Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease. In patients with SLE, the prevalence of antiphospholipid antibodies is considerably higher, and is largely responsible for thrombosis. Splenic infarction is a rare complication of arterial thrombosis in patients with SLE. It is important to consider splenic infarction in a patient with SLE complaining of left upper quadrant (LUQ) pain because of the possibility of severe infarction-related complications, such as subcapsular hemorrhage and splenic rupture. We report a case of solitary splenic infarction in a patient with SLE. The only symptom was LUQ pain of 3-day duration. Lupus anticoagulant activity was positive and abdominal-pelvic computed tomography (CT) was consistent with splenic infarction. She did not show any other evidence of thrombotic events. The patient was diagnosed with antiphospholipid syndrome that presented as a splenic infarction in a SLE patient.
Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Autoimmune Diseases ; Hemorrhage ; Humans ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic* ; Prevalence ; Splenic Infarction* ; Splenic Rupture ; Thrombosis

Histiocytoma, Benign Fibrous/surgery* ; Humans ; Splenectomy ; Splenic Diseases/pathology* ; Splenic Neoplasms/surgery*

Tuberculosis is a common chronic infectious disease, although the spleen is an uncommon organ to harbor tubercle bacilli. Immunocompromised subjects are primarily prone to miliary tuberculosis and in them the spleen is invaded by Mycobacterium tuberculosis. Spleen tuberculosis is manifested commonly as a miliary form. The basic pathology is granulomatous inflammation. The CT finding of splenic tuberculosis are multiple, well-defined, roung or ovoid, low-density masses. Lymphadenopathy in the abdomen and mediastinum and pleural effusion can be found. We report two cases with tuberculosis of the spleen proved by computed tomography and histologic identification. One paitient did not improve following antituberculous medication, so splenectomy was performed. The other patient has been treated with antituberculous medication.
Abdomen ; Communicable Diseases ; Humans ; Inflammation ; Lymphatic Diseases ; Mediastinum ; Mycobacterium tuberculosis ; Pathology ; Pleural Effusion ; Spleen* ; Splenectomy ; Tuberculosis* ; Tuberculosis, Miliary ; Tuberculosis, Splenic

Splenic pseudocyst is a rare complication of abdominal trauma. Although it is rare, splenic pseudocyst is well-documented in the literature. According to the current classification, approximately 30% of all splenic cysts or pseudocysts result from direct abdominal trauma. In addition, chronic pancreatitis leads to change of nearby organs with possible acute and chronic complications including splenic lesions. This unusual complication can occur in both emergent and nonemergent conditions. The useful diagnostic procedures to assess intrasplenic pseudocyst are sonogram, CT scan, splenic scan, and occasionally angiography. However, definite diagnosis of pseudocyst is possible only after splenectomy when the absence of epithelial lining is confirmed histologically. Splenic pseudocyst requires surgical resection. We experienced a 31-year-old man who confirmed of warmness in the left side of back with left upper quadrant abdominal pain for several months. First impression was splenic lymphangioma based on CT scan and sonogram finding. Splenectomy was performed. Microscopic examination revealed splenic pseudocyst with fibrous capsule without epithelial lining.
Adult ; Cysts/*diagnosis/radiography/ultrasonography ; Diagnosis, Differential ; Humans ; Lymphangioma/diagnosis ; Male ; Splenectomy ; Splenic Diseases/*diagnosis/radiography/ultrasonography ; Splenic Neoplasms/diagnosis ; Tomography, X-Ray Computed

Cysts ; diagnosis ; Diagnostic Errors ; Female ; Hemangioma ; diagnosis ; surgery ; Humans ; Laparoscopy ; methods ; Middle Aged ; Splenectomy ; methods ; Splenic Diseases ; diagnosis ; Splenic Neoplasms ; surgery

We present a case of intrapancreatic accessory splenic infarction in a 28-year-old woman. It was discovered during a workup for an acute right epigastric pain. Computed tomography imaging of abdomen demonstrated a hemorrhagic high attenuation with enhancing solid portion in the tail of pancreas. The clinical and radiological differential diagnosis included pancreatic mucinous cystic neoplasm, pancreatic endocrine neoplasm, solid pseudopapillary tumor, ductal adenocarcinoma, and metastasis. A distal pancreatectomy was completed. The microscopic examination revealed heterotopic splenic tissue with infarction and her abdominal pain disappeared. In this case report, we first describe a symptomatic accessory splenic infarction which presented as a hemorrhagic mass in the tail of pancreas mimicking pancreatic neoplasm.
Adult ; Diagnosis, Differential ; Female ; Hemorrhage/etiology ; Humans ; Pancreas/pathology/surgery ; Pancreatectomy ; Pancreatic Diseases/*diagnosis/pathology/surgery ; Pancreatic Neoplasms/diagnosis ; Spleen/pathology ; Splenic Infarction/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

Spontaneous splenic rupture is a rare disease but can cause a life threatening situation. It can occur under a pathological spleen such as infection, neoplastic, infiltrative and inflammatory disease. Although splenectomy is the treatment of choice for splenic rupture, it is uncertain that the effectiveness of non- surgical treatment in the hemodynamically stable patient. We report a case of a 66-year-old male undergoing hemodialysis for 4 years who presented to the emergency department with abdominal pain and distention. Blood pressure was 130/80 mmHg, heart rate was 108 bpm. White blood cell count was 7,130/mm3, hemoglobin was 6.7 g/dL, platelet was 156,000/mm3. PT INR was elevated up to 2.01 because he had taken warfarin due to splenic infarction. Abdominal CT scan revealed hemoperitoneum due to splenic rupture. We performed angiography but there was no active bleeding. We decided conservative management without embolization because of stable condition and increased bleeding risk in operation. He received 6 pints of packed red blood cell transfusion during continuous renal replacement therapy for 24 hours on ICU. He was discharged with complete recovery on the 21st hospital day. We suggest that non-surgical treatment in splenic rupture also could be considered in hemodynamically stable patients with a high risk of postoperative complication.
Abdominal Pain ; Aged ; Angiography ; Blood Platelets ; Blood Pressure ; Emergencies ; Erythrocyte Transfusion ; Heart Rate ; Hemoglobins ; Hemoperitoneum ; Hemorrhage ; Humans ; International Normalized Ratio ; Leukocyte Count ; Male ; Mustard Compounds ; Rare Diseases ; Renal Dialysis ; Renal Replacement Therapy ; Spleen ; Splenectomy ; Splenic Infarction ; Splenic Rupture ; Warfarin

Epstein-Barr virus (EBV) infection can be presented with various clinical manifestations and different levels of severity when infected. Infectious mononucleosis, which is most commonly caused by EBV infection in children and adolescents, is a clinical syndrome characterized by fatigue, malaise, fever, sore throat, and generalized lymphadenopathy. But rarely, patients with infectious mononucleosis may present with gastrointestinal symptoms and complicated by gastritis, splenic infarction, and splenic rupture. We encountered a 16-year-old girl who presented with fever, fatigue, and epigastric pain. Splenic infarction and EBV-associated gastritis were diagnosed by using esophagogastroduodenoscopy and abdominal computed tomography. Endoscopy revealed a generalized hyperemic nodular lesion in the stomach, and the biopsy findings were chronic gastritis with erosion and positive in situ hybridization for EBV. As splenic infarction and acute gastritis are rare in infectious mononucleosis and are prone to be overlooked, we must consider these complications when an infectious mononucleosis patient presents with gastrointestinal symptom.
Adolescent ; Biopsy ; Child ; Endoscopy ; Endoscopy, Digestive System ; Epstein-Barr Virus Infections ; Fatigue ; Female ; Fever ; Gastritis* ; Herpesvirus 4, Human* ; Humans ; In Situ Hybridization ; Infectious Mononucleosis ; Lymphatic Diseases ; Pharyngitis ; Splenic Infarction* ; Splenic Rupture ; Stomach

BACKGROUND: Splenic Actinomycosis is a rare entity which usually presents as a difficult diagnostic case. It is a chronic granulomatous infectious disease, caused by Actinomyces which is commonly associated with history of abdominal surgery and manipulation. Majority of cases would present as an enlarging abdominal mass often mimicking malignant tumors.
CASE PRESENTATION: This paper presents a rare case of splenic actinomycosis in a 24-year-old Filipino female presenting as multiple splenic abscesses leading to gradual progressive ascites initially thought to be due to a malignant lymphoma. On physical examination, massive ascites and splenomegaly were the only abnormality appreciated. Initial radiologic imaging (x-ray, ultrasound, CT scan) revealed presence of multiple splenic nodules associated with extensive mediastinal and retroperitoneal lymphadenopathy as well as peritoneal extension/carcinomatosis (Figure 1 and 2). Splenic biopsy revealed presence of actinomyces (Figure 3).
TREATMENT AND OUTCOME: Patient was started on amoxicillin 2.0 g per day for 24 months which led to a significant resolution of her massive ascites. Subsequent abdominal ultrasound showed gradual reduction in the hepatic and splenic size with resolution of splenic foci. Patient is currently on frequent follow-up.
CONCLUSION: Splenic actinomycosis although extremely rare should be included as a differential diagnosis when presented with an unusual splenic mass or abscess on CT scan. Majority would mimic different forms of malignancy hence early histologic biopsy is usually needed to prevent unnecessary extensive and invasive surgical procedures. Radiologic and biochemical test are usually non-specific and not helpful with the establishment of the diagnosis. Although surgery remains to be the cornerstone for its management, prolonged antibiotic therapy might show promising results due to intensive closer follow up and accessibility to monitoring modalities for treatment response.

Human ; Female ; Adult ; Actinomyces ; Splenomegaly ; Amoxicillin ; Splenic Diseases ; Abscess ; Ascites ; Actinomycosis ; Lymphoma ; Neoplasms ; Anti-bacterial Agents ; Lymphadenopathy

Primary splenic tumors are rare and mainly found incidentally on radiologic studies. Among them, sclerosing angiomatoid nodular transformation (SANT) of the spleen is a new entity defined as a benign pathologic lesion. Most SANTs have no clinical symptoms and are occasionally accompanied by other splenic diseases such as malignancies. So, the exact diagnosis of the nature of the splenic tumor is mandatory for further treatment. But, preoperative diagnosis is not easy since it is difficult to obtain the tissue from the spleen for pathological study. Recently, laparoscopic splenectomy has become the more standard procedure for the spleen for diagnosis and treatment. Here, we report a rare case of SANT diagnosed following laparoscopic splenectomy.
Spleen ; Splenectomy ; Splenic Diseases