2015 Elsevier Inc. All rights reserved.

Radioisotope spleen scan in patients with splenic injury

International Nuclear Information System (INIS)

Mishalany, H.G.; Miller, J.H.; Woolley, M.M.

1982-01-01

The technetium /sup 99m/Tc sulfur colloid liver-spleen scan is a valuable aid in diagnosis and treatment of patients with splenic injury. After reviewing the charts of 47 patients who were ill as a result of splenic trauma, we came to the following conclusions: (1) the scan identified the injury, accurately mapped its extent, and indicated the presence or absence of associated liver injuries; (2) the scans were useful in following the extent and rate of healing of the splenic injury; (3) the scan is an indirect measurement of of return of splenic fuction; (4) the procedure can be performed in a reasonable time frame with no serious morbidity; and (5) the indications, contraindications, and timing of scans are now reasonably well established

Radioisotope spleen scan in patients with splenic injury

Energy Technology Data Exchange (ETDEWEB)

Mishalany, H.G.; Miller, J.H.; Woolley, M.M.

1982-09-01

The technetium /sup 99m/Tc sulfur colloid liver-spleen scan is a valuable aid in diagnosis and treatment of patients with splenic injury. After reviewing the charts of 47 patients who were ill as a result of splenic trauma, we came to the following conclusions: (1) the scan identified the injury, accurately mapped its extent, and indicated the presence or absence of associated liver injuries; (2) the scans were useful in following the extent and rate of healing of the splenic injury; (3) the scan is an indirect measurement of of return of splenic fuction; (4) the procedure can be performed in a reasonable time frame with no serious morbidity; and (5) the indications, contraindications, and timing of scans are now reasonably well established.

Gastrointestinal involvement of recurrent renal cell carcinoma: CT findings and clinicpathologic features

Energy Technology Data Exchange (ETDEWEB)

Park, Hyo Jung; Kim, Hyun Jin; Park, Seung Ho; Lee, Jong Seok; Kim, Ah Young [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Ha, Hyun Kwon [Dept. of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung (Korea, Republic of)

2017-06-15

To retrospectively evaluate the CT findings and clinicopathologic features in patients with gastrointestinal (GI) involvement of recurrent renal cell carcinoma (RCC). The medical records were reviewed for 15 patients with 19 pathologically proven GI tract metastases of RCC. The CT findings were analyzed to determine the involved sites and type of involvement; lesion size, morphology, and contrast enhancement pattern; and occurrence of lymphadenopathy, ascites and other complications. The most common presentation was GI bleeding (66.7%). The average interval between nephrectomy and the detection of GI involvement was 30.4 ± 37.4 months. GI lesions were most commonly found in the ileum (36.8%) and duodenum (31.6%). A distant metastasis (80%) was more common than a direct invasion from metastatic lesions. The mean lesion size was 34.1 ± 15.0 mm. Intraluminal polypoid masses (63.2%) with hyperenhancement (78.9%) and heterogeneous enhancement (63.2%) were the most common findings. No patients had regional lymphadenopathy. Complications occurred in four patients, with one each of bowel obstruction, intussusception, bile duct dilatation, and pancreatic duct dilatation. GI involvement of recurrent RCC could be included in the differential diagnosis of patients with heterogeneous, hyperenhanced intraluminal polypoid masses in the small bowel on CT scans along with a relative paucity of lymphadenopathy.

Clinical indications and biological mechanisms of splenic irradiation in autoimmune diseases

International Nuclear Information System (INIS)

Weinmann, M.; Becker, G.; Einsele, H.; Bamberg, M.

2001-01-01

Background: Splenic irradiation (SI) is a fairly unknown treatment modality in autoimmune disorders like autoimmune thrombocytopenia (AIT) or autoimmune hemolytic anemia (AIHA), which may provide an effective, low toxic and cost-effective treatment for selected patients. Patients, Materials and Methods: This article reviews the limited experiences on splenic irradiation in autoimmune thrombocytopenia by analyzing the current studies including 71 patients and some preliminary reports on splenic irradiation in autoimmune hemolytic anemia. Results: In autoimmune thrombocytopenia between 40 and 90% of all patients responded, but most of them relapsed within 4 to 6 months after splenic irradiation. Between 10 and 20% of all patients had a sustained response. The efficacy of splenic irradiation in HIV-associated cases of thrombocytopenia is probably lower than in other forms of autoimmune thrombocytopenia, but especially in this group immunosuppressive drug treatment of autoimmune thrombocytopenia exposes some problems. In autoimmune hemolytic anemia there are some case reports about efficacy of splenic irradiation. Toxicity of splenic irradiation in both diseases was very moderate. Conclusions: For HIV patients, for elderly patients or patients at high risk for complications following splenectomy splenic irradiation might be a treatment option. Splenic irradiation as preoperative treatment in patients not responding to or not suitable for immunosuppressive drugs prior to splenectomy may be a promising new application of splenic irradiation to reduce adverse effects of splenectomy in thrombocytopenic patients. A further analysis of the biological mechanisms underlying splenic irradiation may help to improve patient selection, to optimize dose concepts and treatment schedules and will improve understanding of radiotherapy as an immunomodulatory treatment modality. (orig.) [de

[Multidisciplinary protocol for computed tomography imaging and angiographic embolization of splenic injury due to trauma: assessment of pre-protocol and post-protocol outcomes].

Science.gov (United States)

Koo, M; Sabaté, A; Magalló, P; García, M A; Domínguez, J; de Lama, M E; López, S

2011-11-01

To assess conservative treatment of splenic injury due to trauma, following a protocol for computed tomography (CT) and angiographic embolization. To quantify the predictive value of CT for detecting bleeding and need for embolization. The care protocol developed by the multidisciplinary team consisted of angiography with embolization of lesions revealed by contrast extravasation under CT as well as embolization of grade III-V injuries observed, or grade I-II injuries causing hemodynamic instability and/or need for blood transfusion. We collected data on demographic variables, injury severity score (ISS), angiographic findings, and injuries revealed by CT. Pre-protocol and post-protocol outcomes were compared. The sensitivity and specificity of CT findings were calculated for all patients who required angiographic embolization. Forty-four and 30 angiographies were performed in the pre- and post-protocol periods, respectively. The mean (SD) ISSs in the two periods were 25 (11) and 26 (12), respectively. A total of 24 (54%) embolizations were performed in the pre-protocol period and 28 (98%) after implementation of the protocol. Two and 7 embolizations involved the spleen in the 2 periods, respectively; abdominal laparotomies numbered 32 and 25, respectively, and 10 (31%) vs 4 (16%) splenectomies were performed. The specificity and sensitivity values for contrast extravasation found on CT and followed by embolization were 77.7% and 79.5%. The implementation of this multidisciplinary protocol using CT imaging and angiographic embolization led to a decrease in the number of splenectomies. The protocol allows us to take a more conservative treatment approach.

CT assessment of the correlation between clinical examination and bone involvement in oral malignant tumors

International Nuclear Information System (INIS)

Albuquerque, Marco Antonio Portela; Oliveira, Ilka Regina Souza; Cavalcanti, Marcelo Gusmao Paraiso; Kuruoshi, Marcia Etsuko

2009-01-01

Oral cancers have a tendency to invade the surrounding bone structures, and this has a direct influence on the treatment management and on outcomes. The objective of this study was to correlate the clinical parameters (location, clinical presentation and TNM staging) of oral malignant tumors that can be associated with a potential of bone invasion and determine the accuracy of clinical examination to predict bone involvement, using computed tomography (CT). Twenty five patients, with oral malignant tumors were submitted to clinical and CT examinations. CT was considered the standard parameter to evaluate the presence of bone involvement. Clinical assessment of location, presentation form and TNM staging of the tumors were then compared to the CT findings in predicting bone involvement. Bone involvement was observed in 68% of the cases. It was predicted that tumors located in the retromolar trigone and hard palate, with a clinical aspect of infiltrative ulcer or nodule and classified in stage IV had a high potential to cause bone involvement. The clinical examination assessment of these tumors showed to be a valuable tool to predict bone invasion, with high sensitivity (82%) and specificity (87.5%), based on the results found in the CT images. No statistical significance was found between the CT and clinical examinations regarding bone involvement. The identification of some clinical parameters such as location, clinical presentation, and TNM stage, associated with a detailed clinical examination, was considered a valuable tool for the assessment of bone destruction by oral malignant tumors. (author)

Traumatic rupture of a solitary splenic hydatid cyst: A case report

Directory of Open Access Journals (Sweden)

Moustafa Lakis

2015-02-01

Full Text Available Summary: The rupture of an Echinococcus granulosus hydatid cyst in the spleen due to trauma is a rare event. In this case report we describe the case of a 39-year-old Lebanese male victim of a motor vehicle accident with a ruptured solitary splenic hydatid cyst discovered by CT scan and excised during exploratory laparotomy.Echinococcosis or hydatid disease is a parasitic infestation by the Echinococcus genus of tapeworm. The eggs of E. granulosus, a species of Echinococcus, are fecal-orally transmitted to human hosts, most often from dog feces, and manifest as cystic lesions termed hydatid. E. granulosus most commonly affects the liver (75%, lungs (15%, and rarely the spleen (2–5% [1,2]. E. granulosus is particularly endemic to cattle rearing areas of the Middle East. Infected patients most commonly present with vague abdominal pain, as a result of mass effect or spontaneous rupture of the cyst. Nevertheless, patient presentation may be due to traumatic rupture of a hydatid cyst; however, this is very rare. Herein we report a case of traumatic rupture of a solitary splenic hydatid cyst in a 39-year-old male following a motor vehicle crash, managed following the Advanced Trauma Life Support (ATLS protocol. Keywords: Echinococcus, Hydatid, Trauma, Splenectomy, Cysts, Surgery

Isolated splenic calcifications in two patients with portal hypertension

International Nuclear Information System (INIS)

Aleixandre, A.; Cugat, A.; Ruiz, A.; Marti-Bonmati, L.; Tardaguila, F.

2002-01-01

Calcification of the walls of the veins of the portal hypertension (PHT) (1-0), is uncommon. Calcification of the intra splenic vessels is exceptional. We report two cases of isolated calcification of intra splenic vessels, without calcification of the splenoportal venous axis, in patients with liver cirrhosis and PHT. The calcification was not clear. Computed tomography identified the calcification as linear tubular, branched structures located in the wall of intra splenic vessels. magnetic resonance imaging disclosed signs of cirrhosis and PHT but did not show the splenic classifications because of technical limitations. The cause of these calcifications was sustained PHT due to chronic liver disease. (Author) 15 refs

Scrub typhus: radiological and clinical findings in abdominopelvic involvement.

Science.gov (United States)

Kim, Kun Yung; Song, Ji Soo; Park, Eun Hae; Jin, Gong Yong

2017-03-01

To describe the clinical and radiological findings of abdominopelvic involvement in scrub typhus. Abdominopelvic computed tomography (CT) of 78 patients with scrub typhus were evaluated by two readers. The presence of gallbladder wall thickening, arterial inhomogeneous enhancement of the liver, periportal edema, splenic infarction, hepatomegaly, splenomegaly, ascites, pleural effusion, and sites of lymphadenopathy were evaluated. Patients were divided into four clinical subgroups according to laboratory findings. Association between imaging findings and subgroups was analyzed by Chi squared test or Fisher's exact test. The most common CT finding was hepatomegaly (74.4%), followed by splenomegaly (66.7%). The majority of patients had at least three areas of abdominopelvic lymphadenopathy (71.8%). Pelvic lymphadenopathy was most commonly seen when eschar was found in the ipsilateral lower extremity (left, n = 5/7; right, n = 8/13). Significant association between hepatic dysfunction and perigastric lymphadenopathy was documented (p = 0.03). Scrub typhus has a spectrum of variable clinical and radiological findings mimicking those of acute hepatitis. Diffuse abdominopelvic lymphadenopathy involving the retroperitoneum and pelvic area may aid in early diagnosis of scrub typhus. Perigastric lymphadenopathy could be a sign of severe scrub typhus combined with hepatic dysfunction.

Transcatheter Coil Embolization of Splenic Artery Aneurysm

International Nuclear Information System (INIS)

Yamamoto, Satoshi; Hirota, Shozo; Maeda, Hiroaki; Achiwa, Sachiko; Arai, Keisuke; Kobayashi, Kaoru; Nakao, Norio

2008-01-01

The purpose of this study was to evaluate clinical results and technical problems of transcatheter coil embolization for splenic artery aneurysm. Subjects were 16 patients (8 men, 8 women; age range, 40-80 years) who underwent transcatheter embolization for splenic artery aneurysm (14 true aneurysms, 2 false aneurysms) at one of our hospitals during the period January 1997 through July 2005. Two aneurysms (12.5%) were diagnosed at the time of rupture. Multiple splenic aneurysms were found in seven patients. Aneurysms were classified by site as proximal (or strictly ostial) (n = 3), middle (n = 3), or hilar (n = 10). The indication for transcatheter arterial embolization was a false or true aneurysm 20 mm in diameter. Embolic materials were fibered coils and interlocking detachable coils. Embolization was performed by the isolation technique, the packing technique, or both. Technically, all aneurysms were devascularized without severe complications. Embolized aneurysms were 6-40 mm in diameter (mean, 25 mm). Overall, the primary technical success rate was 88% (14 of 16 patients). In the remaining 2 patients (12.5%), partial recanalization occurred, and re-embolization was performed. The secondary technical success rate was 100%. Seven (44%) of the 16 study patients suffered partial splenic infarction. Intrasplenic branching originating from the aneurysm was observed in five patients. We conclude that transcatheter coil embolization should be the initial treatment of choice for splenic artery aneurysm

Sonographic Measurement of Normal Splenic Length in Korean Adults

Energy Technology Data Exchange (ETDEWEB)

Shin, Sang Bum; Cheon, Byung Kook; Kim, Jong Min; Oh, Kyung Seoung; Jung, Gyoo Sik; Huh, Jin Do; Joh, Young Duk [Kosin University College of Medicine, Busan (Korea, Republic of)

1996-12-15

To establish upper limit of normal splenic length of Korean adults on ultrasonography and to determice the degree of interobserver and intraobserver variation. Ultrasonographic scans were performed to measure the maximum length of spleen in 105 of 150 adults selected by convenience sampling. Remained 45 cases with any conditions that could alter splenic size were excluded from this study. The maximum length of spleen was measured and correlated with body surface area, patient height, weight, age and sex. In 31 of the 105 adults we evaluated the interobserver and intraobserver variations in sonographic measurements of splenic length obtained by three radiologists in blind fashion. The mean splenic length in 105 adults was 8.56cm ({+-} 0.95). The splenic length positively correlated with body surface area, patient height and weight (P <0.001), and negatively correlated with patient age (P < 0.01). Male spleen (8.87 cm {+-} 1.07) was longer than female spleen (8.35 cm {+-} 0.81) (P < 0.05). The following guidelines are proposed for the upper limit of normal splenic length at different groups of body surface area: no longer than 10 cm at 1.20{approx}1.59 m{sup 2}, 11 cm at1.60{approx}1.79 m{sup 2}, and 12 cm at 1.80{approx}1.99 m{sup 2}. The mean interobserver variation between any two radiologists ranged from 0.32 cm ({+-} 0.29) to 0.39 cm ({+-} 0.33) and interobserver variations were within 1 cm in 96%. The mean intraobserver variations were within 0.5 cm in 91%. The splenic length closely correlated with body surface area, patient height, weight and age. Particularly the upper limit of normal splenic length changed according to body surface area. Interobserver variation about 1 cm and intraobserver variation about 0.5 cm should be considered in the measurement of the splenic length on ultrasonography

Spiral CT features and anatomic basis of posterior pararenal space involvement in acute pancreatitis

International Nuclear Information System (INIS)

Min Pengqiu; Yan Zhihan; Yang Hengxuan; Liu Zaiyi; Song Bin; Wu Bing; Zhang Jin; Liu Rongbo

2005-01-01

Objective: To evaluate spiral CT features and anatomic basis of the posterior pararenal space (PPS) involvement in acute pancreatitis (AP). Methods: CT images of 87 cases with AP were retrospectively studied with focus on spiral CT features, incidence of the PPS involvement, and its correlations with the posterior renal fascia or lateroconal fascia. Results: Our study showed that the incidence of the PPS involvement was 47% (41/87), with Grade A 53% (46/87), Grade B 24%(21/87), and Grade C 23% (20/87), and Grade 0 53% (46/87), Grade I 22% (19/87), and Grade II 25% (22/87), respectively. The pancreatitis fluid collection in the PPS was continuous with that in the anterior pararenal space or with the fluid between the two laminae of the posterior renal fascia. In 3 follow-up cases, pseudocysts in the PPS were continuous with that in anterior pararenal space below the cone of renal fascia. Conclusion: Spiral CT features of the PPS involvement varies from mild inflammatory changes to fluid collection or phlegmonous mass. Fluid within anterior pararenal space in AP flows into the PPS by three routes. (authors)

Benign and malignant skull-involved lesions: discriminative value of conventional CT and MRI combined with diffusion-weighted MRI.

Science.gov (United States)

Tu, Zhanhai; Xiao, Zebin; Zheng, Yingyan; Huang, Hongjie; Yang, Libin; Cao, Dairong

2018-01-01

Background Little is known about the value of computed tomography (CT) and magnetic resonance imaging (MRI) combined with diffusion-weighted imaging (DWI) in distinguishing malignant from benign skull-involved lesions. Purpose To evaluate the discriminative value of DWI combined with conventional CT and MRI for differentiating between benign and malignant skull-involved lesions. Material and Methods CT and MRI findings of 58 patients with pathologically proven skull-involved lesions (43 benign and 15 malignant) were retrospectively reviewed. Conventional CT and MRI characteristics and apparent diffusion coefficient (ADC) value of the two groups were evaluated and compared. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the differential performance of each parameter separately and together. Results The presence of cortical defects or break-through and ill-defined margins were associated with malignant skull-involved lesions (both P benign and malignant skull-involved lesions. Conclusion The combination of CT, MRI, and DWI can help to differentiate malignant from benign skull-involved lesions. CT + MRI + DWI offers optimal sensitivity, while DWI offers optimal specificity.

Radionuclide scan findings in delayed splenic rupture

International Nuclear Information System (INIS)

Flickinger, F.W.; Jackson, G.L.

1978-01-01

An initial liver/spleen scan performed on a patient with blunt abdominal trauma was negative 3 days following the accident. A follow-up scan 7 days later showed definite evidence of splenic rupture, proved surgically. The authors conclude that, in such cases, spleen scans may be negative initially because of delayed splenic ruptures

Splenic radionuclide angiography in the portal hypertension assessment

International Nuclear Information System (INIS)

Artiko, V.; Kostic, K.; Perisic-Savic, M.; Janosevic, S.; Obradovic, V.

2004-01-01

The aim of this study is the presentation of the hepatic and splenic radionuclide angiograms (SRA) in various portal blood flow disturbances, as well as an analysis of the splenic arterio-venous ratio (SAVR) results, obtained as a slope ratio between inflow, arterial and the outflow, venous phases on the splenic TA curve. Splenic radionuclide angiography was performed after bolus injection of 740 MBq of 99m-Tc-pertechnetate, using ROTA scintillation camera (Siemens) and MicroDelta computer'. Four types of the SRA were established: a) very acute descendent slope (DS) in the controls; b) less acute DS in the patients with LC; c) horisontal venous phase caused by impaired outflow to the portal vein in LC with expressed portal hypertension, collateral circulation and LCEV; d) ascending outflow phase, characterizing the splenic and/or portal venous thrombosis. SAVR values were increased in liver cirrhosis (LC) with esophageal vahces (LCEV, n=10) (6.1 +/- 3.4) in comparison to the controls (n=10)(3.7 +/- 1.3)(U=25, p 0.05). However, in another two patients with LC and in 8 with LCEV it was not possible to access SAVR because of the appearance of the horisontal or rising venous phase on the splenic TA curve, instead of descendent. SRA and increased SAVR values reflect various blood flow alterations in the portal system and give additional data to the more accurate interpretation of the results obtained by hepatic radionuclide angiography. (authors)

Spontaneous splenic rupture in Waldenstrom's macroglobulinemia: a case report

Directory of Open Access Journals (Sweden)

Charakidis Michail

2010-09-01

Full Text Available Abstract Introduction We report the case of a patient with Waldenstrom's macroglobulinemia complicated by spontaneous splenic rupture. Case presentation A 49-year-old Caucasian woman was referred to our emergency department by her general practitioner following a three-week history of malaise, night sweats, six kilograms of weight loss, intermittent nausea and vomiting, progressive upper abdominal pain and easy bruising. On the fourth day following her admission, she had a rapid clinical deterioration, with subsequent radiological investigations revealing a splenic rupture. Her morphology, biochemistry, flow cytometry and histology were strongly suggestive of Waldenstrom's macroglobulinemia. Conclusions Spontaneous splenic rupture is not an expected complication of low-grade lymphoplasmacytic lymphomas, such as Waldenstrom's macroglobulinemia. To the best of our knowledge, this is the only reported case of early spontaneous splenic rupture due to Waldenstrom's macroglobulinemia. Our case highlights that despite the typical disease course of low-grade hematological malignancies, signs and symptoms of imminent splenic rupture should be considered when formulating a clinical assessment.

[Giant splenic cyst in a teenager girl: Case report].

Science.gov (United States)

Martínez Torres, Beatriz; Medina García, Manuel; Zafra Anta, Miguel Ángel; García Muñoz-Najar, Alejandro José; Tardío Dovao, Juan C

2017-06-01

Giant nonparasitic splenic epidermoid cysts are relatively uncommon. These lesions can lead abdominal pain, but most of then are asymptomatic, and they are discovered incidentally. We report a 13-y old female with a giant splenic epidermoid cystic, given the special interest of diagnostic and therapeutic decision-making of this rare entity. A 13-y old female with clinical history of abdominal pain since the last two months. On physical examination a firm, tender mass was palpable in left hypochondrium. Diagnosis of a large cystic splenic mass was made based on ultrasound and abdominal computed tomography scan. Splenectomy was performed, and histopathological-immunohistochemistry studies revealed findings suggestive of primary epithelial cyst. The post-operative clinical course was satisfactory and uneventful. Treatment of giant nonparasitic splenic cysts is surgical. Preserve splenic parenchyma must be the aim in an individualized decision-making. The different types of surgical modalities will be according to the diagnosis and clinical situation (cyst size, age, comorbidities).

Changing treatment of pediatric splenic trauma

International Nuclear Information System (INIS)

Kakkasseril, J.S.; Stewart, D.; Cox, J.A.; Gelfand, M.

1982-01-01

A review of splenic injuries at Cincinnati Children's Hospital Medical Center from July 1978 to June 1980 revealed this form of injury in 29 patients. Treatment without surgery was successful in 21 patients. Seven patients required operation. One patient died shortly after admission of severe associated injuries. All patients admitted with blunt abdominal trauma were initially treated conservatively. If the clinical state improved, after transfusions if necessary, or remained stable and there were no objective signs of further blood loss, conservative therapy was continued. Liver-spleen scans were obtained on an urgent basis to confirm the diagnosis of splenic injury in patients who did not undergo surgery. No complications of treatment without surgery were recognized. The satisfactory outcome in these patients suggests that there is a place for treatment without surgery in some children with splenic injury

Changing treatment of pediatric splenic trauma

Energy Technology Data Exchange (ETDEWEB)

Kakkasseril, J.S.; Stewart, D.; Cox, J.A.; Gelfand, M.

1982-06-01

A review of splenic injuries at Cincinnati Children's Hospital Medical Center from July 1978 to June 1980 revealed this form of injury in 29 patients. Treatment without surgery was successful in 21 patients. Seven patients required operation. One patient died shortly after admission of severe associated injuries. All patients admitted with blunt abdominal trauma were initially treated conservatively. If the clinical state improved, after transfusions if necessary, or remained stable and there were no objective signs of further blood loss, conservative therapy was continued. Liver-spleen scans were obtained on an urgent basis to confirm the diagnosis of splenic injury in patients who did not undergo surgery. No complications of treatment without surgery were recognized. The satisfactory outcome in these patients suggests that there is a place for treatment without surgery in some children with splenic injury.

Imaging characteristics of focal splenic and hepatic lesions in type 1 Gaucher disease.

Science.gov (United States)

Regenboog, Martine; Bohte, Anneloes E; Somers, Inne; van Delden, Otto M; Maas, Mario; Hollak, Carla E M

2016-09-01

In Gaucher disease (GD) imaging of liver and spleen is part of routine follow-up of GD patients. Focal lesions in both liver and spleen are frequently reported at radiological examinations. These lesions often represent benign accumulations of Gaucher cells, so-called "gaucheroma", but malignancies, especially hepatocellular carcinoma, are more frequently found in GD as well. We report the imaging characteristics of all focal lesions in liver and spleen in the Dutch GD cohort. Of the 95 GD1 patients, 40% had focal splenic and/or hepatic lesions, associated with more severe GD. Lesions identified as gaucheroma have variable imaging characteristics: hyper- to hypointense on MRI, hyper- or hypoechoic on US and hypodense on computed tomography (CT). Hepatic lesions were classified as simple cysts or haemangioma based upon imaging characteristics. Focal nodular hyperplasia (FNH), gaucheroma and hepatocellular carcinoma (HCC) could not be distinguished by conventional US, CT or MRI. Growth of these lesions and/or characteristics of HCC on dynamic CT or MRI and pathology was used to identify or rule out HCC. We propose a decision-making algorithm including the use of growth and dynamic CT- or MRI-scanning to characterize lesions. Copyright © 2016 Elsevier Inc. All rights reserved.

Imaging and transcatheter arterial embolization for traumatic splenic injuries: review of the literature.

Science.gov (United States)

Raikhlin, Antony; Baerlocher, Mark Otto; Asch, Murray R; Myers, Andy

2008-12-01

The spleen is the most commonly injured visceral organ in blunt abdominal trauma in both adults and children. Nonoperative management is the current standard of practice for patients who are hemodynamically stable. However, simple observation alone has been reported to have a failure rate as high as 34%; the rate is even higher among patients with high-grade splenic injuries (American Association for the Surgery of Trauma [AAST] grade III-V). Over the past decade, angiography with transcatheter splenic artery embolization, an alternative nonoperative treatment for splenic injuries, has increased splenic salvage rates to as high as 97%. With the help of splenic artery embolization, success rates of more than 80% have also been described for high-grade splenic injuries. We discuss the role of computed tomography and transcatheter splenic artery embolization in the diagnosis and treatment of blunt splenic trauma. We review technical considerations, indications, efficacy and complication rates. We also propose an algorithm to guide the use of angiography and splenic embolization in patients with traumatic splenic injury.

The evaluation of CT and MRI in the diagnosis of pancreatic tuberculosis and peripancreatic tuberculous lymphadenopathy

International Nuclear Information System (INIS)

Yang Zenian; Wang Xiaoyan; Peng Zhenpeng; Lin Jianqin; Zhang Ting

2008-01-01

Objective: To study the manifestations and its pathologic basis of pancreatic tubeiculosis and peripancreatic tuberculous lymphadenopathy. And evaluate the diagnostic values of CT and MRI. Methods: Two cases of pancreatic tuberculosis and eleven cases of peripancreatic tuberculous lymphadenopathy were collected. All cases were conformed by pathology or clinic. Plain scan and enhanced scan with spiral CT were performed in all cases. Plain scan and enhanced scan with MRI were performed in two cases. The CT and MRI features of 13 cases were analyzed retrospectively. Results: Pancreatic tuberculosis showed that the lesion was located mainly at the head of the pancreas and displayed on CT as a low-density mass with marginal or honeycomb enhancement. Peripancreatic tuberculous lymphadenopathy was seen in 11 cases, of which ring-like enhancement was seen in seven cases, calcifications in two cases and mixed in two cases. Splenic involvement was found in five cases. Conclusion: Pancreatic tuberculosis and peripancreatic tuberculous lymphadenopathy have the main features of low-density mass With marginal or honeycomb enhancement and ting-like enhancement in petipancreatic lymphadenopathy. CT and MRI are feasible methods in diagnosis of pancreatic tuberculosis and peripancreatic tuberculous lymphadenopathy. (authors)

Limitations of CT and ultrasound diagnoses in the evaluation of uterine cancer involvement

International Nuclear Information System (INIS)

Sato, Yasumi; Maki, Masahiro; Seki, Haruo; Saito, Yoshiharu.

1988-01-01

The concordance rates between preoperative diagnostic imagings and postoperative pathologic findings were examined in a total of 36 patients with resectable uterine cancer (19 with cervical cancer and 27 with endometrial cancer). The accuracy of CT was 47 % in the evaluation of cervical cancer involvement to the parametrium; and was 83 % in the evaluation of wall involvement of endometrial cancer. The concordance rate was 74 % in the evaluation of stage-grouping in endometrial cancer. Out of 8 patients with resectable stage II cervical cancer, four (50 %) were found to have had involvement to the parametrium by transrectal echography. The results indicate that CT scanning and transrectal echography have limitations in the diagnosis of cervical cancer involvement to the parametrium. (Namekawa, K.)

Splenic arteriovenous fistula treated with percutaneous transarterial embolization

DEFF Research Database (Denmark)

Madsen, M.A.; Frevert, S.; Madsen, P.L.

2008-01-01

Splenic arteriovenous fistula is a rare complication following splenectomy. We report a case of a large splenic arteriovenous fistula 23 years after splenectomy in a 50-year old male with abdominal pain, gastro-intestinal bleeding, ascites, diarrhoea, dyspnoea, portal hypertension and heart failure...

Splenic conservation in children with splenic injury at Nnewi - South ...

African Journals Online (AJOL)

Hitherto, the mode of treatment has been towards resuscitation and splenectomy but over the past one and half decades, the trend moved to conserve. Objective: We therefore review the management of splenic injuries in children over the past ten years as well as highlight management problems. Patients and Methods: ...

Melioidosis Presenting with Isolated Splenic Abscesses: A Case Report

Directory of Open Access Journals (Sweden)

Chun-Yu Lin

2007-08-01

Full Text Available Splenic abscesses caused by Burkholderia pseudomallei are rarely reported in Taiwan. Here we report a middle-aged man who presented with fever, chills, and general malaise for several days. Abdominal echo revealed isolated splenic abscesses and he received antibiotics treatment according to the initial blood culture result, Serratia marcescens. However, fever did not subside. Then he was referred to our hospital and meropenem was prescribed. Fever subsided 5 days after the beginning of meropenem administration. Repeated fine-needle aspiration of splenic abscesses drained out the pus, which was cultured as B. pseudomallei. He was finally diagnosed as a case of melioidosis based on microbiological evidence. Physicians must take melioidosis into consideration when splenic abscesses are encountered clinically.

Nonoperative Management of Splenic Injury in Combat: 2002-2012

Science.gov (United States)

2015-03-01

recognized as the defini- tive treatment for splenic injury when Dr. Johnston reported 150 splenectomies for trauma in 1908.4 However, in 1968, Upadhyaya...management safe and effective for all splenic blunt trauma ? A systematic review. Crit Care 2013; 17(5): R185. 6. Joint Theater Trauma System Clinical Practice...2014. 7. Zonies D, Eastridge B: Combat management of splenic injury: trends during a decade of conflict. J Trauma Acute Care Surg 2012; 73(2 Suppl 1

Splenic Abscess: An Uncommon Entity with Potentially Life-Threatening Evolution

Directory of Open Access Journals (Sweden)

Mei-Chun Lee

2018-01-01

Full Text Available Background/Purpose. Splenic abscess is rare with potentially life-threatening evolution. The aim of this study is to review the clinical features, microbiological etiologies, treatment, and outcomes of patients with splenic abscess. Methods. We reviewed the admitted patients with suspected splenic abscess and made the diagnosis of splenic abscess. The clinical characteristics, underlying diseases, treatment course, organism spectra, abscess number and size, therapeutic methods, and clinical outcome at a tertiary medical center in Taiwan over a period of 5 years were analyzed. Results. Of 16 patients with splenic abscess, the male to female ratio was 1 : 1. Common presentations were fever (11 patients, 68.7%, diffuse abdominal pain (6 patients, 37.5%, left upper quadrant pain or tenderness (6 patients, 37.5%, and left-sided pleural effusions (8 patients, 50%. Antimicrobial therapy was administered in all patients. Fourteen (87.5% patients recovered under medical treatment. One (6.2% patient underwent splenectomy, four (25% patients performed percutaneous drainage of their splenic abscess, and 11 (68.7% patients received antimicrobial therapy alone. Conclusion. We noted that mortality may be more related to patients with underlying immunodeficiency. Patients with splenic abscesses receiving antimicrobial therapy alone were in a relatively high proportion and got a good prognosis especially in patients with small and multiple abscesses.

Characteristic of muscle involvement evaluated by CT scans in early stages of progressive muscular dystrophy

International Nuclear Information System (INIS)

Arai, Yumi

1993-01-01

Muscle CT scans were performed in order to compare the characteristic distribution of progressive muscle involvement in the early stages of Duchenne type (DMD) and Fukuyama type muscular dystrophy (FCMD). Muscle images at the levels of the 3rd lumbar vertebra, thigh and calf were assessed by visual inspection, and mean CT numbers calculated for individual muscles were statistically analysed. On visual inspection, intramuscular low density areas and muscular atrophy were observed in the muscles of older patients with either disease. These changes were, however, more extensive at thigh level in DMD, and at calf level in FCMD. Nevertheless, the mean CT numbers of muscles in which only slight changes were grossly visible on CT scans displayed progressive decreases with increasing age. Moreover, a significant negative relationship was recognizable between age and mean CT number in almost all muscles examined. Comparison of the slopes of the regression lines revealed that the so-called selective pattern of muscle involvement characteristic of the symptomatic stage had already partially manifested in the preclinical or early stages of both diseases. In FCMD, the rates of decrease in CT numbers were extremely rapid for calf muscles as compared with those in DMD, indicating that this is one reason for FCMD patients never becoming ambulatory. However, for almost all of the other muscles, the CT numbers in FCMD decreased in parallel with the corresponding CT numbers in DMD; thus, these diseases displayed a similarity in the pattern of muscle involvement, despite their different pathogenetic mechanisms and inheritance patterns. (author)

Coronary ostial involvement in acute aortic dissection: detection with 64-slice cardiac CT.

LENUS (Irish Health Repository)

Ryan, E Ronan

2012-02-01

A 41-year-old man collapsed after lifting weights at a gym. Following admission to the emergency department, a 64-slice cardiac computed tomography (CT) revealed a Stanford Type A aortic dissection arising from a previous coarctation repair. Multiphasic reconstructions demonstrated an unstable, highly mobile aortic dissection flap that extended proximally to involve the right coronary artery ostium. Our case is an example of the application of electrocardiogram-gated cardiac CT in directly visualizing involvement of the coronary ostia in acute aortic dissection, which may influence surgical management.

Complicated congenital splenic cyst: Saved by a splenunculus ...

African Journals Online (AJOL)

A 12-year-old girl presented with a large congenital splenic cyst complicated by Salmonella organisms. After failure of conservative management and percutaneous drainage, a splenectomy was performed. An incidental splenunculus was preserved. On follow up the splenunculus had increased to normal splenic size and ...

Spontaneous resolution of splenic infarcts after distal splenorenal ...

African Journals Online (AJOL)

Background: In cases of portal hypertension with splenic infarcts, splenectomy with proximal splenorenal shunt has been recommended. We are sharing our experience with distal splenorenal shunt in these cases contrary to the popular belief. Materials and Methods: Splenic infarcts were graded as mild, moderate and ...

Diagnosis of diseases involving solid organs in the supramesocolic compartment

Energy Technology Data Exchange (ETDEWEB)

Herbreteau, D.; Solvit, D.; Anglade, M.C.; Mathieu, D.

1989-04-01

Sonographic and computed tomographic (CT) examinations have modified the investigation of hepatic, splenic and pancreatic tumors. Because of advances in non-invasive diagnostic procedures, these different benign or malignant tumors are now more frequently detected and surgically treated. However, for these different lesions sonography is the gold standard imaging technique. The different indications of CT and magnetic resonance imaging are discussed for each tumor. For the diagnostic imaging of an acutely injured patient, sonography remains the useful examination in emergencies. The indications of CT scans are limited to the difficulties of sonographic diagnosis in stable trauma patients.

Splenic irradiation in chronic myeloid leukemia

Energy Technology Data Exchange (ETDEWEB)

Hukku, S.; Baboo, H.A.; Venkataratnam, S.; Vidyasagar, M.S.; Patel, N.L. (Department of Radiation Therapy, Gujarat Cancer Research Institute, Ahmedabad, India)

1983-01-01

Results of splenic irradiation as the initial and only method of treatment are reported in 25 patients with chronic myeloid leukemia. Peripheral remission was induced in all the patients. Induction was achieved after a short period of 11 to 30 days in the majority of the patients, the longest period being 40 days. Several patients were in remission 9 months after treatment. The results are compared with those obtained by chemotherapy. Some advantages of splenic irradiation over chemotherapy are emphasized.

Magnetic resonance imaging of splenic iron overload

International Nuclear Information System (INIS)

Arrive, L.; Thurnher, S.; Hricak, H.; Price, D.C.

1990-01-01

The value of magnetic resonance (MR) imaging in assessing iron overload in the spleen was retrospectively investigated in 40 consecutive patients. MR appearance, mesaure of signal intensity and T1-and T2-relaxation times were correlated with the histologically determined level of iron in the spleen in each patient. Histologic examination revealed no iron overload in 19 patients, mild iron overload in seven, moderate iron overload in six, and severe iron overload in eight. All 19 patients with no splenic iron overload and 11 of the other 21 patients with splenic iron overload were correctly identified by MR imaging (sensitivity 52%, specificity 100%, accuracy 75%). Splenic iron overload was diagnosed when a decrease of signal intensity of the spleen compared with those of adipose tissue and renal cortex was demonstrated. MR images demonstrated all eight cases of severe, three of the six cases of moderate, and none of the seven cases of mild iron overload. Only spleens with severe iron overload had a significant mean decrease in signal intensity and T1- and T2-relaxation times. Although specific, MR imaging is poorly sensitive to splenic iron overload. (author). 15 refs.; 5 figs.; 3 tabs

Blunt splenic trauma in children: are we too careful?

Science.gov (United States)

De Jong, W J J; Nellensteijn, D R; Ten Duis, H J; Albers, M J I J; Moumni, M El; Hulscher, J B F

2011-08-01

There has been a shift from operative treatment (OT) to non-operative treatment (NOT) of splenic injury. We evaluated the outcomes of treatment of pediatric patients with blunt splenic trauma in our hospital, with special focus on the outcomes after NOT. The data of all patients splenic injury admitted between 1988 and 2007 were retrospectively analyzed. Mechanism of injury, type of treatment, ICU stay, total hospital stay, morbidity and mortality were assessed. Patients suffering isolated splenic injuries were assessed separately from patients with multiple injuries. Patients were subsequently divided into those admitted before and after 2000. There were 64 patients: 49 males and 15 females with a mean age of 13 years (range 0-18). 3 patients died shortly after admission due to severe neurological injury and were excluded. In the remaining 61 patients concomitant injuries, present in 62%, included long bone fractures (36%), chest injuries (16%), abdominal injuries (33%) and head injuries (30%). Mechanisms of injury were: car accidents (26%), motorcycle (20%), bicycle (19%), fall from height (17%) and pedestrians struck by a moving vehicle (8%). A change in treatment strategy was evident for the pre- and post-2000 periods. Significantly more patients had NOT after 2000 in both the isolated splenic injury group and the multi-trauma group [4/11 (36%) before vs. 10/11 (91%) after (p=0.009); 15/19 (79%) before vs. 8/20 (40%) after 2000 (p=0.03)]. There was also a significant shift to spleen-preserving operations. All life-threatening complications occurred within trauma group. Splenic injury in children is associated with substantial mortality. This is due to concomitant injuries and not to the splenic injury. Non-operative treatment is increasingly preferred to operative procedures when treating splenic injuries in hemodynamically, stable children. ICU and hospital stay have, despite the change from OT to NOT, remained the same. Complications after NOT are rare. We

CT and US demonstration of gastrointestinal involvement in children with rheumatoid purpura

International Nuclear Information System (INIS)

Li Xin; Li Lin; Wang Chunxiang; Zhao Bin

2002-01-01

Objective: To evaluate the usefulness of CT and US in the diagnosis of gastrointestinal involvement in children with rheumatoid purpura. Methods: Abdominal CT and US findings in 14 cases of clinical and laboratory confirmed of rheumatoid purpura were analyzed. There were 9 males and 5 females with the age ranged from 6 months to 14 years. All patients was hospitalized because of acute abdominal emergency, and the clinical presentations included paroxysm of abdomen pain, vomiting, without skin rashes and subcutaneous hemorrhage. CT examination was done in 7 cases, and contrast enhancement was performed in 1 case. Abdominal ultrasound was done in 9 cases. Both CT and US were done in 2 cases. Results: All patients demonstrated multiple or single areas of bowel-wall thickening, localized intraluminal narrowing, mesenteric edema, and liquid in abdominal cavity by CT and ultrasound. Conclusion: Abdominal CT and US examination have important values in differential diagnosis of acute abdominal disorders in children patients with rheumatoid purpura. Before appearing skin rashes, classical picture can help for the diagnosis and clinical treatment. Abdominal CT and US examination can also find the intussusception, bowel obstruction, and perforation in rheumatoid purpura

Thermal ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism.

Science.gov (United States)

Duan, Ya-Qi; Liang, Ping

2013-05-01

Many studies have been conducted on splenic thermal ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism. In this article, we review the evolution and current status of radiofrequency and microwave ablation in the treatment of spleen diseases. All publications from 1990 to 2011 on radiofrequency and microwave ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism were retrieved by searching PubMed. Thermal ablation in the spleen for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism can preserve part of the spleen and maintain splenic immunologic function. Thermal ablation for assisting hemostasis in partial splenectomy minimizes blood loss during operation. Thermal ablation for spleen trauma reduces the number of splenectomy and the amount of blood transfusion. Thermal ablation for splenic metastasis is minimally invasive and can be done under the guidance of an ultrasound, which helps shorten the recovery time. Thermal ablation for hypersplenism increases platelet (PLT) and white blood cell (WBC) counts and improves liver function. It also helps to maintain splenic immunologic function and even improves splenic immunologic function in the short-term. In conclusion, thermal ablative approaches are promising for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism. In order to improve therapeutic effects, directions for future studies may include standardized therapeutic indications, prolonged observation periods and enlarged sample sizes.

CT, Magnetic Resonance, and 18F-Fluorodeoxyglucose Positron Emission Tomography/CT Imaging Features of Mucosa-Associated Lymphoid Tissue Lymphoma Involving Medial Rectus Muscle: A Case Report

International Nuclear Information System (INIS)

Lee, Sang Kwon; Choe, Mi Sun

2013-01-01

We report a case of mucosa-associated lymphoid tissue (MALT) lymphoma involving the medial rectus muscle in a 47-year-old man along with CT, MRI, 18 F-fluorodeoxy-glucose positron emission tomography/CT ( 18 F-FDG PET/CT), and pathologic features. The lesion was manifested as a fusiform enlargement isolated to the right medial rectus muscle with involvement of its tendinous insertion. The lesion was isoattenuating to the brain on non-enhanced CT images, showing as isointense to gray matter on fast spin echo T1- and T2-weighted images with fat saturation, and showed homogeneous enhancement on contrast-enhanced CT and MR images. The maximum stan- dardized uptake value on 18 F-FDG PET/CT was 4.9 g/mL. The results of histological and immunohistochemical examinations of the specimen obtained by biopsy of the right medial rectus muscle were consistent with MALT lymphoma. It should be noted that the extraocular muscle (EOM) is a rare location for the involvement of MALT lympho- ma, and MALT lymphoma of the EOM may mimic thyroid orbitopathy.

Evaluation of a 15-year experience with splenic injuries in a state trauma system.

Science.gov (United States)

Harbrecht, Brian G; Zenati, Mazen S; Ochoa, Juan B; Puyana, Juan C; Alarcon, Louis H; Peitzman, Andrew B

2007-02-01

The management of splenic injuries has evolved with a greater emphasis on nonoperative management. Although several institutions have demonstrated that nonoperative management of splenic injuries can be performed with an increasing degree of success, the impact of this treatment shift on outcome for all patients with splenic injuries remains unknown. We hypothesized that outcomes for patients with splenic injuries have improved as the paradigm for splenic injury treatment has shifted. Consecutive patients from 1987 to 2001 with splenic injuries who were entered into a state trauma registry were reviewed. Demographic variables, injury characteristics, and outcome data were collected. The number of patients who were diagnosed with splenic injuries increased from 1987 through 2001, despite a stable number of institutions submitting data to the registry. The number of minor injuries and severe splenic injuries remained stable, and the number of moderately severe injuries significantly increased over time. Overall mortality rate improved but primarily reflected the decreased mortality rates of moderately severe injuries; the mortality rate for severe splenic injuries was unchanged. Trauma centers are seeing increasing numbers of splenic injuries that are less severe in magnitude, although the number of the most severe splenic injuries is stable. The increased proportion of patients with less severe splenic injuries who are being admitted to trauma centers is a significant factor in the increased use and success rate of nonoperative management.

Characterizing bone marrow involvement in Hodgkin's lymphoma by FDG-PET/CT

International Nuclear Information System (INIS)

Weiler-Sagie, Michal; Kagna, Olga; Dann, Eldad J.; Ben-Barak, Ayelet; Israel, Ora

2014-01-01

Fluoro-deoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) is superior to iliac bone marrow biopsy (iBMB) for detection of bone marrow involvement (BMI) in staging of Hodgkin's lymphoma (HL). The present study aims to characterize the patterns and distribution of BMI in HL as determined by FDG-PET/CT. Reports of FDG-PET/CT studies performed for staging of HL were reviewed. BMI was defined as positive iBMB and/or foci of pathological FDG uptake in the skeleton that behaved in concordance with other sites of lymphoma in studies following chemotherapy. Number of FDG uptake foci, their specific location in the skeleton and the presence of corresponding lesions in the CT component of the study, and stage according to the Ann Arbor staging system, were recorded. The study included 473 patients. iBMB was performed in 336 patients. Nine patients had positive iBMB (9/336, 3 %). Seventy-three patients (73/473, 15 %) had FDG-PET/CT-defined BMI. The BM was the only extranodal site of HL in 52/473 patients (11 %). Forty-five patients had three or more foci of pathological skeletal FDG uptake (45/73, 62 %). Sixty-four patients (64/73, 88 %) had at least one uptake focus in the pelvis or vertebrae. In 60 patients (60/73, 82 %), the number of skeletal FDG uptake foci without corresponding CT lesions was equal to or higher than the number of foci with morphological abnormalities. FDG-PET/CT demonstrated BMI in 15 % of patients with newly diagnosed HL. Diagnosis of BMI in HL by FDG-PET/CT was more sensitive than iBMB with potential upstage in 11 % of patients. The most common pattern of FDG-PET/CT BMI was multifocal (at least three foci) skeletal FDG uptake, with at least one focus in the pelvis or vertebrae and no corresponding CT lesions. (orig.)

Evaluation of abdominal CT in the initial treatment of abdominal trauma

International Nuclear Information System (INIS)

Watanabe, Shinsuke; Ishii, Takashi; Kuwata, Katsuya; Yoneyama, Chihiro; Kitamura, Kazuya; Sasaki, Yoshifumi; Kamachi, Masahiro; Nishiguchi, Hiroyasu.

1986-01-01

During the last four years 102 patients with abdominal trauma were examined by CT for preoperative evaluation in our hospital. In 35 patients (34 %), the CT scans revealed no abnormal findings. They were all managed conservatively except for one case of perforated small bowel. In 67 patients (66 %) CT revealed evidences of substantial abdominal or retroperitoneal trauma. In 30 of them CT findings were confirmed by surgery. Hepatic injury is usually easily recognized by CT. CT is also useful for the detection of renal or splenic injuries. The majority of those parenchymatous organ injuries were successfully managed with conservative therapy, despite apparent traumatic lesions revealed by CT. Repeat CT scans is proved to be very useful to follow the changes of these traumatic lesions. In conclusion, application of abdominal CT is extremely useful for the initial decision making in treatment of patients with abdominal trauma and for the follow-up observation of injured lesions. (author)

Minimally Invasive Approach for Spleen-Preserving Distal Pancreatectomy: a Comparative Analysis of Postoperative Complication Between Splenic Vessel Conserving and Warshaw's Technique.

Science.gov (United States)

Lee, Lip Seng; Hwang, Ho Kyoung; Kang, Chang Moo; Lee, Woo Jung

2016-08-01

Spleen-preserving distal pancreatectomy with Warshaw's technique (WT) was reported to have higher spleen-related complication. The aim of this study was to evaluate the postoperative complication between the splenic vessel-conserving technique (SVC) and the WT when they were performed by the minimally invasive approach. From January 2006 to June 2015, data of the patients who had laparoscopic or robotic-assisted spleen-preserving distal pancreatectomy for benign or borderline malignant tumors were retrospectively reviewed. Patients were divided into SVC and the WT group for comparison. Of the 89 patients who had the spleen-preserving distal pancreatectomy, 63 were SVC, whereas 26 were WT. The CT scans showed that patients who had WT were found to have higher rate of splenic infarction (P < 0.001) and had significantly higher rate of collateral vessel formation at 1 year (P < 0.001). All the splenic infarctions were low grade and asymptomatic which resolved spontaneously. None of the patients with collateral formation experienced gastrointestinal bleeding. The postoperative complication of SVC and WT did not differ significantly. SVC and WT were found to have comparable outcome. Both techniques can be used to achieve higher spleen-preserving rate.

[Isolated splenic metastases from cervical cancer: a rare entity].

Science.gov (United States)

Villalón-López, José Sebastián; Souto-del Bosque, Rosalía; Montañez-Lugo, Juan Ignacio; Chávez-González, Bruno

2014-01-01

Splenic metastases from solid tumors are a rare event with an incidence of only 2.9% to 9%. Splenic metastases from cervical cancer are a rare entity. Only a few cases have been reported of isolated spleen metastases from cervical cancer. We present the case of a 76-year-old woman with moderately differentiated endocervical adenocarcinoma stromal and endocervical invasion. Clinical stage was Ib1 and Ca-125 values of 150 U. She was managed with hysterectomy and pelvic lymphadenectomy. She received pelvic radiotherapy (45 Gy) followed 24 Gy of brachytherapy. Two years later she presented with abdominal pain. Abdominal computed tomography showed two splenic parenchymal lesions without disease in the remainder of the abdominal cavity and chest with a Ca-125 of 2,733 U. The patient is submitted to splenectomy. Histopathology demonstrates splenic metastases of well-differentiated adenocarcinoma from the endocervix. Immunohistochemical stain showed positivity from carcinoembryonic antigen; estrogen and progesterone receptors are negative. Ca-125 level 8 weeks after surgery was 16 U/ml. The patient received six cycles of adjuvant chemotherapy with paclitaxel and cisplatin. At 12 months follow-up the patient is alive and without evidence of tumor activity. The spleen is an uncommon site of metastasis. Splenectomy is considered the appropriate treatment in order to avoid complications such as splenic rupture and splenic vein thrombosis as well as to improve pain control from splenomegaly. Twelve months after surgery our patient is alive and without evidence of tumor activity.

Open splenectomy for Varicella zoster induced spontaneous splenic rupture

Directory of Open Access Journals (Sweden)

Mark Christopher Sykes

2018-01-01

Conclusion: Atraumatic splenic rupture should be considered as an important differential in those presenting with abdominal pain and peritonism without a history of preceding trauma. Haematological and infectious diagnoses should be sought to identify causation for the splenic rupture.

Imaging of nontraumatic benign splenic lesions

Energy Technology Data Exchange (ETDEWEB)

Choi, Jin Young; Kim, Eun Kyung; Chung, Jae Joon; Kim, Myeong Jin; Lee, Jong Tae; Yoo, Hyung Sik; Kim, Seong Joon [Yonsei Univ. College of Medicine Research Institute of Radiological Science, Seoul (Korea, Republic of); Kim, Lu Ci A [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

1999-04-01

The spleen is one of the largest organ in the reticuloendothelial system and plays an important role in the activation of immune response. It is the organ most commonly injured after blunt abdominal trauma, and malignant lesions such as lymphoma, or these due to metastasis, occur not infrequently. Even so, it is ignored even in abdominal ultrasonography. Some benign splenic lesions, however can cause severe symptoms and result in high mortality, and their accurate diagnosis is therefore essential. This study describes the imaging findings and histopathologic features of various nontraumatic benign splenic lesions.

Imaging of nontraumatic benign splenic lesions

International Nuclear Information System (INIS)

Choi, Jin Young; Kim, Eun Kyung; Chung, Jae Joon; Kim, Myeong Jin; Lee, Jong Tae; Yoo, Hyung Sik; Kim, Seong Joon; Kim, Lu Ci A

1999-01-01

The spleen is one of the largest organ in the reticuloendothelial system and plays an important role in the activation of immune response. It is the organ most commonly injured after blunt abdominal trauma, and malignant lesions such as lymphoma, or these due to metastasis, occur not infrequently. Even so, it is ignored even in abdominal ultrasonography. Some benign splenic lesions, however can cause severe symptoms and result in high mortality, and their accurate diagnosis is therefore essential. This study describes the imaging findings and histopathologic features of various nontraumatic benign splenic lesions

Blunt splenic trauma: Assessment, management and outcomes.

Science.gov (United States)

El-Matbouly, Moamena; Jabbour, Gaby; El-Menyar, Ayman; Peralta, Ruben; Abdelrahman, Husham; Zarour, Ahmad; Al-Hassani, Ammar; Al-Thani, Hassan

2016-02-01

The approach for diagnosis and management of blunt splenic injury (BSI) has been considerably shifted towards non-operative management (NOM). We aimed to review the current practice for the evaluation, diagnosis and management of BSI. A traditional narrative literature review was carried out using PubMed, MEDLINE and Google scholar search engines. We used the keywords "Traumatic Splenic injury", "Blunt splenic trauma", "management" between December 1954 and November 2014. Most of the current guidelines support the NOM or minimally approaches in hemodynamically stable patients. Improvement in the diagnostic modalities guide the surgeons to decide the timely management pathway Though, there is an increasing shift from operative management (OM) to NOM of BSI; NOM of high grade injury is associated with a greater rate of failure, prolonged hospital stay, risk of delayed hemorrhage and transfusion-associated infections. Some cases with high grade BSI could be successfully treated conservatively, if clinically feasible, while some patients with lower grade injury might end-up with delayed splenic rupture. Therefore, the selection of treatment modalities for BSI should be governed by patient clinical presentation, surgeon's experience in addition to radiographic findings. About one-fourth of the blunt abdominal trauma accounted for BSI. A high index of clinical suspicion along with radiological diagnosis helps to identify and characterize splenic injuries with high accuracy and is useful for timely decision-making to choose between OM or NOM. Careful selection of NOM is associated with high success rate with a lower rate of morbidity and mortality. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Management of pediatric splenic injuries in Canada.

Science.gov (United States)

McDonald, Lindsay A; Yanchar, Natalie L

2012-03-01

Nonoperative management (NOM) of blunt splenic injuries has become the standard of care in hemodynamically stable children. This study compares the management of these injuries between pediatric and nonpediatric hospitals in Canada. Data were obtained from the Canadian Institute of Health Information trauma database on all patients aged 2 to 16 years, admitted to a Canadian hospital with a diagnosis of splenic injury between May 2002 and April 2004. Variables included age, sex, associated major injuries, splenic procedures, intensive care unit (ICU) admissions, blood transfusions, and length of stay. Hospitals were coded as pediatric or nonpediatric. Univariate analysis and logistic regression were used to determine associations between hospital type and outcomes. Of 1284 cases, 654 were managed at pediatric hospitals and 630 at nonpediatric centers. Patients at pediatric centers tended to be younger and more likely to have associated major injuries. Controlling for covariates, including associated major injuries, patients managed at pediatric centers were less likely to undergo splenectomy compared with those managed at nonpediatric centers (odds ratio [OR], 0.2; 95% confidence interval, 0.1-0.4). The risk of receiving blood products, admission to the ICU, and staying in hospital for more than 5 days was associated only with having associated major injuries. Even in the presence of other major injuries, successful NOM of blunt splenic injuries occurs more frequently in pediatric hospitals in Canada. This has policy relevance regarding education of adult surgeons about the appropriateness of NOM in children and developing guidelines on appropriate regional triaging of pediatric patients with splenic injury in Canada. Copyright © 2012 Elsevier Inc. All rights reserved.

Impact of splenic hilar lymph node metastasis on prognosis in patients with advanced gastric cancer.

Science.gov (United States)

Son, Taeil; Kwon, In Gyu; Lee, Joong Ho; Choi, Youn Young; Kim, Hyoung-Il; Cheong, Jae-Ho; Noh, Sung Hoon; Hyung, Woo Jin

2017-10-13

Impact of splenic hilar LN dissection during total gastrectomy for proximal advanced gastric cancer is controversial. The objective of this study was to assess the impact on prognosis of splenic hilar lymph node(LN) metastasis compared to that of metastasis to other regional LN groups. Patients who underwent total gastrectomy with D2 LN dissection from 2000 to 2010 were reviewed retrospectively. The clinicopathologic characteristics and long-term results of patients with splenic hilar LN metastasis were compared to those of patients with only metastasis to other extraperigastric LNs (stations #8a, #9, #11, or #12a). To investigate the survival benefit of performing splenic hilar LN dissection, the estimated therapeutic index for the procedure was calculated by multiplying the incidence of metastases in the hilar region by the survival rates for individuals with nodal involvement in that region. Of 602 patients, 87(14.5%) had hilar LN metastasis. The 5-year overall and relapse-free survival rates for patients with hilar LN metastasis were 24.1% and 12.1%, respectively. These rates were similar to those for patients with metastasis to other extraperigastric LNs ( P > 0.05), with similar recurrence patterns. Overall survival in the hilar LN metastasis group was better than that for patients with distant metastasis( P hilar LN dissection was 3.5, which was similar to index values for LN dissection at other extraperigastric LNs. Dissection of splenic hilar LNs during total gastrectomy for advanced gastric cancer allows for a prognosis similar to that achieved with dissection of extraperigastric LNs.

CT, Magnetic Resonance, and {sup 18}F-Fluorodeoxyglucose Positron Emission Tomography/CT Imaging Features of Mucosa-Associated Lymphoid Tissue Lymphoma Involving Medial Rectus Muscle: A Case Report

Energy Technology Data Exchange (ETDEWEB)

Lee, Sang Kwon; Choe, Mi Sun [Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

2013-06-15

We report a case of mucosa-associated lymphoid tissue (MALT) lymphoma involving the medial rectus muscle in a 47-year-old man along with CT, MRI, 18 F-fluorodeoxy-glucose positron emission tomography/CT ( 18 F-FDG PET/CT), and pathologic features. The lesion was manifested as a fusiform enlargement isolated to the right medial rectus muscle with involvement of its tendinous insertion. The lesion was isoattenuating to the brain on non-enhanced CT images, showing as isointense to gray matter on fast spin echo T1- and T2-weighted images with fat saturation, and showed homogeneous enhancement on contrast-enhanced CT and MR images. The maximum stan- dardized uptake value on 18 F-FDG PET/CT was 4.9 g/mL. The results of histological and immunohistochemical examinations of the specimen obtained by biopsy of the right medial rectus muscle were consistent with MALT lymphoma. It should be noted that the extraocular muscle (EOM) is a rare location for the involvement of MALT lympho- ma, and MALT lymphoma of the EOM may mimic thyroid orbitopathy.

Increasing number of fractured ribs is not predictive of the severity of splenic injury following blunt trauma: an analysis of a National Trauma Registry database.

Science.gov (United States)

Boris, Kessel; Forat, Swaid; Itamar, Ashkenazi; Oded, Olsha; Kobi, Peleg; Adi, Givon; Igor, Jeroukhimov; Ricardo, Alfici

2014-05-01

Association between rib fractures and incidence of abdominal solid organs injury is well described. However, the correlation between the number of fractured ribs and severity of splenic injury is not clear. The purpose of this study was to assess whether an increasing number of rib fractures predicts the severity of splenic injury in blunt trauma patients. A retrospective cohort study involving blunt trauma patients with concomitant splenic injuries and rib fractures, between the years 1998 and 2012, registered in the Israeli National Trauma Registry. Of 321,618 patients with blunt mechanism of trauma, 57,130 had torso injuries, and of these 14,651 patients sustained rib fractures, and 3691 patients suffered from splenic injury. Concomitant splenic injury occurred in 1326 of the patients with rib fractures (9.1%), as compared to 2365 patients sustaining splenic injury without rib fractures (5.6%). The incidence of splenic injury among patients sustaining 5 or more rib fractures was significantly higher compared to patients suffering from 1 to 4 rib fractures. Among patients with splenic injury, the tendency to sustain associated rib fractures increased steadily with age. Patients with concomitant rib fractures had higher Injury Severity Score (ISS), but similar mortality rates, compared to patients with splenic injury without rib fractures. Among patients with concomitant rib fractures and splenic injury, there was no relation between the number of fractured ribs and the severity of splenic injury, neither as a whole group, nor after stratification according to the mechanism of injury. Although the presence of rib fractures increases the probability of splenic injury in blunt torso trauma, there is no relation between the number of fractured ribs and splenic injury severity. Copyright © 2014 Elsevier Ltd. All rights reserved.

Spontaneous occlusion of post-traumatic splenic pseudoaneurysm: report of two cases in children

Energy Technology Data Exchange (ETDEWEB)

Raghavan, Ashok; Wong, Christopher Kah Fook; Lam, Albert; Stockton, Vivienne [Department of Medical Imaging, The Children' s Hospital at Westmead, Sydney (Australia)

2004-04-01

Conservative therapy for splenic injuries is widely advocated. The advantages of conservative therapy for splenic injuries include the preservation of splenic immune function, prevention of overwhelming post-splenectomy sepsis, and avoidance of laparotomy and its associated early and late complications. Pseudoaneurysms of the splenic artery branch are encountered because of the prevalence of conservative management and widespread use of imaging techniques in the follow-up of these cases. We report two cases of post-traumatic splenic pseudoaneurysm in children which thrombosed spontaneously, one during the diagnostic angiogram examination and another on follow-up studies. (orig.)

Imaging of blunt pancreatic trauma: The value of initial and sequential CT examinations

International Nuclear Information System (INIS)

Szmigielski, W.; Darweesh, A.; Kassem, H.; Alhilli, S.

2008-01-01

The purpose of the study was to assess the value of initial, repeated and sequential computed tomography (CT) in patients with blunt pancreatic trauma, and then define and correlate CT findings with endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP), ultrasound (US), both laboratory and surgical findings. This retrospective study covers an eight-year period from 1999 to 2007. The material includes 21 patients (17 males and 4 females) with confirmed pancreatic injury. CT was performed on admission in all cases and in 15 cases follow-up CT was performed from 24 hrs to 14 days later. US was performed in 9 cases, ERCP in 8 cases and MRCP in one case. Serum amylase level was obtained at the admission in all cases. The CT at admission was positive in 17 patients (81.0%); the diagnosis was missed in 4 patients (19.0%), all performed on single row spiral CT. In all these four cases repeated CT was positive. ERCP showed rupture of the main pancreatic duct in 7 cases, one was inconclusive. One MRCP was positive. The serum amylase was elevated in 14 cases (66.7%) Specific CT features in initial and repeated examinations together were: organ fracture - 33.3%, swelling - 38.1%, haematoma/ contusion - 38.1%, fluid between splenic vein and pancreas - 19.0%. Non-specific features were: thickening of anterior-renal fascia- 23.8%, fluid in lesser sac - 28.6%, extra peritoneal fluid - 42.9%, associated splenic injury -14.3% and intraperitoneal fluid - 38.1%. On retrospective analysis, two out of four false negative CT results could have been avoided. No correlation between the CT features and the outcome of surgical and conservative management could be found in this study. A proper technique and accurate reading of images are mandatory for the diagnosis of pancreatic injury. When CT performed on admission is negative and there is abdominal pain and an elevated serum amylase, CT examination should be repeated within 24-48 hours

Splenic Trauma during Colonoscopy: The Role of Intra-Abdominal Adhesions

OpenAIRE

Chime, Chukwunonso; Ishak, Charbel; Kumar, Kishore; Kella, Venkata; Chilimuri, Sridhar

2018-01-01

Splenic rupture following colonoscopy is rare, first reported in 1974, with incidence of 1–21/100,000. It is critical to anticipate splenic trauma during colonoscopy as one of the causes of abdominal pain after colonoscopy especially when located in the left upper quadrant or left shoulder. Postoperative adhesions is a predisposing factor for splenic injury, and management is either operative or nonoperative, based on hemodynamic stability and/or extravasation which can be seen on contrast-en...

Evaluation of venous involvement with oral and neck legions by CT-angiography

Energy Technology Data Exchange (ETDEWEB)

Morita, Yasuhiko; Hiraoka, Takashi; Sato, Tsuyoshi; Noikura, Takenori [Kagoshima Univ. Dental School (Japan)

1998-03-01

Intravenous contrast enhancements were employed in eight cases at CT to evaluate the involvement of head and neck lesions at the neck artery and vein. Cases were branchial cyst, inflammation of the oral floor, a hemangioma, and five malignant tumors. A total of 100 ml contrast enhancement media (240 mg/ml iodine) was injected using a automatic injector at a speed of 0.7-1.0 ml/sec. A spiral CT (Somatom Plus, Siemens, Germany) was used in this study. Spiral scans with 3-5 mm slice thickness and the table speed of 3-5 mm/rotations were performed at data acquisition. Three scans were usually performed before, during, and just after enhancement. Images were reconstructed every one or two mm from the data during enhancement. The relations between the lesions and artery and vein were observed using cine-mode display. The results showed that involvement with malignant tumor: Two cases which were diagnosed as free from involvement with tumors at artery were correctly diagnosed in corresponding to clinical findings at surgery and follow-up examination. Other three cases were diagnosed as having tumors at the arteries. In case No. 5, diagnosed as having tumor involvement, the external carotid artery was shown at surgery to be free from infiltration. Other diseases: CT images offer useful information about the vessels in cases of cyst or inflammation. High enhancement effect of tumor was also helpful for the diagnosis of hemangioma. The result indicated that spiral scan and cine-mode display were useful to identify the veins and arteries. For the more accurate diagnosis of tumor involvement, method or diagnostic criterion that could reduce the false-positive case are requested. (author)

Acinar Cell Carcinoma of the Pancreas with Colon Involvement

Directory of Open Access Journals (Sweden)

Naoki Asayama

2014-01-01

Full Text Available We report a case of acinar cell carcinoma of the pancreas with colon involvement that was difficult to distinguish from primary colon cancer. A 60-year-old man was admitted with a 1-month history of diarrhea. Contrast-enhanced computed tomography (CT revealed a large tumor (10.6×11.6 cm at the splenic flexure of the colon. Colonoscopy showed completely round ulcerative lesions, and biopsy revealed poorly differentiated adenocarcinoma. Left hemicolectomy, resection of the jejunum and pancreas body and tail, and splenectomy were performed based on a diagnosis of descending colon cancer (cT4N0M0, stage IIB, and surgery was considered to be curative. Diagnosis was subsequently confirmed as moderately differentiated acinar cell carcinoma of the pancreas by immunohistochemical staining (pT3N0M0, stage IIA. Multiple liver metastases with portal thrombosis were found 8 weeks postoperatively. Despite combination chemotherapy with oral S-1 and gemcitabine, the patient died of hepatic failure with no effect of chemotherapy 14 weeks postoperatively. Correct diagnosis was difficult to determine preoperatively from the clinical, CT, and colonoscopy findings. Moreover, the disease was extremely aggressive even after curative resection. Physicians should consider pancreatic cancer in the differential diagnosis of similar cases.

Gastric dilatation-volvulus after splenic torsion in two dogs.

Science.gov (United States)

Millis, D L; Nemzek, J; Riggs, C; Walshaw, R

1995-08-01

Two dogs developed gastric dilatation-volvulus 2 and 17 months, respectively, after splenectomy for treatment of splenic torsion. Splenic displacement and torsion may stretch the gastric ligaments, allowing increased mobility of the stomach. After splenectomy, an anatomic void may be created in the cranioventral part of the abdomen, contributing to the mobility of the stomach. Veterinarians treating dogs with isolated splenic torsion may wish to consider prophylactic gastropexy at splenectomy, to reduce the chance of future gastric dilatation-volvulus. Prophylactic gastropexy should be done only if the dog's hemodynamic status is stable enough to allow for performance of the additional surgery.

CT features of peritoneal and mesenteric involvement in pediatric malignancies. Experience from thirteen cases

International Nuclear Information System (INIS)

Grenier, N.; Filiatrault, D.; Garel, L.; Dube, J.; Paille, P.; Grenier, N.

1986-01-01

A retrospective study of all patients presenting with abdominal malignancies since November 1982 was undertaken in order to assess the CT features of peritoneal and mesenteric involvement in childhood. Thirteen cases, including 4 cases of malignant lymphomas, 1 case of Hodgkin's disease, 5 cases of adrenal tumors and 3 cases of ovarian tumors, were selected. Providing a good technique, CT appears as the best imaging modality of the mesentery. CT is also reliable in showing peritoneal implants, even without ascites. A high quality vascular opacification is needed in order to recognize the involvement of the lesser omentum (6/13 cases in our series). Precise knowledge of the intra-abdominal extension of the primary neoplasm has a definite impact upon the surgical indications and therefore upon the prognosis [fr

Ultrasound-guided percutaneous core needle biopsy of splenic lesions

Energy Technology Data Exchange (ETDEWEB)

Park, SangIk; Shin, Yong Moon; Won, Hyung Jin; Kim, Pyo Nyun; Lee, Moon Gyu [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

2017-05-15

To evaluate the safety and efficacy of ultrasound-guided percutaneous core needle biopsy of splenic lesions. This retrospective study included 30 patients who underwent percutaneous core needle biopsy of their splenic lesions using 18- or 20-gauge needles between January 2001 and July 2016 in a single tertiary care center. The characteristics of the splenic lesions were determined by reviewing the ultrasound and computed tomography examinations. Acquisition rate and diagnostic accuracy were calculated, using pathologic results of the splenectomy specimen, clinical course and/or imaging follow-up as a reference standard. Post-procedure complications were identified from electronic medical records, laboratory findings and computed tomography images. Seventy-three specimens were obtained from the 30 patients and splenectomy was performed in 2 patients. Twenty-nine of the 30 patients had focal splenic lesions, while the remaining patient had homogeneous splenomegaly. Acquisition rate and diagnostic accuracy were 80.0% (24/30) and 76.7% (23/30), respectively. Perisplenic hemorrhage without hemodynamic instability developed in one patient. Ultrasound-guided percutaneous core needle biopsy of splenic lesions is a safe method for achieving a histopathologic diagnosis and can be considered as an alternative to splenectomy in patients with a high risk of splenectomy-related complications.

Ultrasound-guided percutaneous core needle biopsy of splenic lesions

International Nuclear Information System (INIS)

Park, SangIk; Shin, Yong Moon; Won, Hyung Jin; Kim, Pyo Nyun; Lee, Moon Gyu

2017-01-01

To evaluate the safety and efficacy of ultrasound-guided percutaneous core needle biopsy of splenic lesions. This retrospective study included 30 patients who underwent percutaneous core needle biopsy of their splenic lesions using 18- or 20-gauge needles between January 2001 and July 2016 in a single tertiary care center. The characteristics of the splenic lesions were determined by reviewing the ultrasound and computed tomography examinations. Acquisition rate and diagnostic accuracy were calculated, using pathologic results of the splenectomy specimen, clinical course and/or imaging follow-up as a reference standard. Post-procedure complications were identified from electronic medical records, laboratory findings and computed tomography images. Seventy-three specimens were obtained from the 30 patients and splenectomy was performed in 2 patients. Twenty-nine of the 30 patients had focal splenic lesions, while the remaining patient had homogeneous splenomegaly. Acquisition rate and diagnostic accuracy were 80.0% (24/30) and 76.7% (23/30), respectively. Perisplenic hemorrhage without hemodynamic instability developed in one patient. Ultrasound-guided percutaneous core needle biopsy of splenic lesions is a safe method for achieving a histopathologic diagnosis and can be considered as an alternative to splenectomy in patients with a high risk of splenectomy-related complications

[Infectious endocarditis due to Gemella morbillorum found by splenic infarction--a case report].

Science.gov (United States)

Hosaka, Yumiko; Kimura, Takuma; Suzuki, Ryo; Chong, Tonghyo; Shoji, Michi; Aoki, Yasuko

2010-09-01

A 64-year-old man with prostate cancer and bone metastasis admitted for nausea, left abdominal pain showed no abnormal, and fever, abdominal ultrasound or chest X-ray findings. Despite antibiotics, left abdominal pain persisted for several days. Abdominal computed tomography (CT), showed splenic infarction. Transesophageal echocardiography suggested infectious endocarditis (IE) as a possible infarction cause, and roth spots were found on the retina. Gemella morbillorum was detected from blood culture. IE commonly causes Fever of Unknown Origin found by infarction. G. morbillorum, an anaerobic gram-positive, viridans group streptococci, is indigenous to the oropharynx, upper respiratory, urogenital, and gastrointestinal tracts, and is thought to have weak toxicity and pathogenicity in the body.

Radionuclide diagnosis of splenic rupture in infectious mononucleosis

International Nuclear Information System (INIS)

Vezina, W.C.; Nicholson, R.L.; Cohen, P.; Chamberlain, M.J.

1984-01-01

Spontaneous splenic rupture is a rare but serious complication of infectious mononucleosis. Although radionuclide spleen imaging is a well accepted method for diagnosis of traumatic rupture, interpretation can be difficult in the setting of mononucleosis, as tears may be ill-defined and diagnosis hampered by inhomogeneous splenic uptake. Four proven cases of spontaneous rupture are presented, three of which illustrate these diagnostic problems

Blunt Splenic Trauma in Children : Are We Too Careful?

NARCIS (Netherlands)

De Jong, W. J. J.; Nellensteijn, D. R.; ten Duis, H. J.; Albers, M. J. I. J.; El Moumni, M.; Hulscher, J. B. F.

Introduction: There has been a shift from operative treatment (OT) to non-operative treatment (NOT) of splenic injury. We evaluated the outcomes of treatment of pediatric patients with blunt splenic trauma in our hospital, with special focus on the outcomes after NOT. Patients and Methods: The data

Splenic injury after colonoscopy

DEFF Research Database (Denmark)

Petersen, C.R.; Adamsen, S.; Gocht-Jensen, P.

2008-01-01

the colonoscopy, ranging from 4 hours to 7 days, before presenting with signs of splenic injury. In all cases the spleen was torn, and the amount of blood in the peritoneal cavity ranged from 1500 mL to 5000 mL. Two patients died postoperatively. The number of cases reported after 2000 indicates......Splenic injury is a rare and serious complication of colonoscopy. The most likely mechanism is tension on the splenocolic ligament and adhesions. Eight cases were identified among claims for compensation submitted to the Danish Patient Insurance Association during the period 1992-2006, seven...... that this potentially lethal complication might be more common than was previously assumed, and it is possibly under-reported. Preventive measures include good colonoscopic technique to avoid loop formation and the use of excessive force; and it is possible that emerging endoscopic technologies will lead to a reduced...

A Case of Multiple Splenic Lymph angiomas Diagnosed by Percutaneous Needle Biopsy

Energy Technology Data Exchange (ETDEWEB)

Ki, Seung Seog; Jeong, Sook Hyang; Yoon, Chang Jin; Chang, Se Jung; Choi, Joon Hyuk; Ha, Ji Su; Kim, Soon Je [KEPCO Medical foundation Hanil General Hospital, Seoul (Korea, Republic of); Lee, Hye Seung [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

2007-06-15

Lymphangioma of the spleen is an extremely rare disease in adults, and performing splenectomy has been considered necessary for its diagnosis and treatment, but the diagnosis of an isolated splenic mass lesion without performing splenectomy is a challenging problem. Herein, we report on a case of multiple splenic lymphangiomas that were found incidentally in a 56-year-old female; these lesions were diagnosed by percutaneous splenic biopsy without splenectomy. We suggest that this approach is a reasonable option for benign looking-appearing splenic tumors because splenectomy and its postsplenectomy complications can be avoided

A Case of Multiple Splenic Lymph angiomas Diagnosed by Percutaneous Needle Biopsy

International Nuclear Information System (INIS)

Ki, Seung Seog; Jeong, Sook Hyang; Yoon, Chang Jin; Chang, Se Jung; Choi, Joon Hyuk; Ha, Ji Su; Kim, Soon Je; Lee, Hye Seung

2007-01-01

Lymphangioma of the spleen is an extremely rare disease in adults, and performing splenectomy has been considered necessary for its diagnosis and treatment, but the diagnosis of an isolated splenic mass lesion without performing splenectomy is a challenging problem. Herein, we report on a case of multiple splenic lymphangiomas that were found incidentally in a 56-year-old female; these lesions were diagnosed by percutaneous splenic biopsy without splenectomy. We suggest that this approach is a reasonable option for benign looking-appearing splenic tumors because splenectomy and its postsplenectomy complications can be avoided

Bacterial clearance after total splenectomy and splenic autotransplantation in rats

Energy Technology Data Exchange (ETDEWEB)

Marques, R.G. E-mail: rmarques@uerj.br; Petroianu, Andy; Oliveira, M.B.N. de; Bernardo-Filho, M.; Boasquevisque, E.M.; Portela, M.C

2002-12-01

Wistar rats submitted to isolated total splenectomy or total splenectomy combined with splenic autotransplantation were inoculated with {sup 99m}technetium-labeled Escherichia coli. Measurement of isotope uptake in the organs of the mononuclear phagocytic system showed a greater bacterial bloodstream clearance in rats with splenic autotransplantation. Although uptake of bacteria in the spleen was higher in the control group, the number of bacteria remaining in the bloodstream did not differ between groups. These results indicate that splenic autotransplantation preserves the phagocytic function of the spleen.

Bacterial clearance after total splenectomy and splenic autotransplantation in rats

International Nuclear Information System (INIS)

Marques, R.G.; Petroianu, Andy; Oliveira, M.B.N. de; Bernardo-Filho, M.; Boasquevisque, E.M.; Portela, M.C.

2002-01-01

Wistar rats submitted to isolated total splenectomy or total splenectomy combined with splenic autotransplantation were inoculated with 99m technetium-labeled Escherichia coli. Measurement of isotope uptake in the organs of the mononuclear phagocytic system showed a greater bacterial bloodstream clearance in rats with splenic autotransplantation. Although uptake of bacteria in the spleen was higher in the control group, the number of bacteria remaining in the bloodstream did not differ between groups. These results indicate that splenic autotransplantation preserves the phagocytic function of the spleen

The Straightened Splenic Vessels Method Improves Surgical Outcomes of Laparoscopic Distal Pancreatectomy.

Science.gov (United States)

Nagakawa, Yuichi; Sahara, Yatsuka; Hosokawa, Yuichi; Takishita, Chie; Kasuya, Kazuhiko; Tsuchida, Akihiko

2017-01-01

In laparoscopic distal pancreatectomy (LDP), isolating the splenic artery and vein requires advanced techniques. This study aimed to assess the efficacy of a novel method termed the 'straightened splenic vessels' (SSV) method for isolating the splenic vessels in LDP. In SSV, to adjust the instrument axis, the splenic artery was straightened by grasping 2 points of its nerve sheath. Then, the layer between the splenic artery's nerve sheath and the pancreatic parenchyma was dissected. Next, the pancreas was mobilized from body to tail, and the splenic vein was straightened by 3-point retraction before isolation. To evaluate this method's efficacy, we investigated 51 patients who underwent LDP. In 39 patients who underwent LDP with splenectomy, the mean operating time was significantly shorter in the SSV group than in the conventional group (p = 0.004). In 12 patients who underwent LDP with preserving the splenic vessels, the mean intraoperative blood loss in the SSV group was 27.6 ml, which was significantly lower than that in the conventional group (p = 0.012). This method may be applied as a standard procedure with little blood loss and short operation time for LDP. Larger prospective studies are needed to further evaluate the feasibility. © 2017 S. Karger AG, Basel.

FEASIBILITY OF THE CONSERVATIVE TREATMENT OF SPLENIC INJURIES IN BLUNT ABDOMINAL TRAUMA

Directory of Open Access Journals (Sweden)

M. M. Abakumov

2013-01-01

Full Text Available ABSTRACT. In blunt trauma, the structural features of the splenic parenchyma usually predispose to a significant intra-abdominal bleeding, so the excision of the damaged spleen is considered a main treatment technique in a majority of cases. However, a number of recent clinical studies have proved the necessity of a differentiated approach to making the treatment decisions and demonstrated the possibility of spleen salvage in certain cases.The most debatable issue is the management tactics in splenic injury associated with the formation of subcapsular hematoma. It is necessary to emphasize that the conservative treatment of such splenic injury implies a persisting risk of double-stage splenic rupture with following intra-abdominal bleeding.The Sklifosovsky Research Institute traditionally deals with injury management in all aspects and has gained a wide experience in splenic injury treatment that makes possible to demonstrate the choice of treatment tactics with regard to the splenic injury severity, and patient’s condition. A conservative management of spleen injury is reasonable only in stable patients and requires an additional use of instrumental diagnostic techniques. Morphological studies suggest that reparation processes around the splenic hematoma arise early enough and proceed, as a rule, with no signs of a purulent inflammation. 

Splenic simulation by left hepatic lobe following splenectomy

International Nuclear Information System (INIS)

Noel, A.; Harbert, J.C.

1984-01-01

Remodeling of the liver following splenectomy may simulate hypertrophy of an accessory spleen on sulfur colloid scans. Two patients are reported. In one case splenic simulation is attributed to unusual hepatic scarring confirmed at autopsy. In the second the unusual configuration appears to have been caused by molding of the liver. The clinician should be aware of possible splenic simulation in postsplenectomy patients suspected of hypersplenism

Splenic rupture in a neonate – a rare complication

African Journals Online (AJOL)

differential diagnosis of a hypovolaemic shocked infant with an abdominal mass. The symptoms of splenic rupture are ... A diagnosis of splenic rupture due to possible birth trauma was made. The mother admitted a month later ... parenchyma, e.g. erythroblastosis fetalis and congenital syphilis, as an enlarged spleen is more ...

Syncope as the Presenting Feature of Splenic Rupture after Colonoscopy

Directory of Open Access Journals (Sweden)

Daniel Jamorabo

2014-01-01

Full Text Available Splenic rupture is a rare, catastrophic complication of colonoscopy and an exceptional cause of syncope. This injury is believed to be from direct trauma or tension on the splenocolic ligament with subsequent capsule avulsion or else from direct instrument-induced splenic injury. Diagnosis requires a high index of suspicion that may be absent because presentation can be subtle, nonspecific, and delayed anywhere from hours to days and therefore not easily attributed to a recent endoscopy. We describe a case of syncope as the initial manifestation of splenic rupture after colonoscopy. Our patient’s pain was delayed; his discomfort was mild and not localized to the left upper quadrant. Clinicians should consider syncope, lightheadedness, and drop in hemoglobin in absence of rectal bleeding following a colonoscopy as possible warning signs of imminent or emergent splenic injury.

Pleural effusion following blunt splenic injury in the pediatric trauma population.

Science.gov (United States)

Kulaylat, Afif N; Engbrecht, Brett W; Pinzon-Guzman, Carolina; Albaugh, Vance L; Rzucidlo, Susan E; Schubart, Jane R; Cilley, Robert E

2014-09-01

Pleural effusion is a potential complication following blunt splenic injury. The incidence, risk factors, and clinical management are not well described in children. Ten-year retrospective review (January 2000-December 2010) of an institutional pediatric trauma registry identified 318 children with blunt splenic injury. Of 274 evaluable nonoperatively managed pediatric blunt splenic injures, 12 patients (4.4%) developed left-sided pleural effusions. Seven (58%) of 12 patients required left-sided tube thoracostomy for worsening pleural effusion and respiratory insufficiency. Median time from injury to diagnosis of pleural effusion was 1.5days. Median time from diagnosis to tube thoracostomy was 2days. Median length of stay was 4days for those without and 7.5days for those with pleural effusions (psplenic injury (IV-V) (OR 16.5, p=0.001) was associated with higher odds of developing a pleural effusion compared to low-grade splenic injury (I-III). Pleural effusion following pediatric blunt splenic injury has an incidence of 4.4% and is associated with high-grade splenic injuries and longer lengths of stay. While some symptomatic patients may be successfully managed medically, many require tube thoracostomy for progressive respiratory symptoms. Copyright © 2014 Elsevier Inc. All rights reserved.

CT findings of normal pancreatic tail: variety of morphology and location

Energy Technology Data Exchange (ETDEWEB)

Han, Hye Seung; Son, San Hoo; Moon, Gae Hyuk; Kim, Hu Ho; Gong Jae Chul; Yang Jae Boum [Inchon Christian Hospital, Inchon (Korea, Republic of); Park, Mee Sook [Jaesung Hospital. (Korea, Republic of)

1998-02-01

To determine the morphology and location of normal pancreatic tail, as seen on abdominal CT. A hundred and one patients without pancreatic disease underwent CT scanning. We then determined how to relate the location of the pancreatic tail with the splenic hilum, left kidney, and pancreatic body. We compared the thickness of the tail with that of the body and analysed of the morphology of the tail. Seventy-seven percent of all pancreatic tails were located below the splenic hilum, with 59% of this proportion located 1 to 2 cm below. Fifty percent of tails were located at the level of the uppermost quarter of the left kidney, and a further 27% at the level of the second quarter; 75 % were located in the ventrolateral portion of this kidney and 23% in the ventral portion. In 48% of patients, the pancreatic tail and body were the same thickness, and in a further 48 %, the tail was thicker than the body. In 34% of patients, the tail showed focal bulging, and in another 32%, it tapered smoothly. Forty seven percent of tails were located below the pancreatic body and a further 37% were found at the same level as the body. Abdominal CT scans showed differing morphology and location of the pancreatic tail. The recognition of these variations will diminish speculation as to their true nature. (author). 12 refs., 4 figs.

Clinical study on embolization syndromes after splenic arterial embolization

International Nuclear Information System (INIS)

Liu Minhua; Zhou Rumin

2004-01-01

Objective: To analyze the reaction of splenic arterial embolization (embolization syndromes) using 3 different materials together with the therapeutic methods. Methods: Thirty nine patients of cirrhosis with hypersplenism and hypersplenotrophy, 11 of them were treated with steel coils, 15 with gelfoam, 13 with the PVA. The embolized area was approximately 60% of the whole splenic area. Results: Thirty nine cases obtained the curative effect. The blood white cell and platelet counts were normal or close to normal. The rates of splenic pain in steel coils group, gelfoam group and PVA group were 81.8%, 100% and 100% respectively. The duration of serious pain were 2-5 d, 1-7 d and 1-7 d in coil group, gelfoam group and PVA group respectively. 33 patients had moderate fever around 38.5 degree C and 8 patients had eructation after embolization. The symptoms disappeared after using antibiotics, dexamethasone and analgesic. Conclusions: The algetic grade of splenic arterial embolization was inverse proportional with the size of embolus. The correct management could effectively control the symptoms of postembolization of the spleen

Preliminary experimental study on splenic hemodynamics of radiofrequency ablation for the spleen.

Science.gov (United States)

Baba, Yasutaka; Hayashi, Sadao; Nagasato, Kohei; Higashi, Michiyo; Yoshiura, Takashi

2017-08-01

To test the splenic blood flow change after radiofrequency ablation (RFA) of the spleen in a porcine experimental model. Six pigs underwent RFA of the spleen via laparotomy. During the procedure of RFA, clamping of splenic artery (one) and both splenic artery/vein (one) was also performed. Measurement of blood flow of both splenic artery (SA) and splenic vein (SV) with flow-wire at pre- and post-RFA of the spleen was also performed. Ablated splenic lesions were created as estimating ∼50% area of the spleen in all pigs. Resected specimens reveal not only the coagulated necrosis but also the congestion of the spleen. On the SA hemodynamics, maximum peak velocity (MPV) changed from 37 ± 7 to 24 ± 8 cm/s (normal), 11 to 10 cm/s (clamp of the SA), and 12 to 7.5 cm/s (clamp of both SA/SV), respectively. On the SV hemodynamic, MPV changed from 15 ± 5 to 13 ± 4 cm/s (normal), 17 to 15 cm/s (clamp of the SA), and 17 to 26 cm/s (clamp of both SA/SV), respectively. RFA of the spleen could induce coagulation necrosis and reduce the splenic arterial blood flow.

A Case of Ruptured Splenic Artery Aneurysm in Pregnancy

Directory of Open Access Journals (Sweden)

Elizabeth K. Corey

2014-01-01

Full Text Available Background. Rupture of a splenic artery aneurysm is rare complication of pregnancy that is associated with a significant maternal and fetal mortality. Case. A multiparous female presented in the third trimester with hypotension, tachycardia, and altered mental status. A ruptured splenic artery aneurysm was discovered at the time of laparotomy and cesarean delivery. The patient made a full recovery following resection of the aneurysm. The neonate survived but suffered severe neurologic impairment. Conclusion. The diagnosis of ruptured splenic artery aneurysm should be considered in a pregnant woman presenting with signs of intra-abdominal hemorrhage. Early intervention by a multidisciplinary surgical team is key to preserving the life of the mother and fetus.

Haematological and biochemical characteristics of the splenic effluent blood in schistosomal patients undergoing splenectomy

Directory of Open Access Journals (Sweden)

Andy Petroianu

Full Text Available OBJECTIVE: To assess hematological and biochemical features of splenic effluent blood and their influence on the rise of hematological values after splenectomy. METHODS: we studied 20 patients undergoing surgical treatment for schistosomatic portal hypertension. We collected blood samples for CBC, coagulation, bilirubin and albumin in the splenic vein (perioperative and peripheral blood (immediately pre and postoperative periods. RESULTS: the splenic blood showed higher values of red blood cells, hemoglobin, hematocrit, platelet count, total leukocytes, neutrophils, lymphocytes, monocytes, eosinophils and basophils, as well as reduction of laboratory coagulation parameters in relation to peripheral blood collected preoperatively. In the postoperative peripheral blood there was an increase in the overall leukocytes and in their neutrophil component, and decreased levels of basophils, eosinophils and lymphocytes. The other postoperative variables of complete blood count and coagulation tests were not different compared with the splenic blood. The albumin values were lower postoperatively when compared to preoperative and splenic blood. There were higher values of direct bilirubin in the postoperative period when compared with the preoperative and splenic blood. Postoperative indirect bilirubin was lower compared to its value in the splenic blood. CONCLUSION: hematological and biochemical values of splenic effluent blood are higher than those found in peripheral blood in the presence of schistosomal splenomegaly. However, the splenic blood effluent is not sufficient to raise the blood levels found after splenectomy.

Salmonella sepsis following posttraumatic splenectomy and implantation of autologous splenic tissue

DEFF Research Database (Denmark)

Schrøder, H M; Hovendal, C

1985-01-01

A severe complication following implantation of autologous splenic tissue occurred in a 51-year-old man. Indirect injury to abdomen resulted in a lesion of the splenic artery. Following splenectomy and reimplantation of splenic tissue into three pouches, a severe Salmonella sepsis developed withi...... 24 hours. At second look laparotomy two pouches were infected. Recently there had been moderate signs of gastroenteritis and the same bacteria was cultivated from feces. Modifications of the implantation procedure are discussed....

Unusual long-term complications of a splenic cyst.

LENUS (Irish Health Repository)

Ward, E V M

2012-02-01

Splenic cysts are relatively uncommon, and are usually asymptomatic. They are benign, typically treated conservatively and followed up with ultrasound examination, with few reported complications. We report a case of a simple splenic cyst that was followed up on imaging over a seven-year period. During that time, the cyst gradually enlarged from 5 cm to 12 cm in diameter, however the patient remained asymptomatic. After seven years, the patient was admitted with abdominal pain and a pelvic mass. The spleen was located within the pelvis, which was felt to be due to the weight of the cyst which caused the spleen to migrate out of its normal position. This case illustrates an extremely unusual complication, and suggests that while most splenic cysts may be managed conservatively, enlarging cysts may be prone to gravitational effects and prophylactic treatment should be considered.

Unusual long-term complications of a splenic cyst.

LENUS (Irish Health Repository)

Ward, E V M

2010-01-01

Splenic cysts are relatively uncommon, and are usually asymptomatic. They are benign, typically treated conservatively and followed up with ultrasound examination, with few reported complications. We report a case of a simple splenic cyst that was followed up on imaging over a seven-year period. During that time, the cyst gradually enlarged from 5 cm to 12 cm in diameter, however the patient remained asymptomatic. After seven years, the patient was admitted with abdominal pain and a pelvic mass. The spleen was located within the pelvis, which was felt to be due to the weight of the cyst which caused the spleen to migrate out of its normal position. This case illustrates an extremely unusual complication, and suggests that while most splenic cysts may be managed conservatively, enlarging cysts may be prone to gravitational effects and prophylactic treatment should be considered.

Giant splenic hematoma can be a hidden condition

DEFF Research Database (Denmark)

Jensen, Kristian Kiim; Hangaard, Stine

2014-01-01

An otherwise healthy 28-year old male presented to his general practitioner with dyspnoea in the morning and abdominal discomfort through months. Four months earlier, he had experienced a blunt trauma to the left side of his abdomen. Abdominal ultrasonography revealed a splenic hematoma and the p......An otherwise healthy 28-year old male presented to his general practitioner with dyspnoea in the morning and abdominal discomfort through months. Four months earlier, he had experienced a blunt trauma to the left side of his abdomen. Abdominal ultrasonography revealed a splenic hematoma...... and the patient was admitted to hospital. Vital signs were normal, and blood samples revealed a marginal anaemia and elevated C-reactive protein, but were otherwise normal. Computed tomography showed an 18 centimetre wide splenic hematoma. The patient was referred to another hospital for conservative treatment...

Splenic arteriovenous malformation manifested by thrombocytopenia in hereditary hemorrhagic telangiectasia: a case report

Energy Technology Data Exchange (ETDEWEB)

Kwon, Hee Jin; Choi, Jong Cheol; Oh, Jong Yeong; Cho, Jin Han; Kang, Myong Jin; Lee, Jin Hwa; Yoon, Seong Kuk; Nam, Kyeong Jin [College of Medicine, Dong-A University, Busan (Korea, Republic of)

2008-09-15

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant inherited disease characterized by epistaxis, telangiectases and visceral arteriovenous malformations (AVMs). The involvement of the gastrointestinal tract, liver, lung and cerebrum for HHT has been described, whereas little is known about AVMs of the spleen. We report here the radiological findings of a case of a splenic AVM manifested by thrombocytopenia in HHT.

Splenic arteriovenous malformation manifested by thrombocytopenia in hereditary hemorrhagic telangiectasia: a case report

International Nuclear Information System (INIS)

Kwon, Hee Jin; Choi, Jong Cheol; Oh, Jong Yeong; Cho, Jin Han; Kang, Myong Jin; Lee, Jin Hwa; Yoon, Seong Kuk; Nam, Kyeong Jin

2008-01-01

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant inherited disease characterized by epistaxis, telangiectases and visceral arteriovenous malformations (AVMs). The involvement of the gastrointestinal tract, liver, lung and cerebrum for HHT has been described, whereas little is known about AVMs of the spleen. We report here the radiological findings of a case of a splenic AVM manifested by thrombocytopenia in HHT

Splenic dynamics of indium-111 labeled platelets in idiopathic thrombocytopenic purpura

International Nuclear Information System (INIS)

Syrjaelae, M.T.Sa.; Savolainen, S.; Nieminen, U.; Gripenberg, J.; Liewendahl, K.; Ikkala, E.

1989-01-01

Splenic dynamics of 111 In-labeled platelets and platelet-associated IgG in 33 patients with idiopathic thrombocytopenic purpura (ITP) were studied. Two half-lives were calculated for the biexponential splenic time-activity curve after i.v. injection of 111 In-labeled platelets. There was no difference in the mean half-life of the rapid component of the splenic curve (ST1) when patients with negative or slightly positive platelet suspension immunofluorescence test (PSIFT) were compared to those with strongly positive PSIFT (3.0 ± 0.7 min vs. 3.6 ± 0.4, p greater than 0.05). Mean half-life of the slow component of the splenic curve (ST2) was found to be longer in patients with a strongly positive than a negative or weakly positive PSIFT (26 ± 5 min vs. 13.2 ± 1.0 min, p less than 0.01). It seems that determination of the two components of the splenic time-activity curve provides a useful method for studying platelet kinetics in ITP

Splenic abscess in children: A report of three patients | Rattan ...

African Journals Online (AJOL)

Splenic abscess is uncommon in paediatric age group. It usually occurs in conditions of disseminated infective focus. Conventional treatment of abscess is incision and drainage, although splenectomy or splenic conservation is alternative. In this report, we are presenting case summaries of three patients suffering from ...

Extrahepatic portal venous obstruction: The effects of early ligation of splenic artery during splenectomy.

Science.gov (United States)

Gazula, Suhasini; Pawar, D K; Seth, T; Bal, C S; Bhatnagar, V

2009-10-01

To objectively demonstrate the gain in blood volume and blood components following early ligation of splenic artery during splenectomy and splenorenal shunts in children with extra hepatic portal venous obstruction (EHPVO). Twenty-eight children (20 males and 8 females, mean age: 9.9 (+/-3.2) years) with EHPVO and hypersplenism were recruited. We followed a protocol of systematically locating and ligating the splenic artery first, followed by a 30-minute waiting period to allow the massive spleen to decongest via the splenic vein and venous collaterals and then completing the splenectomy by standard procedure. No intravenous fluid was administered during this 30-minute period. Blood samples were drawn just prior to splenic artery ligation and soon after splenectomy for the estimation of hematological and biochemical parameters. We noticed a highly significant increase in the hemoglobin, hematocrit, leukocyte, platelet, and RBC counts by early ligation of the splenic artery (p platelet count was equivalent to a platelet transfusion of atleast 4 units of platelet concentrates in an adult. There is a positive correlation between the splenic weight and the platelet gain (p= 0.0568) and the splenic volume on preoperative imaging and the platelet gain (p= 0.0251). Early ligation of the splenic artery during splenectomy results in passive splenic decongestion and thereby a significant gain in blood components. This protocol appears to be a feasible blood conservation method to avoid blood transfusions in this group of hypersplenic EHPVO patients.

Recent progress in the clinical application of partial splenic embolization

International Nuclear Information System (INIS)

Zhou Yaojun; Liu Changjiang; Wang Yaojun

2012-01-01

Partial splenic embolization (PSE) is a non-surgical procedure used to treat hypersplenism in various clinical settings and thus to avoid the disadvantages of splenectomy. PSE can be employed for the treatment of a variety of diseases including hypersplenism, thrombocytopenia, portal hypertension, splenic arterial aneurysms, etc. PSE can effectively relieve the splenic artery steal syndrome which occurred after liver transplantation, and therefore significantly improve the blood perfusion of the recipient liver. Besides, PSE can also be adopted to reduce the bleeding risk in patients with esophageal and gastric varices caused by portal hypertension. PSE is beneficial to the improvement of peripheral hematologic parameters, which helps the patients successfully undergo the high-dose chemotherapy or interferon therapy. In addition, PSE possesses potential curative effect for thrombocytopenia related diseases such as chronic idiopathic thrombocytopenic purpura. This paper aims to make a comprehensive review of the recent progress in the clinical application of partial splenic embolization. (authors)

Splenic infarction associated with acute infectious mononucleosis due to Epstein-Barr virus infection.

Science.gov (United States)

Heo, Dae-Hyuk; Baek, Dae-Youb; Oh, Sang-Min; Hwang, Joo-Hee; Lee, Chang-Seop; Hwang, Jeong-Hwan

2017-02-01

The purpose of this study was to report a case of a previously healthy 20-year-old woman diagnosed with splenic infarction following infectious mononucleosis (IM) by Epstein-Barr virus (EBV) infection and to perform the first systematic review of the clinical characteristics of splenic infarction associated with IM. A systematic review was conducted using English, French, and Japanese literatures of splenic infarction associated with IM due to EBV infection published between 1961 and 2015 in PubMed Medline. A total of 19 cases were extracted from the collected articles. Left upper quadrant (LUQ) pain was observed in 15 (79%) patients. Splenectomy was performed in five (26%) cases, among which four patients presented with stable vital signs. Splenic rupture was accompanied in two (10%) patients. The median time from the onset of IM symptoms to the diagnosis of splenic infarction was 5 days (range, 1-25 days). Fourteen (74%) of 19 patients experienced improvement through medical treatment, and there were no deaths. Splenic infarction associated with IM due to EBV infection can show a favorable clinical outcome after medical treatment. Clinicians should consider the possibility of splenic infarction when patients with IM experience LUQ pain. J. Med. Virol. 89:332-336, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Use of spiral CT angiography to judge central pulmonary vascular involvement from lung cancer

International Nuclear Information System (INIS)

Tan Qunyou; Zhao Shaohong; Wang Fangze; Cai Zulong

2000-01-01

Objective: To evaluate the accuracy of spiral CT angiography (SCTA) in judging central pulmonary vascular involvement from lung cancer located in the hilum and correlate the resultant images with pathologic and surgical findings. Methods: SCTA was done in 33 patients who were preoperatively diagnosed as having lung carcinoma located in the hilum. Contrast medium was injected at a rate of 3 ml/sec with a power injector. The delay time was from 20 to 25 seconds. The pitch was 1 with 3 mm-collimation. Images of central pulmonary arteries and veins were reconstructed with shaded surface display (SSD), maximum intensity projection (MIP), curved planar reformation (CPR), and multi-planar reformation (MPR). Then the relation between tumor and vessels was assessed prospectively on both 3 mm interval axial CT and SCTA images with comparison to subsequent pathologic or surgical findings. Results: (1) In showing the integrity of central pulmonary arteries and veins, images reconstructed by different ways of SCTA had different strong and weak points. (2) The grading standard in this study, with which the relation between vessels and tumor was judged, reflected the basic and common characters of central pulmonary vascular involvement by tumor located in the hilum. compared with axial CT images, SCTA was more accurate in judging the relation between central pulmonary vessels and tumor, and the correlation of SCTA imaging features with pathological patterns and surgical findings was better than that of axial CT images, P < 0.05 and P < 0.0001, respectively. Conclusion: It was feasible to show the relation between central pulmonary vessel and lung cancer located in the hilum with SCTA. And the accuracy of judging the vascular involvement with SCTA was higher than that with axial CT

Splenic Trauma

International Nuclear Information System (INIS)

Cortes Diaz, Fabio F; Buitrago Mejia, Francisco; Ulloa Guerrero, Luis Heber

2001-01-01

The spleen is the organ that is injured during the closed trauma with more frequency and it is the cause more common of foregone death in the patients with wounded abdominal. At the present time the complications of the splenic trauma are related with their severity, associate wounds, diagnostic fail or inadequate treatments. The lesions that are diagnosed in early form are managed quick and satisfactorily, but the forgotten wounds or the diagnoses and late treatments take for themselves high rates of morbid-mortality. The paper includes their phyto pathology, diagnoses, classification and treatment

Laparoscopic unroofing of splenic cysts results in a high rate of recurrences.

Science.gov (United States)

Schier, Felix; Waag, Karl-Ludwig; Ure, Benno

2007-11-01

Laparoscopic unroofing is described as an appropriate treatment modality of nonparasitic splenic cysts. However, we repeatedly encountered recurrences with this technique. Because splenic cysts are rare, we analyzed the combined experience of 3 German pediatric surgical departments. Between 1995 and 2005, primary and secondary nonparasitic splenic cysts were unroofed laparoscopically in 14 children (aged 5-12 years; median, 8.5 years). In 3 patients, the inner surface was coagulated with the argon beamer. In most children, the cavity was surfaced with omentum. In addition, in 4 patients the omentum was sutured to the splenic parenchyma. No intraoperative complications occurred, and no inadvertent splenectomy or blood transfusions were necessary. However, in 9 children (64%) the cysts recurred at intervals ranging from 6 to 12 months (median, 12 months). Also, argon laser treatment of the surface resulted in recurrence. Laparoscopic unroofing of true splenic cysts alone proved inadequate in this series. Either removal of the inner layer or partial splenectomy appears to be necessary to prevent recurrences.

Variation in treatment of blunt splenic injury in Dutch academic trauma centers.

Science.gov (United States)

Olthof, Dominique C; Luitse, Jan S K; de Rooij, Philippe P; Leenen, Loek P H; Wendt, Klaus W; Bloemers, Frank W; Goslings, J Carel

2015-03-01

The incidence of splenectomy after trauma is institutionally dependent and varies from 18% to as much as 40%. This is important because variation in management influences splenic salvage. The aim of this study was to investigate whether differences exist between Dutch level 1 trauma centers with respect to the treatment of these injuries, and if variation in treatment was related to splenic salvage, spleen-related reinterventions, and mortality. Consecutive adult patients who were admitted between January 2009 and December 2012 to five academic level 1 trauma centers were identified. Multinomial logistic regression was used to measure the influence of hospital on treatment strategy, controlling for hemodynamic instability on admission, high grade (American Association for the Surgery of Trauma 3-5) splenic injury, and injury severity score. Binary logistic regression was used to quantify differences among hospitals in splenic salvage rate. A total of 253 patients were included: 149 (59%) were observed, 57 (23%) were treated with splenic artery embolization and 47 (19%) were operated. The observation rate was comparable in all hospitals. Splenic artery embolization and surgery rates varied from 9%-32% and 8%-28%, respectively. After adjustment, the odds of operative management were significantly higher in one hospital compared with the reference hospital (adjusted odds ratio 4.98 [1.02-24.44]). The odds of splenic salvage were significantly lower in another hospital compared with the reference hospital (adjusted odds ratio 0.20 [0.03-1.32]). Although observation rates were comparable among the academic trauma centers, embolization and surgery rates varied. A nearly 5-fold increase in the odds of operative management was observed in one hospital, and another hospital had significantly lower odds of splenic salvage. The development of a national guideline is recommended to minimalize splenectomy after trauma. Copyright © 2015 Elsevier Inc. All rights reserved.

Splenic irradiation before bone marrow transplantation for chronic myeloid leukaemia

International Nuclear Information System (INIS)

Gratwohl, A.; Hermans, J.; Biezen, A.V.

1996-01-01

A total of 229 patients with chronic myeloid leukaemia (CML) in chronic phase were randomized between 1986 and 1990 to receive or not receive additional splenic irradiation as part of their conditioning prior to bone marrow transplantation (BMT). Both groups, 115 patients with and 114 patients without splenic irradiation, were very similar regarding distribution of age, sex, donor/recipient sex combination, conditioning, graft-versus-host disease (GvHD) prevention method and blood counts at diagnosis or prior to transplant. 135 patients (59%) are alive as of October 1995 with a minimum follow-up of 5 years. 52 patients have relapsed (23%), 26 patients in the irradiated, 26 patients in the non-irradiated group (n.s.) with a relapse incident at 6 years of 28%. The main risk factor for relapse was T-cell depletion as the method for GvHD prevention, and an elevated basophil count in the peripheral blood prior to transplant. Relapse incidence between patients with or without splenic irradiation was no different in patients at high risk for relapse, e.g. patients transplanted with T-cell-depleted marrows (P = n.s.) and in patients with low risk for relapse, e.g. patients transplanted with non-T-cell-depleted transplants and basophil counts 3% basophils in peripheral blood). In this patient group, relapse incidence was 11% at 6 years with splenic irradiation but 32% in the non-irradiated group (P = 0.05). Transplant-related mortality was similar whether patients received splenic irradiation or not. This study suggests an advantage in splenic irradiation prior to transplantation for CML in this subgroup of patients and illustrates the need for tailored therapy. (Author)

Insulin radioreceptor assay on murine splenic leukocytes and peripheral erythrocytes

International Nuclear Information System (INIS)

Shimizu, F.; Kahn, R.

1982-01-01

Insulin radioreceptor assays were developed using splenic leukocytes and peripheral erythrocytes from individual mice. Splenic leukocytes were prepared using an NH 4 Cl buffer which did not alter insulin binding, but gave much higher yields than density gradient methods. Mouse erythrocytes were isolated from heparinized blood by three passages over a Boyum gradient, and a similar buffer was used to separate cells from free [ 125 I]iodoinsulin at the end of the binding incubation. Insulin binding to both splenic leukocytes and peripheral erythrocytes had typical pH, temperature, and time dependencies, and increased linearly with an increased number of cells. Optimal conditions for the splenic leukocytes (6 x 10 7 /ml) consisted of incubation with [ 125 I]iodoinsulin at 15 C for 2 h in Hepes buffer, pH 8.0. In cells from 20 individual mice, the specific [ 125 I]iodoinsulin binding was 2.6 +/- 0.1% (SEM), and nonspecific binding was 0.3 +/- 0.04% (10.6% of total binding). Erythrocytes (2.8 x 10 9 /ml) were incubated with [ 125 ]iodoinsulin at 15 C for 2 h in Hepes buffer, pH 8.2. In cells from 25 individual mice, the specific [ 125 I]iodoinsulin binding was 4.5 +/- 0.2%, and nonspecific binding was 0.7 +/- 0.03% (13.6% of total binding). In both splenic leukocytes and peripheral erythrocytes, analysis of equilibrium binding data produced curvilinear Scatchard plots with approximately 3500 binding sites/leukocyte and 20 binding sites/erythrocyte. These data demonstrate that adequate numbers of splenic leukocytes and peripheral erythrocytes can be obtained from individual mice to study insulin binding in a precise and reproducible manner

Splenic TFH expansion participates in B-cell differentiation and antiplatelet-antibody production during immune thrombocytopenia.

Science.gov (United States)

Audia, Sylvain; Rossato, Marzia; Santegoets, Kim; Spijkers, Sanne; Wichers, Catharina; Bekker, Cornelis; Bloem, Andries; Boon, Louis; Flinsenberg, Thijs; Compeer, Ewoud; van den Broek, Theo; Facy, Olivier; Ortega-Deballon, Pablo; Berthier, Sabine; Leguy-Seguin, Vanessa; Martin, Laurent; Ciudad, Marion; Samson, Maxime; Trad, Malika; Lorcerie, Bernard; Janikashvili, Nona; Saas, Philippe; Bonnotte, Bernard; Radstake, Timothy R D J

2014-10-30

Antiplatelet-antibody-producing B cells play a key role in immune thrombocytopenia (ITP) pathogenesis; however, little is known about T-cell dysregulations that support B-cell differentiation. During the past decade, T follicular helper cells (TFHs) have been characterized as the main T-cell subset within secondary lymphoid organs that promotes B-cell differentiation leading to antibody class-switch recombination and secretion. Herein, we characterized TFHs within the spleen of 8 controls and 13 ITP patients. We show that human splenic TFHs are the main producers of interleukin (IL)-21, express CD40 ligand (CD154), and are located within the germinal center of secondary follicles. Compared with controls, splenic TFH frequency is higher in ITP patients and correlates with germinal center and plasma cell percentages that are also increased. In vitro, IL-21 stimulation combined with an anti-CD40 agonist antibody led to the differentiation of splenic B cells into plasma cells and to the secretion of antiplatelet antibodies in ITP patients. Overall, these results point out the involvement of TFH in ITP pathophysiology and the potential interest of IL-21 and CD40 as therapeutic targets in ITP. © 2014 by The American Society of Hematology.

Antibody response to a T-cell-independent antigen is preserved after splenic artery embolization for trauma

NARCIS (Netherlands)

Olthof, D. C.; Lammers, A. J. J.; van Leeuwen, E. M. M.; Hoekstra, J. B. L.; ten Berge, I. J. M.; Goslings, J. C.

2014-01-01

Splenic artery embolization (SAE) is increasingly being used as a nonoperative management strategy for patients with blunt splenic injury following trauma. The aim of this study was to assess the splenic function of patients who were embolized. A clinical study was performed, with splenic function

Isolated splenic metastasis from a thymic carcinoma: A case report.

Science.gov (United States)

Chen, Dongmei; Meng, Xiangying; Zhao, Yaowei; Wu, Shikai

2016-09-01

Thymic carcinomas are rare tumors that arise in the anterior mediastinum. Most of these malignancies develop local metastases limited in the thorax. Splenic metastases from thymic carcinomas are extremely rare. Here we report a case of isolated splenic metastasis from a 38-year-old female patient with Stage IV thymic carcinoma, who was treated with chemoradiotherapy. At twenty-2 months follow-up, the patient was found to have an isolated spleen metastasis, which was treated by Cyberknife with a reduced size of the metastasis, representing a partial response. Although splenic metastasis is a rare phenomenon, physicians need to be aware of the possibility of such metastases.

Stereotyped patterns of B-cell receptor in splenic marginal zone lymphoma

KAUST Repository

Zibellini, S.

2010-05-29

Antigen stimulation may be important for splenic marginal zone lymphoma pathogenesis. To address this hypothesis, the occurrence of stereotyped B-cell receptors was investigated in 133 SMZL (26 HCV+) compared with 4,414 HCDR3 sequences from public databases. Sixteen SMZL (12%) showed stereotyped BCR; 7 of 86 (8%) SMZL sequences retrieved from public databases also belonged to stereotyped HCDR3 subsets. Three categories of subsets were identified: i) SMZL-specific subsets (n=5), composed only of 12 SMZL (9 HCV- from our series); ii) Non-Hodgkin\\'s lymphoma-like subsets (n=5), comprising 5 SMZL (4 from our series) clustering with other indolent lymphomas; iii) "CLL-like subsets" (n=6), comprising 6 SMZL (3 from our series) that belonged to known CLL subsets (n=4) or clustered with public CLL sequences. Immunoglobulin 3D modeling of 3 subsets revealed similarities in antigen binding regions not limited to HCDR3. Overall, data suggest that the pathogenesis of splenic marginal zone lymphoma may involve also HCV unrelated epitopes or an antigenic trigger common to other indolent lymphomas. ©2010 Ferrata Storti Foundation.

Stereotyped patterns of B-cell receptor in splenic marginal zone lymphoma

KAUST Repository

Zibellini, S.; Capello, D.; Forconi, F.; Marcatili, P.; Rossi, D.; Rattotti, S.; Franceschetti, S.; Sozzi, E.; Cencini, E.; Marasca, R.; Baldini, L.; Tucci, A.; Bertoni, F.; Passamonti, F.; Orlandi, E.; Varettoni, M.; Merli, M.; Rizzi, S.; Gattei, V.; Tramontano, A.; Paulli, M.; Gaidano, G.; Arcaini, L.

2010-01-01

Antigen stimulation may be important for splenic marginal zone lymphoma pathogenesis. To address this hypothesis, the occurrence of stereotyped B-cell receptors was investigated in 133 SMZL (26 HCV+) compared with 4,414 HCDR3 sequences from public databases. Sixteen SMZL (12%) showed stereotyped BCR; 7 of 86 (8%) SMZL sequences retrieved from public databases also belonged to stereotyped HCDR3 subsets. Three categories of subsets were identified: i) SMZL-specific subsets (n=5), composed only of 12 SMZL (9 HCV- from our series); ii) Non-Hodgkin's lymphoma-like subsets (n=5), comprising 5 SMZL (4 from our series) clustering with other indolent lymphomas; iii) "CLL-like subsets" (n=6), comprising 6 SMZL (3 from our series) that belonged to known CLL subsets (n=4) or clustered with public CLL sequences. Immunoglobulin 3D modeling of 3 subsets revealed similarities in antigen binding regions not limited to HCDR3. Overall, data suggest that the pathogenesis of splenic marginal zone lymphoma may involve also HCV unrelated epitopes or an antigenic trigger common to other indolent lymphomas. ©2010 Ferrata Storti Foundation.

Curative resection by splenectomy for solitary splenic metastasis from early gastric cancer: a case report and literature review.

Science.gov (United States)

Yoshizawa, Junichi; Kubo, Naoki; Ishizone, Satoshi; Karasawa, Fumitoshi; Nakayama, Ataru

2017-06-20

Solitary metastasis of a malignancy to the spleen is rare, particularly for gastric cancer. Only a few case reports have documented isolated splenic metastasis from early gastric cancer. We describe a case of splenic metastasis from early gastric cancer. A 60-year-old man underwent a distal gastrectomy for early gastric cancer. It infiltrated the submucosa with pathological nodal involvement (pT1bN2M0, stage IIB). One year after the gastrectomy, an abdominal computed tomography scan showed a low-density lesion, 17 mm in diameter, at the upper pole of the spleen. Positron emission tomography/computed tomography showed focal accumulation of fluorine-18 fluorodeoxyglucose in the spleen without extrasplenic tumor dissemination or metastasis. We diagnosed splenic metastasis of gastric cancer, and performed a splenectomy. Histological examination confirmed moderately differentiated tubular adenocarcinoma and poorly differentiated adenocarcinoma (solid type) that was consistent with the features of the primary gastric cancer. The splenic tumor was pathologically and immunohistochemically diagnosed as a metastasis from the gastric carcinoma. More than 18 months after the splenectomy, the patient has had no evidence of recurrent gastric cancer. When solitary metastasis to the spleen is suspected during the postoperative follow-up of a patient with gastric cancer, a splenectomy is a potentially effective treatment.

Unusual case of pancreatic inflammatory myofibroblastic tumor associated with spontaneous splenic rupture

Directory of Open Access Journals (Sweden)

Hassan Fadi K

2010-11-01

Full Text Available Abstract Background Spontaneous splenic rupture considered a relatively rare but life threatening. The three commonest causes of spontaneous splenic rupture are malignant hematological diseases, viral infections and local inflammatory and neoplastic disorders. We describe a unique and unusual case of inflammatory myofibroblastic tumor of the tail of pancreas presented with massively enlarged spleen and spontaneous splenic rupture. Case presentation A 19 years old male patient with no significant past medical history presented to emergency room with abdominal pain and fatigue. Massively enlarged spleen was detected. Hypotension and rapid reduction of hemoglobin level necessitated urgent laparatomy. About 1.75 liters of blood were found in abdominal cavity. A large tumor arising from the tail of pancreas and local rupture of an enlarged spleen adjacent to the tumor were detected. Distal pancreatectomy and splenectomy were performed. To our knowledge, we report the first case of massively enlarged spleen that was complicated with spontaneous splenic rupture as a result of splenic congestion due to mechanical obstruction caused by an inflammatory myofibroblastic tumor of the tail of pancreas. A review of the literature is also presented. Conclusion Inflammatory myofibroblastic tumor of the tail of pancreas should be included in the differential diagnosis of the etiological causes of massively enlarged spleen and spontaneous splenic rupture.

Hepatocellular carcinoma with bile duct involvement : computed Tomographic (CT) findings

International Nuclear Information System (INIS)

Lee, Joon Woo; Han, Joon Koo; Kim, Tae Kyoung; And others

2000-01-01

To describe the radiologic features of computed tomography (CT) in hepatocellular carcinoma (HCC) with bile duct involvement. We retrospectively analyzed the two phase spiral CT findings of 31 patients in whom HCC with bile duct invasion (n=3D28) or compression (n=3D3), was diagnosed. Eight of these underwent follow up CT after transarterial chemoembolization. We analyzed the size, type, location, enhancement pattern, and lipiodol retention of parenchymal and intraductal masses, as well as their lymphadenopathy. In all patients with bile duct invasion, single or multiple masses were demonstrated in the bile ducts. Intraductal masses showed the same enhancement characteristics as the parenchymal mass (kappa 0.550, p less than 0.001), and were contiguous to this mass. In 14 of 28 patients, intraductal masses filled the peripheral intrahepatic bile ducts and extended to the common bile ducts. In the other 14, the parenchymal mass extended to the area of the porta hepatis and then directly invaded the large ducts. In nine of the 28 patients, there was a hypoattenuated cleft between the intraductal mass and ductal wall. In six, a parenchymal mass was not apparent (n=3D2), or was smaller than 2cm (n=3D4). In five of eight patients (62.5%), follow-up CT after transarterial chemoembolization showed compact or partial lipiodol retention within the intraductal mass. In patients with bile duct compression, perihilar lymph nodes were noted along with the dilated intrahepatic duct but no intra ductal mass was demonstrated in the duct. Hepatocellular carcinomas cause bile duct dilatation either by direct invasion or by extrinsic compression of the bile duct with surrounding enlarged nodes. For the diagnosis of this condition, CT is helpful. (author)

Born-again spleen. Return of splenic function after splenectomy for trauma

International Nuclear Information System (INIS)

Pearson, H.A.; Johnston, D.; Smith, K.A.; Touloukian, R.J.

1978-01-01

We assessed splenic activity after splenectomy by interference phase microscopical examination of circulating red cells. Normal eusplenic children had a low number (<1%) of red cells with surface indentations or pits. About 20% of red cells of children who had electively been subjected to splenectomy for hematologic indications were pitted. Thirteen of 22 children who had had emergency splenectomy because of traumatic injury had a low percentage of pitted red cells, suggesting a return of splenic function. In five of these children a /sup 99m/Tc sulfur colloid scan demonstrated multiple nodules of recurrent splenic tissue. In contrast to the prevailing opinion that splenosis is rare, we have found it to be a frequent occurrence. Return of splenic function may, in part, account for the low frequency with which overwhelming bacterial sepsis and meningitis have been documented after splenectomy for traumatic indications

Outcome prediction by extranodal involvement, IPI, and R-IPI in the PET/CT and rituximab era

DEFF Research Database (Denmark)

El-Galaly, Tarec Christoffer; Villa, Diego; Alzahrani, Musa

2015-01-01

PURPOSE: 18F-fluorodeoxyglucose PET/CT (PET/CT) is the current state-of-the-art in the staging of diffuse large B-cell lymphoma (DLBCL) and has a high sensitivity for extranodal involvement. Therefore, reassessment of extranodal involvement and the current prognostic indices in the PET/CT era...... met the inclusion criteria. With a median follow-up of 2.4 years, the 3-year overall (OS) and progression-free survival (PFS) were 73% and 69%, respectively. The Ann Arbor classification had no prognostic impact in itself with the exception of stage IV disease (HR 2.14 for PFS, P... with a dismal outcome. The IPI, R-IPI, and NCCN-IPI predict outcome with high accuracy. This article is protected by copyright. All rights reserved....

Increased Risk of Hemorrhagic and Ischemic Strokes in Patients With Splenic Injury and Splenectomy

Science.gov (United States)

Lin, Jiun-Nong; Lin, Cheng-Li; Lin, Ming-Chia; Lai, Chung-Hsu; Lin, Hsi-Hsun; Yang, Chih-Hui; Kao, Chia-Hung

2015-01-01

Abstract The spleen is a crucial organ in humans. Little is known about the association between stroke and splenic injury or splenectomy. The aim of this study was to determine the risk of stroke in patients with splenic injury and splenectomy. A nationwide cohort study was conducted by analyzing the National Health Insurance Research Database in Taiwan. For comparison, control patients were selected and matched with splenic injury patients in a ratio of 4:1 according to age, sex, and the year of hospitalization. We analyzed the risks of stroke using a Cox proportional-hazards regression analysis. A total of 11,273 splenic injury patients, including 5294 splenectomized and 5979 nonsplenectomized patients, and 45,092 control patients were included in this study. The incidence rates of stroke were 8.05, 6.53, and 4.25 per 1000 person-years in splenic injury patients with splenectomy, those without splenectomy, and the control cohort, respectively. Compared with the control cohort, splenic injury patients with splenectomy exhibited a 2.05-fold increased risk of stroke (95% confidence interval [CI] 1.8–2.34), whereas those without splenectomy exhibited a 1.74-fold increased risk (95% CI 1.51–2). Splenectomy entailed an additional 1.21-fold increased risk of stroke compared with nonsplenectomy in patients with splenic injury. This study revealed that splenic injury and splenectomy were significantly associated with an increased risk of hemorrhagic and ischemic strokes. The results of this study may alert physicians and patients to the complications of splenic injury and splenectomy. PMID:26334909

Coil Migration after Transarterial Coil Embolization of a Splenic Artery Pseudoaneurysm

Directory of Open Access Journals (Sweden)

Bezawit D. Tekola

2013-11-01

Full Text Available A 48-year-old man with a history of splenic artery pseudoaneurysm requiring transarterial embolization 3 months earlier presented to the emergency department with abdominal pain and fever. Computed tomography showed evidence of embolization coil fragments within the gastrointestinal tract. Upper endoscopy showed a large gastric ulcer with numerous embolization coils extruding into the gastric lumen. The patient underwent partial gastrectomy, distal pancreatectomy and resection of the splenic artery pseudoaneurysm. This case illustrates a rare delayed complication of transarterial embolization of a splenic artery pseudoaneurysm.

Clinical Findings in Patients with Splenic Injuries: Are Injuries to the Left Lower Chest Important?

Directory of Open Access Journals (Sweden)

Schneir, Aaron

2001-07-01

Full Text Available The purpose of this study was to describe the clinical findings in patients with splenic injury and to determine if isolated left lower chest injury may be the single clinical indicator of splenic injury. The medical records of all adult blunt trauma patients with splenic injury over a 14 month period were reviewed. Significant left lower chest injury was considered present if the patient had left sided pleuritic chest pain with tenderness to ribs 7-12 or if these ribs were visualized as fractured on any imaging study. Patients were considered to have clinical findings suggestive of splenic injury if they had pre-hospital or emergency department hypotension, abdominal pain or tenderness, a Glasgow coma scale < 15, or gross hematuria. Ninety patients had splenic injury. Thirty-nine (43%. 95% CI 33, 54% patients had significant left lower chest injury. In five (6%. 95% CI 2, 12% patients, injury to this portion of the chest was the single indicator of splenic injury. Nearly half the patients with splenic injury will have significant injury to the left lower chest and this finding may be the only indicator of splenic injury.

CT and MR findings of langerhans cell histiocytois involving the spleen: a case report

Energy Technology Data Exchange (ETDEWEB)

Pyun, Hae Wook; Kim, Mee Eun; Kim, Jang Ho [Fatima Hospital, Taegu (Korea, Republic of)

2002-02-01

Langerhans cell histiocytosis (LCH) is systemic disease resulting from the proliferation and dissemination of abnormal histiocytic cells of the Langerhans cell system. Common sites of involvement include the skin, bone, bone marrow, lung, lymph nodes and central nervous system, and the condition manifests in variety of ways. We present the CT and MR findings of a case of LCH involving the spleen, an organ invloved relatively rarely. Post-contrast CT revealed multiple hypodense nodules. T1-weighted MR images of the spleen depicted no definitive lesion, but T2-weighted images showed abnormal low signals scattered throughout this organ. In addition, post-contrast, fat-saturated T1-weighted MR images lesions showed multiple, low-signal-intensity lesions.

Splenic marginal zone lymphoma.

Science.gov (United States)

Piris, Miguel A; Onaindía, Arantza; Mollejo, Manuela

Splenic marginal zone lymphoma (SMZL) is an indolent small B-cell lymphoma involving the spleen and bone marrow characterized by a micronodular tumoral infiltration that replaces the preexisting lymphoid follicles and shows marginal zone differentiation as a distinctive finding. SMZL cases are characterized by prominent splenomegaly and bone marrow and peripheral blood infiltration. Cells in peripheral blood show a villous cytology. Bone marrow and peripheral blood characteristic features usually allow a diagnosis of SMZL to be performed. Mutational spectrum of SMZL identifies specific findings, such as 7q loss and NOTCH2 and KLF2 mutations, both genes related with marginal zone differentiation. There is a striking clinical variability in SMZL cases, dependent of the tumoral load and performance status. Specific molecular markers such as 7q loss, p53 loss/mutation, NOTCH2 and KLF2 mutations have been found to be associated with the clinical variability. Distinction from Monoclonal B-cell lymphocytosis with marginal zone phenotype is still an open issue that requires identification of precise and specific thresholds with clinical meaning. Copyright © 2016 Elsevier Ltd. All rights reserved.

The pattern and management outcomes of splenic injuries in the ...

African Journals Online (AJOL)

Background: In the last decade or so, the management of splenic injuries has undergone a lot of debate and changes including refinement of the indications for non-operative management (NOM). The aims of this retrospective study are: to characterize the pattern of splenic injuries in the Abha region of Saudi Arabia; ...

The impact of coagulopathy on traumatic splenic injuries.

Science.gov (United States)

Smalls, Norma; Obirieze, Augustine; Ehanire, Imudia

2015-10-01

Patients with pre-injury coagulopathy have worse outcomes than those without coagulopathy. This article investigated the risk-adjusted effect of pre-injury coagulopathy on outcomes after splenic injuries. Review of the National Trauma Data Bank from 2007 to 2010 comparing mortality and complications between splenic injury patients with and without a pre-injury bleeding disorder. Of 58,896 patients, 2% had a bleeding disorder. Coagulopathic patients had higher odds of mortality (odds ratio, 1.3), sepsis (odds ratio, 2.0), acute respiratory distress syndrome (odds ratio, 2.6), acute renal failure (odds ratio, 1.5), cardiac arrest (odds ratio, 1.5), and overall complications (odds ratio, 2.4). The higher odds of myocardial infarction did not achieve statistical significance (odds ratio, 1.6). Pre-injury coagulopathy in patients with splenic injury has a negative impact on cardiac arrest, sepsis, acute respiratory distress syndrome, acute renal failure, and mortality. The higher likelihood of myocardial infarction did not reach statistical significance. Copyright © 2015 Elsevier Inc. All rights reserved.

Splenic irradiation in myelofibrosis. Clinical findings and ferrokinetics

International Nuclear Information System (INIS)

Parmentier, C.; Charbord, P.; Tibi, M.; Tubiana, M.

1977-01-01

Nine patients were submitted to splenic or, in two cases, hepatosplenic irradiation; these patients presented a primary myelofibrosis or a spent polycythemia vera characterized by splenomegaly, anemia, and occasionally leucocytosis and thrombocytopenia. The hematological condition returned to normal in 2 patients. This improvement lasted 4 years after a first series of irradiation. The recurrence of splenomegaly and anemia indicated a second series of irradiation, the results of which were as good as those of the first series. Ineffective medullary and splenic erythropoiesis without preeminent aplasia appeared to be correlated with a beneficial effect of splenic irradiation. Absence of hepatomegaly and marked leucocytosis were less important prognostic factors. The modee of action of radiotherapy and the way in which it differs from splenectomy are discussed. The irradiation delivered moderate doses (450 rad in 18 sessions of 25 rad). Hepatic irradiation did not appear to be essential even in cases of intense hepatic myeloid metaplasia: in 2 patients liver erythropoiesis regressed when the spleen alone was irradiated

Discordant lymphoma consisting of splenic mantle cell lymphoma and marginal zone lymphoma involving the bone marrow and peripheral blood: a case report

Directory of Open Access Journals (Sweden)

Caracciolo Francesco

2011-09-01

Full Text Available Abstract Introduction Discordant lymphomas are rare entities characterized by the simultaneous presence of two distinct types of lymphomas in different anatomic sites. We describe a very rare case of simultaneous occurrence of splenic mantle cell lymphoma and marginal zone lymphoma involving the bone marrow and peripheral blood. Case presentation We report the case of a 60-year-old asymptomatic Caucasian woman in whom discordant lymphomas were discovered when a slight lymphocytosis and a conspicuous splenomegaly were observed. The different morphological, immunophenotypical and immunohistochemical features found in the different pathologic samples obtained from peripheral blood, bone marrow and spleen sections made it possible to differentiate two types of non-Hodgkin B-cell lymphomas: a mantle cell lymphoma infiltrating the spleen and a marginal zone lymphoma involving both the bone marrow and peripheral blood. Since a similar IgH gene rearrangement was found both in the bone marrow and in the spleen, the hypothesis of a common origin, followed by a different clonal selection of the neoplastic lymphocytes may be taken into consideration. Conclusion Our case emphasizes the usefulness of investigating simultaneous specimens from different anatomic sites from the same patient and the relevant diagnostic role of splenectomy.

Stimulatory effect of low dose radionuclide on DNA synthesis and UDS in splenic lymphocytes

International Nuclear Information System (INIS)

Zhu Shoupeng; Yang Zhanshan

1999-12-01

To study the stimulatory effect on DNA synthesis and unscheduled DNA synthesis (UDS) in splenic lymphocytes induced by low dose enriched uranium 235 U. By using 3 H-TdR incorporation assay technique, the DNA replicative synthesis in PHA and LPS stimulated splenic lymphocytes was observed. By using DNA synthesis inhibitor such as hydroxyurea, the UV-induced unscheduled DNA synthesis in splenic lymphocytes occurred. When the injected low dose of enriched uranium 235 u was 0.1 μg/kg body weight, the transformation capacity was elevated for splenic T lymphocytes, simultaneously the stimulative index increased. The UDS of splenic lymphocytes induced by ultra-violate revealed a statistically significant increase by low dose of enriched uranium 235 U at the range of 0.1-20 μg/kg body weight. A stimulatory action of low dose enriched uranium 235 U on DNA replicative synthesis as well as on UV-induced UDS in splenic lymphocytes was detected

[Routine screening of splenic or portal vein thrombosis after splenectomy].

Science.gov (United States)

Bouvier, A; Gout, M; Audia, S; Chalumeau, C; Rat, P; Deballon, O

2017-01-01

Portal and/or splenic vein thrombosis (PSVT) is common after splenectomy. It can be a life-threatening complication, with a risk of bowel ischemia and portal hypertension. An early diagnosis allows an effective medical treatment and prevents life-threatening complications. There is no consensus regarding the benefit of systematic screening of patients after splenectomy for PSVT. We started in January 2012 a routine screening of PSVT after elective splenectomy. The aim of this study was to assess this policy. Since January 2012, all patients undergoing an elective splenectomy had an abdominal CT-scan on postoperative-day 7. Demographic data, pathology, type of surgery, platelet counts before and after surgery, outcome, results of medical imaging, and management of PSVT and its results were recorded. Over 3 years, 52 patients underwent an elective splenectomy. All of them had a CT-scan at postoperative-day 7. A PSVT was found in 11 patients (21.2 %). They were all asymptomatic. Lymphoma and splenomegaly were the main factors associated with PSVT in the univariate analysis. All patients with PSVT were treated with anticoagulation and no complication of PSVT occurred. The follow-up CT confirmed the efficacy of anticoagulation therapy in all patients. Routine screening of PSVT after elective splenectomy is warranted because it allows to start anticoagulant therapy and avoid further life-threatening complications. The incidence of PSVT is particularly high among patients operated on for lymphoma or with splenomegaly. Copyright © 2016 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Trans-Splenic Portal Vein Embolization: A Technique to Avoid Damage to the Future Liver Remnant

International Nuclear Information System (INIS)

Sarwar, Ammar; Brook, Olga R.; Weinstein, Jeffrey L.; Khwaja, Khalid; Ahmed, Muneeb

2016-01-01

Portal vein embolization (PVE) induces hypertrophy of the future liver remnant (FLR) in patients undergoing extensive hepatic resection. Portal vein access for PVE via the ipsilateral hepatic lobe (designated for resection) places veins targeted for embolization at acute angles to the access site requiring reverse curve catheters for access. This approach also involves access close to tumors in the ipsilateral lobe and requires care to avoid traversing tumor. Alternatively, a contralateral approach (through the FLR) risks damage to the FLR due to iatrogenic trauma or non-target embolization. Two patients successfully underwent PVE via trans-splenic portal vein access, allowing easy access to the ipsilateral portal veins and eliminating risk of damage to FLR. Technique and advantages of trans-splenic portal vein access to perform PVE are described.

Trans-Splenic Portal Vein Embolization: A Technique to Avoid Damage to the Future Liver Remnant

Energy Technology Data Exchange (ETDEWEB)

Sarwar, Ammar, E-mail: asarwar@bidmc.harvard.edu; Brook, Olga R.; Weinstein, Jeffrey L. [Beth Israel Deaconess Medical Center/Harvard Medical School, Division of Interventional Radiology, Department of Radiology (United States); Khwaja, Khalid [Beth Israel Deaconess Medical Center/Harvard Medical School, Division of Transplant Surgery, Department of Surgery (United States); Ahmed, Muneeb [Beth Israel Deaconess Medical Center/Harvard Medical School, Division of Interventional Radiology, Department of Radiology (United States)

2016-10-15

Portal vein embolization (PVE) induces hypertrophy of the future liver remnant (FLR) in patients undergoing extensive hepatic resection. Portal vein access for PVE via the ipsilateral hepatic lobe (designated for resection) places veins targeted for embolization at acute angles to the access site requiring reverse curve catheters for access. This approach also involves access close to tumors in the ipsilateral lobe and requires care to avoid traversing tumor. Alternatively, a contralateral approach (through the FLR) risks damage to the FLR due to iatrogenic trauma or non-target embolization. Two patients successfully underwent PVE via trans-splenic portal vein access, allowing easy access to the ipsilateral portal veins and eliminating risk of damage to FLR. Technique and advantages of trans-splenic portal vein access to perform PVE are described.

Splenic avulsion and bleeding shown on radiocolloid images

International Nuclear Information System (INIS)

Levy, H.A.; Sziklas, J.J.; Spencer, R.P.; Rosenberg, R.J.

1983-01-01

A case is discussed of a man who presented with trauma to the chest and abdomen. A radiocolloid image showed uptake by the liver. However, the spleen was not identified. Areas of activity outside of the spleen were noted. The patient had splenic avulsion; extra sites of activity likely represented bleeding sites in the abdomen. Failure to identify the spleen on a radiocolloid image, after trauma, should be an alerting sign to possible splenic avulsion (especially when there are also ectopic sites of accumulation of the radiocolloid)

Splenic avulsion and bleeding shown on radiocolloid images

Energy Technology Data Exchange (ETDEWEB)

Levy, H.A.; Sziklas, J.J.; Spencer, R.P.; Rosenberg, R.J.

1983-06-01

A case is discussed of a man who presented with trauma to the chest and abdomen. A radiocolloid image showed uptake by the liver. However, the spleen was not identified. Areas of activity outside of the spleen were noted. The patient had splenic avulsion; extra sites of activity likely represented bleeding sites in the abdomen. Failure to identify the spleen on a radiocolloid image, after trauma, should be an alerting sign to possible splenic avulsion (especially when there are also ectopic sites of accumulation of the radiocolloid).

Extrahepatic portal venous obstruction: The effects of early ligation of splenic artery during splenectomy

Directory of Open Access Journals (Sweden)

Gazula Suhasini

2009-01-01

Full Text Available Aim: To objectively demonstrate the gain in blood volume and blood components following early ligation of splenic artery during splenectomy and splenorenal shunts in children with extra hepatic portal venous obstruction (EHPVO. Methods: Twenty-eight children (20 males and 8 females, mean age: 9.9 (±3.2 years with EHPVO and hypersplenism were recruited. We followed a protocol of systematically locating and ligating the splenic artery first, followed by a 30-minute waiting period to allow the massive spleen to decongest via the splenic vein and venous collaterals and then completing the splenectomy by standard procedure. No intravenous fluid was administered during this 30-minute period. Blood samples were drawn just prior to splenic artery ligation and soon after splenectomy for the estimation of hematological and biochemical parameters. Results: We noticed a highly significant increase in the hemoglobin, hematocrit, leukocyte, platelet, and RBC counts by early ligation of the splenic artery (p < 0.0004. The gain in hemoglobin and hematocrit was equivalent to a transfusion of atleast 100-150 ml of packed RBC. The increase in platelet count was equivalent to a platelet transfusion of atleast 4 units of platelet concentrates in an adult. There is a positive correlation between the splenic weight and the platelet gain (p= 0.0568 and the splenic volume on preoperative imaging and the platelet gain (p= 0.0251. Conclusion: Early ligation of the splenic artery during splenectomy results in passive splenic decongestion and thereby a significant gain in blood components. This protocol appears to be a feasible blood conservation method to avoid blood transfusions in this group of hypersplenic EHPVO patients.

Blunt splenic injuries in the adolescent trauma population: the role of angiography and embolization.

Science.gov (United States)

Mayglothling, Julie A; Haan, James M; Scalea, Thomas M

2011-07-01

Splenic artery embolization (SAE) improves non-operative splenic salvage rates in adults, but its utility and safety in the pediatric population is less well defined. Because adolescent trauma patients are often triaged to adult trauma centers, we were interested in evaluating SAE in this particular population. We hypothesize that angiography and embolization is a safe and effective adjunct to non-operative management in the adolescent population. A retrospective review of all patients aged 13-17 years admitted to our Level I Trauma Center with blunt splenic injury from 1997-2005 was performed. We reviewed patient demographics, operative reports, admission, and follow-up abdominal computed tomography (ACT) results, angiographic reports, and patient outcomes. A total of 97 patients were reviewed. Eighteen patients underwent immediate surgery, and 79 of the remaining patients had planned non-operative management. Of those participating in non-operative management, 35/79 (44%) were initially observed and 44/79 (56%) underwent initial angiography, 23/44 having embolization. Patients in the embolization group had an overall high grade of injury (American Association for the Surgery of Trauma mean grade 3.3, SD 0.6). The overall splenic salvage rate was 96% (76/79) in the non-operative management group; 100% splenic salvage was seen in the observational group; 100% salvage was also seen in patients with negative angiography, and 87% salvage (20/23) in the splenic artery embolization group. Splenic artery embolization may be a valuable adjunct in adolescent blunt splenic injury, especially in higher grade injuries or with evidence of splenic vascular injury on ACT. Copyright © 2011 Elsevier Inc. All rights reserved.

Intra-abdominal desmoplastic small round cell tumors: CT findings and clinicopathological correlations in 13 cases

Energy Technology Data Exchange (ETDEWEB)

Chouli, Malik [Department of Radiology, Institute Gustave Roussy, 39 Rue Camille Desmoulines, 94805 Villejuif Cedex (France); Viala, Juliette [Department of Radiology, Institute Gustave Roussy, 39 Rue Camille Desmoulines, 94805 Villejuif Cedex (France); Dromain, Clarisse [Department of Radiology, Institute Gustave Roussy, 39 Rue Camille Desmoulines, 94805 Villejuif Cedex (France); Fizazi, Karim [Department of Medicine, Institute Gustave Roussy, 39 Rue Camille Desmoulines, 94805 Villejuif Cedex (France); Duvillard, Pierre [Department of Histopathology, Institute Gustave Roussy, 39 Rue Camille Desmoulines, 94805 Villejuif Cedex (France); Vanel, Daniel [Department of Radiology, Institute Gustave Roussy, 39 Rue Camille Desmoulines, 94805 Villejuif Cedex (France)]. E-mail: vanel@igr.fr

2005-06-01

Purpose: We report computed tomography (CT) findings in 13 patients with a primary abdominal desmoplastic small round cell tumor. Materials and methods: 13 cases (12 men, 1 woman, mean age = 24.8 years) were found in our hospital database between 1991 and 2003. Clinical, CT and histopathological features were studied retrospectively. Results: Peritoneal involvement was the most common feature. In 10 cases, several lobulated peritoneal soft tissue masses (with a mean of four masses per patient) were seen. Two patients had diffused irregular peritoneal carcinomatosis without any distinct peritoneal masses. One patient had a solitary mass in the pelvic space. The main sites of peritoneal involvement were the pelvic space (n 7), omentum (n = 5), retroperitoneal space (n = 4), small bowel mesentery (n = 3), paracolic gutter (n = 2 on the right and n = 1 on the left), transverse colon mesentery (n = 1), peri-splenic space (n = 1), peri-hepatic space (n 1). The soft tissue masses were often bulky (mean 6 cm, range 1-28 cm), lobulated and heterogeneous with hypodense areas (in 73% of cases). In six cases, moderate ascites was seen. In one case of pelvic involvement, unilateral hydronephrosis was seen. Adenopathies were present in seven cases at the time of the diagnosis (at intraperitoneal, retroperitoneal and pelvic sites in six patients and in the groin in one patient). Five patients had liver metastases (four lesions per case excepted one patient with 30 metastases). Associated thoracic metastases were seen in three patients. The diagnosis was confirmed with four CT-guided percutaneous biopsies. Conclusion: Although CT features are nonspecific, the diagnosis of desmoplastic small round cell tumor may be suspected in young men with multiple bulky heterogeneous peritoneal soft tissue masses. Imaging is useful for staging and also to guide biopsies.

Clinical indications and biological mechanisms of splenic irradiation in autoimmune diseases

Energy Technology Data Exchange (ETDEWEB)

Weinmann, M.; Becker, G. [Tuebingen Univ. (Germany). Abt. fuer Strahlenonkologie; Einsele, H.; Bamberg, M. [Tuebingen Univ. (Germany). Abt. fuer Innere Medizin 2

2001-02-01

Background: Splenic irradiation (SI) is a fairly unknown treatment modality in autoimmune disorders like autoimmune thrombocytopenia (AIT) or autoimmune hemolytic anemia (AIHA), which may provide an effective, low toxic and cost-effective treatment for selected patients. Patients, Materials and Methods: This article reviews the limited experiences on splenic irradiation in autoimmune thrombocytopenia by analyzing the current studies including 71 patients and some preliminary reports on splenic irradiation in autoimmune hemolytic anemia. Results: In autoimmune thrombocytopenia between 40 and 90% of all patients responded, but most of them relapsed within 4 to 6 months after splenic irradiation. Between 10 and 20% of all patients had a sustained response. The efficacy of splenic irradiation in HIV-associated cases of thrombocytopenia is probably lower than in other forms of autoimmune thrombocytopenia, but especially in this group immunosuppressive drug treatment of autoimmune thrombocytopenia exposes some problems. In autoimmune hemolytic anemia there are some case reports about efficacy of splenic irradiation. Toxicity of splenic irradiation in both diseases was very moderate. Conclusions: For HIV patients, for elderly patients or patients at high risk for complications following splenectomy splenic irradiation might be a treatment option. Splenic irradiation as preoperative treatment in patients not responding to or not suitable for immunosuppressive drugs prior to splenectomy may be a promising new application of splenic irradiation to reduce adverse effects of splenectomy in thrombocytopenic patients. A further analysis of the biological mechanisms underlying splenic irradiation may help to improve patient selection, to optimize dose concepts and treatment schedules and will improve understanding of radiotherapy as an immunomodulatory treatment modality. (orig.) [German] Hintergrund: Die Bestrahlung der Milz zur Behandlung von haematologischen

Isolated splenic metastasis of endometrial adenocarcinoma--a case report.

Science.gov (United States)

Andrei, S; Preda, C; Andrei, A; Becheanu, G; Herlea, V; Lupescu, I; Popescu, I

2011-01-01

The spleen in rarely the place for solid, non-haematological tumors, isolated splenic metastases from adenocarcinomas being extremely rare findings, regardless of the origin and the histological type of the primary tumor. We present the case of a female patient with isolated splenic metastasis diagnosed by abdominal computer tomography at only 20 months after curative surgery for endometrial adenocarcinoma, in which the final diagnosis has been established by histological and immunohistochemical examination of the splenectomy piece. The haematogenous dissemination of the endometrial cancer occurs most commonly in the lungs, liver or bones, the spleen being rarely affected. In the medical literature there are cited up to date only 12 cases of solitary splenic metastasis from endometrial adenocarcinoma. The particularity of the case presented by us is the early appearance of an isolated splenic metastasis, at less than two years after curative surgery (compared to an average of 4-5 years cited in the literature), from an endometrial cancer which was classified histologicaly in the group with low-risk for relapse (well differentiated endometrioid adenocarcinoma). In conclusion, although solitary splenic secondary determinations are very rare, the incidence of the reported cases in the medical literature is increasing, their late appearance (a few years after the primary tumor's resection) and the lack of symptoms until the tumor reaches appreciable size or it complicates with necrosis, justifies the periodic abdominal imaging examination, on long-term, for postoperative monitorisation after the initial curative surgery. Their treatment of choice is open, classical splenectomy that must be followed by chemotherapy in order to prevent the development of other possible micrometastases.

Surgical repair of an aberrant splenic artery aneurysm: report of a case.

Science.gov (United States)

Illuminati, Giulio; LaMuraglia, Glenn; Nigri, Giuseppe; Vietri, Francesco

2007-03-01

Aneurysms of the splenic artery are the most common splanchnic aneurysms. Aneurysms of a splenic artery with an anomalous origin from the superior mesenteric artery are however rare, with eight previously reported cases. Their indications for treatment are superposable to those of aneurysms affecting an orthotopic artery. Methods of treatment of this condition include endovascular, minimally invasive techniques and surgical resection. We report one more case of aneurysm of an aberrant splenic artery, treated with surgical resection, and preservation of the spleen.

Central nervous system involvement of leukemia and systemic lymphoma in children. CT and MR findings

International Nuclear Information System (INIS)

Tomura, Noriaki; Hirano, Hiroko; Kato, Kohki; Sashi, Ryuji; Hashimoto, Manabu; Watarai, Jiro; Watanabe, Arata

1997-01-01

The purpose of this paper is to retrospectively evaluate CT and MR findings of central nervous system (CNS) involvement of leukemia and systemic lymphoma in children. Over a 12-year period, sixty-five patients with leukemia and fifteen patients with systemic lymphoma underwent cerebral CT and/or MR imaging. Nine patients were diagnosed as CNS involvement of leukemia and lymphoma. The CT and MR abnormalities in these patients were correlated with the findings of histology, cerebrospinal fluid cytology, and/or treatment. The age of the patients ranged from 0 to 15 years old. They consisted of 6 boys and 3 girls. The CT examinations were performed before and after contrast administration. MR examinations were performed on a 1.5-T unit, and T1-weighted, T2-weighted, and proton density-weighted images were obtained using spin-echo or fast spin-echo sequences. Tumor masses were present in seven with leukemia, and in two with malignant lymphoma. On the CT scan, tumor masses were hyperdense with contrast enhancement. On the MR images, their signals were variable. In all of nine patients, tumor masses were contiguous with a meningeal surface. Postcontrast T1-weighted images were valuable in demonstrating meningeal infiltration. Tumoral hemorrhage was found in two patients. In a patient with tumor at the superior sagittal sinus, venous infarct was observed. CNS leukemic and lymphomatous masses are almost hyperdense on the CT and they are characteristically contiguous with a meningeal surface. MR imaging was valuable in demonstrating meningeal infiltration. (K.H.)

Percutaneous Treatment of Splenic Cystic Echinococcosis: Results of 12 Cases

Energy Technology Data Exchange (ETDEWEB)

Akhan, Okan, E-mail: akhano@tr.net; Akkaya, Selçuk, E-mail: selcuk.akkaya85@gmail.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey); Dağoğlu, Merve Gülbiz, E-mail: drmgkartal@gmail.com [Istanbul University, Department of Radiology, Istanbul School of Medicine (Turkey); Akpınar, Burcu, E-mail: burcu-akpinar@yahoo.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey); Erbahçeci, Aysun, E-mail: aysunerbahceci@yahoo.com [Istanbul Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Department of Radiology (Turkey); Çiftçi, Türkmen, E-mail: turkmenciftci@yahoo.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey); Köroğlu, Mert, E-mail: mertkoroglu@hotmail.com [Antalya Education and Research Hospital, Department of Radiology (Turkey); Akıncı, Devrim, E-mail: akincid@hotmail.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey)

2016-03-15

PurposeCystic echinococcosis (CE) in the spleen is a rare disease even in endemic regions. The aim of this study was to examine the efficacy of percutaneous treatment for splenic CE.Materials and MethodsTwelve patients (four men, eight women) with splenic CE were included in this study. For percutaneous treatment, CE1 and CE3A splenic hydatid cysts were treated with either the PAIR (puncture, aspiration, injection, respiration) technique or the catheterization technique.ResultsEight of the hydatid cysts were treated with the PAIR technique and four were treated with catheterization. The volume of all cysts decreased significantly during the follow-up period. No complication occurred in seven of 12 patients. Abscess developed in four patients. Two patients underwent splenectomy due to cavity infection developed after percutaneous treatment, while the spleen was preserved in 10 of 12 patients. Total hospital stay was between 1 and 18 days. Hospital stay was longer and the rate of infection was higher in the catheterization group. Follow-up period was 5–117 months (mean, 44.8 months), with no recurrence observed.ConclusionThe advantages of the percutaneous treatment are its minimal invasive nature, short hospitalization duration, and its ability to preserve splenic tissue and function. As the catheterization technique is associated with higher abscess risk, we suggest that the PAIR procedure should be the first percutaneous treatment option for splenic CE.

Splenic marginal zone lymphoma: comprehensive analysis of gene expression and miRNA profiling.

Science.gov (United States)

Arribas, Alberto J; Gómez-Abad, Cristina; Sánchez-Beato, Margarita; Martinez, Nerea; Dilisio, Lorena; Casado, Felipe; Cruz, Miguel A; Algara, Patrocinio; Piris, Miguel A; Mollejo, Manuela

2013-07-01

Splenic marginal zone lymphoma is a small B-cell neoplasm whose molecular pathogenesis is still essentially unknown and whose differentiation from other small B-cell lymphomas is hampered by the lack of specific markers. We have analyzed the gene expression and miRNA profiles of 31 splenic marginal zone lymphoma cases. For comparison, 7 spleens with reactive lymphoid hyperplasia, 10 spleens infiltrated by chronic lymphocytic leukemia, 12 spleens with follicular lymphoma, 6 spleens infiltrated by mantle cell lymphoma and 15 lymph nodes infiltrated by nodal marginal zone lymphoma were included. The results were validated by qRT-PCR in an independent series including 77 paraffin-embedded splenic marginal zone lymphomas. The splenic marginal zone lymphoma miRNA signature had deregulated expression of 51 miRNAs. The most highly overexpressed miRNAs were miR-155, miR-21, miR-34a, miR-193b and miR-100, while the most repressed miRNAs were miR-377, miR-27b, miR-145, miR-376a and miR-424. MiRNAs located in 14q32-31 were underexpressed in splenic marginal zone lymphoma compared with reactive lymphoid tissues and other B-cell lymphomas. Finally, the gene expression data were integrated with the miRNA profile to identify functional relationships between genes and deregulated miRNAs. Our study reveals miRNAs that are deregulated in splenic marginal zone lymphoma and identifies new candidate diagnostic molecules for splenic marginal zone lymphoma.

Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma : A Propensity Score Analysis

NARCIS (Netherlands)

Olthof, Dominique C.; Joosse, Pieter; Bossuyt, Patrick M. M.; de Rooij, Philippe P.; Leenen, Loek P. H.; Wendt, Klaus W.; Bloemers, Frank W.; Goslings, J. Carel

Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE primarily compared SAE

Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma: A Propensity Score Analysis

NARCIS (Netherlands)

Olthof, Dominique C.; Joosse, Pieter; Bossuyt, Patrick M. M.; de Rooij, Philippe P.; Leenen, Loek P. H.; Wendt, Klaus W.; Bloemers, Frank W.; Goslings, J. Carel

2016-01-01

Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE primarily compared SAE

Observation Versus Embolization in Patients with Blunt Splenic Injury after Trauma: A Propensity Score Analysis

NARCIS (Netherlands)

D.C. Olthof; P. Joosse (Pieter); P.M.M. Bossuyt (Patrick); P.P. de Rooij (Philippe); L.P.H. Leenen (Luke); K.W. Wendt (Klaus); F.W. Bloemers (Frank); J.C. Goslings (Carel)

2016-01-01

textabstractBackground: Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE

A correlative study of CT findings and pulmonary function in patients with pulmonary involvement during the active phase of rheumatoid arthritis

International Nuclear Information System (INIS)

Zhu Xiaolei; Xu Defu

2006-01-01

Objective: It is a correlative study of CT findings and pulmonary function in patients with pulmonary involvement during the active phase of rheumatoid arthritis. Methods: The CT images of 28 cases of pulmonary involvement during the active phase of rheumatoid arthritis were retrospectively analyzed. The pulmonary abnormalities revealed on CT images including distribution and extend of the lesions were quantitatively analyzed and scored. The correlation of CT scores with the results of pulmonary function tests was compared statistically. Results: Interlobular septa thickening was shown in 16 cases; ground-glass opacification was revealed in 14 cases; irregular lines were found in 11 cases; bronchiolectasis was noted in 7 cases; micro nodules were demonstrated in 4 cases; and honey combing alteration was visualized in 3 cases. The abnormality most frequent seen on CT images was reticular shadow and ground-glass opacification. CT visual score had a negative correlation with pulmonary function. Conclusion: CT visual score provides quantitative evaluation of the pulmonary involvement during the active phase of rheumatoid arthritis, and also indicates the pulmonary function and prognosis as well. (authors)

Splenic Pregnancy: A New Minimally Invasive Approach to Treatment

Energy Technology Data Exchange (ETDEWEB)

Klang, Eyal, E-mail: eyalkla@hotmail.com; Keddel, Nicholas; Inbar, Yael; Rimon, Uri; Amitai, Michal [Tel Hashomer Hospital, The Chaim Sheba Medical Center, Department of Radiology (Israel)

2016-09-15

The spleen is a rare site of abdominal ectopic pregnancy. In a review of the literature, we found 16 published cases of primary splenic pregnancies. Of the cases identified, all received surgical intervention, with one case successfully treated with laparoscopic methotrexate injection, and the rest underwent splenectomy. We would like to present a case of primary splenic pregnancy in a 35-year-old woman successfully treated with percutaneous image-guided injection of methotrexate and KCl.

Splenic Pregnancy: A New Minimally Invasive Approach to Treatment

International Nuclear Information System (INIS)

Klang, Eyal; Keddel, Nicholas; Inbar, Yael; Rimon, Uri; Amitai, Michal

2016-01-01

The spleen is a rare site of abdominal ectopic pregnancy. In a review of the literature, we found 16 published cases of primary splenic pregnancies. Of the cases identified, all received surgical intervention, with one case successfully treated with laparoscopic methotrexate injection, and the rest underwent splenectomy. We would like to present a case of primary splenic pregnancy in a 35-year-old woman successfully treated with percutaneous image-guided injection of methotrexate and KCl.

Fcγ receptor expression on splenic macrophages in adult immune thrombocytopenia

NARCIS (Netherlands)

Audia, S; Santegoets, K; Laarhoven, A G; Vidarsson, G; Facy, O; Ortega-Deballon, P; Samson, M; Janikashvili, N; Saas, P; Bonnotte, B; Radstake, T R

2017-01-01

Splenic macrophages play a key role in immune thrombocytopenia (ITP) pathogenesis by clearing opsonized platelets. Fcγ receptors (FcγR) participate in this phenomenon, but their expression on splenic macrophages and their modulation by treatment have scarcely been studied in human ITP. We aimed to

Asymptomatic Partial Splenic Infarction In Laparoscopic Floppy Nissen Fundoplication And Brief Literature Review

Science.gov (United States)

Odabasi, Mehmet; Abuoglu, Haci Hasan; Arslan, Cem; Gunay, Emre; Yildiz, Mehmet Kamil; Eris, Cengiz; Ozkan, Erkan; Aktekin, Ali; Muftuoglu, Tolga

2014-01-01

Short gastric vessels are divided during the laparoscopic Nissen fundoplication resulting in splenic infarct in some cases. We report a case of laparoscopic floppy Nissen fundoplication with splenic infarct that was recognized during the procedure and provide a brief literature review. The patient underwent a laparoscopic floppy Nissen fundoplication. We observed a partial infarction of the spleen. She reported no pain. A follow-up computed tomography scan showed an infarct, and a 3-month abdominal ultrasound showed complete resolution. Peripheral splenic arterial branches have very little collateral circulation. When these vessels are occluded or injured, an area of infarction will occur immediately. Management strategies included a trial of conservative management and splenectomy for persistent symptoms or complications resulting from splenic infarct. In conclusion, we believe that the real incidence is probably much higher because many cases of SI may have gone undiagnosed during or following an operation, because some patients are asymptomatic. We propose to check spleen carefully for the possibility of splenic infarct. PMID:24833155

Results of non-operative management of splenic trauma and its complications in children

Directory of Open Access Journals (Sweden)

Ndour Oumar

2014-01-01

Full Text Available Introduction: Non-operative management (NOM of splenic trauma in children is currently the treatment of choice. Purpose: We report a series of 83 cases in order to compare our results with literature data. Patients and Methods: For this, we conducted a retrospective study of 13 years and collected 83 cases of children with splenic trauma contusion, managed at Lapeyronie Montpellier Hospital in Visceral Pediatric Surgery Department. The studied parameters were age, sex, circumstances, the blood pressure (BP, hematology, imaging, associated injuries, transfusion requirements, treatment, duration of hospital stay, physical activity restriction and evolution. Results: NOM was successful in 98.7% of cases. We noted 4 complications including 3 pseudo aneurysms (PSA of splenic artery and 1 pseudocyst spleen with a good prognosis. There was no mortality in our series. Conclusion: NOM is the treatment of choice for splenic trauma in children with a success rate of over 90%. Complications are rare and are dominated by the PSA of splenic artery.

Partial splenectomy and autotransplantation of splenic fragments in pigs: a model for prevention of septicemia

International Nuclear Information System (INIS)

Pabst, R.; Binns, R.M.

1986-01-01

Normal young piglets and miniature piglets of the Gottingen breed were used as animal models for autotransplantation of splenic fragments. In pigs, regeneration kinetics seem to be comparable to man. Even after six mo, only small splenic nodules with a reduced blood flow were found. No effective stimulator of splenic regeneration has been found for pigs. Pig spleen size and blood supply enable partial splenectomies and ligation of the splenic artery which are models for spleen surgery in man

Subtotal resection and omentoplasty of the epidermoid splenic cyst: a case report

Science.gov (United States)

Spahija, Gazmend S; Hashani, Shemsedin I; Osmani, Eshref A; Hoxha, Sejdullah A; Hamza, Astrit H; Gashi-Luci, Lumturije H

2009-01-01

Introduction Nonparasitic splenic cysts are uncommon clinical entity and because of it, there is no information regarding their optimal surgical treatment. Case presentation A 41-years-old female with incidentally diagnosed nonparasitic splenic cyst which initially was asymptomatic. After two years of follow up, the patient underwent surgery; subtotal cystectomy and omentoplasty as an additional procedure. Postoperative course was uneventful. Conclusion Short and mid term results showed that near total cystectomy with omentoplasty was a safe successful procedure for treatment of epidermoid splenic cyst. PMID:19829799

[Primary infection with cytomegalovirus: An infectious cause of splenic infarction].

Science.gov (United States)

Kassem, H; Khamadi, K; Farrugia, C; Ho Hio Hen, N; El Gharbi, T; Turner, L

2017-08-01

Cytomegalovirus-associated thrombosis has been extensively reported in the medical literature, mainly in immune-compromised patients. However, the association with splenic infarcts has rarely been reported. We report a 32-year-old Caucasian and immunocompetent woman who presented with a splenic infarction during a primary infection with CMV. The differential diagnostic ruled out embolic, hematologic, gastrointestinal and coagulation disorders. The outcome was favorable with symptomatic treatment. A primary infection with CMV must be added to the diagnostic work-up in the presence of a febrile splenic infarction, especially when it is associated with a biological mononucleosis reaction. Copyright © 2016 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Epidermotropic presentation by splenic B-cell lymphoma: The importance of clinical-pathologic correlation.

Science.gov (United States)

Hedayat, Amin A; Carter, Joi B; Lansigan, Frederick; LeBlanc, Robert E

2018-04-01

There are exceedingly rare reports of patients with epidermotropic B-cell lymphomas. A subset presented with intermittent, variably pruritic papular eruptions and involvement of their spleens, peripheral blood and bone marrow at the time of diagnosis. Furthermore, some experienced an indolent course despite dissemination of their lymphomas. We report a 66-year-old woman with a 12-year history of intermittent eruptions of non-pruritic, salmon-colored papules on her torso and proximal extremities that occurred in winter and resolved with outdoor activity in spring. Skin biopsy revealed an epidermotropic B-cell lymphoma with a non-specific B-cell phenotype and heavy chain class switching with IgG expression. On workup, our patient exhibited mild splenomegaly and low-level involvement of her peripheral blood and bone marrow by a kappa-restricted B-cell population. A splenic B-cell lymphoma was diagnosed. Considering her longstanding history and absences of cytopenias, our patient has been followed without splenectomy or systemic therapy. Furthermore, the papules have responded dramatically to narrowband UVB. Our case and a review of similar rare reports aim to raise awareness among dermatopathologists and dermatologists of a clinically distinct and indolent subset of epidermotropic splenic lymphomas with characteristic clinical and histologic findings. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Splenic rupture in a neonate – a rare complication | Lloyd | South ...

African Journals Online (AJOL)

Birth trauma is well described in the neonatal literature, but intra-abdominal injuries occur infrequently and are often forgotten in the differential diagnosis of a hypovolaemic shocked infant with an abdominal mass. The symptoms of splenic rupture are nonspecific, creating a diagnostic dilemma for the clinician. As splenic ...

Tc-99m sulfur colloid spleen imaging following splenic artery and vein resection for pancreas organ donation

International Nuclear Information System (INIS)

Kuni, C.C.; Crass, J.R.; Du Cret, R.P.; Boudreau, R.J.; Loken, M.K.

1987-01-01

The authors retrospectively studied the records and Tc-99m sulfur colloid (TSC) splenic artery and vein resection for donation to HLA-compatible relatives. Of 37 patients with postoperative TSC studies, four had no postoperative splenic abnormalities. Nineteen of the abnormal TSC studies were followed with TSC studies 2 weeks to 14 months later; three showed no change, seven showed improvements,and ten became normal. One patient required splenectomy 2 days after pancreatectomy for splenic infarction; her TSC study showed no uptake. These data suggest that the spleen usually survives splenic artery and vein resection. Absent splenic TSC uptake raises the possibility of splenic infarction but usually improves

Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

International Nuclear Information System (INIS)

Luo, Xuefeng; Nie, Ling; Wang, Zhu; Tsauo, Jiaywei; Tang, Chengwei; Li, Xiao

2014-01-01

PurposeRegional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.MethodsFrom December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).ResultsTechnical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3–34) months, no recurrence of GI bleeding was observed.ConclusionsTransjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications

Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

Energy Technology Data Exchange (ETDEWEB)

Luo, Xuefeng; Nie, Ling; Wang, Zhu; Tsauo, Jiaywei; Tang, Chengwei; Li, Xiao, E-mail: simonlixiao@126.com [West China Hospital, Sichuan University, Department of Gastroenterology (China)

2013-05-02

PurposeRegional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.MethodsFrom December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).ResultsTechnical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3–34) months, no recurrence of GI bleeding was observed.ConclusionsTransjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications.

Splenic injuries at Bugando Medical Centre in northwestern Tanzania: a tertiary hospital experience

Science.gov (United States)

2012-01-01

Background Splenic injuries constitute a continuing diagnostic and therapeutic challenge to the trauma or general surgeons practicing in developing countries where sophisticated imaging facilities are either not available or exorbitantly expensive. The purpose of this review was to describe our own experience in the management of the splenic injuries outlining the aetiological spectrum, injury characteristics and treatment outcome of splenic injuries in our local environment and to identify predictors of outcome among these patients. Methods A prospective descriptive study of splenic injury patients was carried out at Bugando Medical Centre in Northwestern Tanzania between March 2009 and February 2011. Statistical data analysis was done using SPSS software version 17.0. Results A total of 118 patients were studied. The male to female ratio was 6.4:1. Their ages ranged from 8 to 74 years with a median age of 22 years. The modal age group was 21-30 years. The majority of patients (89.8%) had blunt trauma and road traffic accidents (63.6%) were the most frequent cause of injuries. Most patients sustained grade III (39.0%) and IV (38.1%) splenic injuries. Majority of patients (86.4%) were treated operatively with splenectomy (97.1%) being the most frequently performed procedure. Postoperative complications were recorded in 30.5% of cases. The overall length of hospital stay (LOS) ranged from 1 day to 120 days with a median of 18 days. Mortality rate was 19.5%. Patients who had severe trauma (Kampala Trauma Score II ≤ 6) and those with associated injuries stayed longer in the hospital (P trauma scores (KTS II), grade of splenic injuries, admission systolic blood pressure ≤ 90 mmHg, estimated blood loss > 2000 mls, HIV infection with CD4 ≤ 200 cells/μl and presence of postoperative complications were significantly associated with mortality (P Trauma resulting from road traffic accidents (RTAs) remains the most common cause of splenic injuries in our setting. Most

Splenic congestion associated with acepromazine administration in dogs

Directory of Open Access Journals (Sweden)

Denise Cláudia Tavares

2015-02-01

Full Text Available The aim of this study was evaluate splenic dilatation induced by acepromazine in a prospective, randomized study. Thirty-three adult mongrel dog were divided into two groups designated as AG (acepromazine 0.05 mg/kg, i.v., n = 23 and CG (0.9% sodium chloride administered at a similar volume, n = 10. In both groups underwent sonographic examinations before (T0 and fifteen minutes (T15 after drug injection. The thickness spleen and splenic vein width were measured. Higher thickness was found in the AG group at T15 (2.47 cm when compared to that at T0 (2.06 cm, p = 0.016, while the T0 (2.33 cm and T15 (2.39 cm measures did not differ within the CG group. Moreover, the splenic vein width was higher (p = 0.013 at T15 than at T0 in the AG group. Based on results of this study, we concluded that acepromazine, in doses of 0.05 mg/kg, promotes splenomegaly in dogs after fifteen minutes of the injection.

Predictors of splenic function preservation in children with sickle cell anemia treated with hydroxyurea.

Science.gov (United States)

Nottage, Kerri A; Ware, Russell E; Winter, Bryan; Smeltzer, Matthew; Wang, Winfred C; Hankins, Jane S; Dertinger, Stephen D; Shulkin, Barry; Aygun, Banu

2014-11-01

More than 90% of children with sickle cell anemia (SCA) lose splenic function by the age of 2 yrs. Splenic function may improve with hydroxyurea, but previous studies are conflicting. We prospectively evaluated the effect of hydroxyurea on splenic filtrative function. Children with SCA enrolled in the Hydroxyurea Study of Long-Term Effects (HUSTLE-NCT00305175) underwent clinical evaluations including Tc(99) m liver-spleen (LS) scans before hydroxyurea initiation and after 3 yrs of treatment to maximum tolerated dose (MTD). LS scans were classified as follows: no uptake, Hydroxyurea at MTD is associated with preserved or improved splenic filtrative function, with 33% demonstrating LS scan uptake after 3 yrs. Younger age, higher %HbF, and baseline splenic function are associated with a favorable outcome. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Comparative study of radiography, CT and MRI in the identification of hip involvement in patients with ankylosing spondylitis

International Nuclear Information System (INIS)

Huang Zhenguo; Zhang Xuezhe; Hu Libin; Wang Guochun; Zhou Huiqiong; Lu Xin; Wang Wu

2012-01-01

Objective: To study the imaging findings of hip involvement and to compare the sensitivity of radiography, CT, and MRI in the identification of hip involvement in patients with ankylosing spondylitis (AS). Methods: Anteroposterior radiography of the pelvis and MRI of hip were performed in 55 patients with AS. CT scan of hip was performed in 29 of 55 patients. T 1 -weighted, T 2 -weighted, short tau inversion recovery (STIR) and three dimensional balanced turbo field echo with water selective excitation (3D-BTFE-WATS) coronal sequences of hips were obtained in all patients, of which fat-saturated contrast-enhanced T 1 -weighted sequence was performed in 24 patients. The imaging data of 55 patients were analyzed. The chi-square test was used to analyze the sensitivity in the identification of hip involvement among radiography, CT, and MRI. Results: Among 110 hips in all 55 patients, abnormal changes were detected in 13 hips by radiography, 85 hips by MRI. The findings of radiography included bone erosions in 13 hips, joint space narrowing in 4 hips,syndesmophytes in 5 hips. MRI revealed bone erosive destruction in 31 hips, joint space narrowing in 4 hips, joint effusion in 80 hips, subchondral bone marrow edema in 32 hips, fat accumulation of bone marrow in 28 hips, enthesitis in 21 hips. Bilateral synovial enhancement was showed in 19 of 24 patients who underwent fat-saturated contrast-enhanced T 1 -weighted sequence. Of the 58 hip joints in 29 patients who underwent CT examination, not only did CT show all bone erosions detected by radiography and MRI, but CT revealed bone erosive destruction that were not identified by radiography in 10 hips and by MRI in 1 hip as well. Abnormal changes were detected in 10.3% (6/58)by radiography, 27.6% (16/58) by CT, and 77.6% (45/58) by MRI. The sensitivity of MRI in the identification of hip involvement is higher than that of radiography and CT (χ 2 =53.22 and 29.08, P<0.05). In addition to chronic bone structural changes, MRI