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Hirata R, Tago M, Yamashita S, Yamamoto S, Yaita S, Hirakawa Y, Ono M, Yamashita S. Acute abdominal pain due to atypical bilateral adrenal infarction in acute myeloid leukemia with alterations related to myelodysplasia: A case report. Clin Case Rep 2023; 11:e7925. [PMID: 37780928 PMCID: PMC10533386 DOI: 10.1002/ccr3.7925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 10/03/2023] Open
Abstract
Key Clinical Message Acute myeloid leukemia (AML) can cause acute abdomen following adrenal insufficiency or adrenal infarction. Therefore, when diffusely enlarged adrenal glands and adrenal insufficiency of unknown cause are seen in a patient presenting with acute abdomen, adrenal infarction due to AML, or other hematologic diseases should be ruled out. Abstract A 49-year-old man developed acute abdominal pain following adrenal insufficiency and was diagnosed with acute myeloid leukemia (AML) with myelodysplasia-related changes. Because AML can cause acute abdominal pain due to adrenal infarction following adrenal insufficiency, a patient with these conditions should be ruled out adrenal infarction due to AML or other hematologic diseases.
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Affiliation(s)
- Risa Hirata
- Department of General MedicineSaga University HospitalSagaJapan
| | - Masaki Tago
- Department of General MedicineSaga University HospitalSagaJapan
| | - Shun Yamashita
- Department of General MedicineSaga University HospitalSagaJapan
| | | | - Shizuka Yaita
- Department of General MedicineSaga University HospitalSagaJapan
| | - Yuka Hirakawa
- Department of General MedicineSaga University HospitalSagaJapan
| | - Maiko Ono
- Department of General MedicineKaratsu Municipal HospitalKaratsuJapan
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2
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Muacevic A, Adler JR, Prakash P, Hussein A, Alzghoul H, Bilal M, Oyetoran A, Iyer UG. A Rare Case of Splenic Artery Thrombosis Provoked By Medroxyprogesterone Acetate Requiring Splenectomy. Cureus 2023; 15:e33880. [PMID: 36819368 PMCID: PMC9933890 DOI: 10.7759/cureus.33880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Splenic artery thrombosis is estimated to occur in only 0.016% of hospital admissions. Hormonal contraception is known to have hypercoagulable side effects, but splenic artery thrombosis (SAT) followed by functional autosplenectomy is a very rare side effect. We report a case of a 48-year-old female with persistent SAT provoked by depot medroxyprogesterone acetate (DMPA). She initially presented with severe left lower quadrant abdominal pain, and imaging revealed an extensive thrombus in the splenic artery. She was immediately started on intravenous heparin, and her symptoms improved after a few days, at which point she was discharged on oral apixaban. Three months after discharge, the patient presented with symptoms similar to the initial presentation. Further history revealed that she received an injectable DMPA shot prior to her initial admission. Other possible causes of SAT were ruled out. On imaging, her previous thrombus had increased in size and now filled the entire splenic artery. Therefore, the patient underwent robotic splenectomy with remarkable improvement in her symptoms. This case represents a rare clinical manifestation of a hypercoagulable state induced by DMPA. We review the existing literature to explain the epidemiology, presentation, diagnosis, and treatment of SAT, and incorporate our patient's presentation into the existing literature regarding the effect of contraception in inducing thrombotic events.
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A COVID-19 Patient with Simultaneous Renal Infarct, Splenic Infarct and Aortic Thrombosis during the Severe Disease. Healthcare (Basel) 2022; 10:healthcare10010150. [PMID: 35052313 PMCID: PMC8776164 DOI: 10.3390/healthcare10010150] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a high incidence of arterial and venous thrombotic complications. However, thromboembolic events in unusual sites such as limb and visceral arterial ischemia are reported rarely in the literature. Herein, we describe a rare case of a patient with severe coronavirus disease 2019 (COVID-19) infection who experienced severe abdominal pain during the hospitalization and presented simultaneously renal artery, splenic artery and vein as well as aortic thrombi despite prophylactic antithrombotic treatment. Information about his follow-up post discharge is also provided. This case report raises significant clinical implications regarding the correct dose of antithrombotic treatment during the acute phase of the severe COVID-19 infection and highlights the need for incessant vigilance in order to detect thrombosis at unusual sites as a possible diagnosis when severe abdominal pain is present in severe COVID-19 patients.
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Trancǎ SD, Antal O, Farcaş AD. Case Report: Acute Splenic Artery Thrombosis in a COVID 19, Postpartum Patient. Front Med (Lausanne) 2021; 8:698627. [PMID: 34805195 PMCID: PMC8604041 DOI: 10.3389/fmed.2021.698627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/19/2021] [Indexed: 12/20/2022] Open
Abstract
The incidence of thromboembolic disease is reported to be high in SARS-CoV2 disease. Pregnancy, an already physiologically hypercoagulable state, associated to COVID 19, generates even more concern regarding the potentially increased risk of thrombotic events. The exact incidence of such complications is yet unknown, but there is data suggesting that coagulopathy and thromboembolism are both increased in pregnancies affected by COVID-19. Since the outbreak of the COVID 19 pandemics, the most common described thrombotic events associated with SARS-COV2 infection have been venous thromboembolism and disseminated intravascular coagulation, while arterial thrombotic events are less commonly described. Splenic infarction is a rare disorder that can be secondary to a hypercoagulable state. There are only few cases of splenic infraction described, but none with splenic artery thrombosis, in a post-partum patient, on therapeutic anticoagulation regimen. We present the case of a 31-year-old Caucasian, 26 weeks pregnant woman, with no prior medical history, admitted to the hospital with a severe form of COVID 19 pneumonia and who, during the course of the disease, developed a massive splenic infarction with splenic artery thrombosis.
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Affiliation(s)
- Sebastian Daniel Trancǎ
- Surgery Department, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Anaesthesia and Intensive Care, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Oana Antal
- Surgery Department, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Anaesthesia and Intensive Care, Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
| | - Anca Daniela Farcaş
- Internal Medicine Department, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Cardiology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania
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Matarneh AS, Sadiq A, Ahmad Khan A, Eltahir AI, Alansari M, Mohammed A. A rare case of spontaneous abdominal aorta thrombosis. Clin Case Rep 2021; 9:e04571. [PMID: 34457277 PMCID: PMC8380076 DOI: 10.1002/ccr3.4571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/16/2021] [Indexed: 11/06/2022] Open
Abstract
Spontaneous aortic thrombosis is rare, and prompt diagnosis is needed whenever encountering a case of unexplained abdominal pain. The cause of the thrombosis needs to be evaluated thoroughly to rule out any underlying thrombophilias.
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Affiliation(s)
| | - Amna Sadiq
- Department of RadiologyHamad Medical CorporationDohaQatar
| | - Adeel Ahmad Khan
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | | | - Mazen Alansari
- Internal medicine DepartmentHamad General HospitalDohaQatar
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Moran J, Lookstein RA, Ranade M. Peripheral Non-cerebrovascular Arterial Stent Retriever Applications. Vasc Endovascular Surg 2021; 56:62-69. [PMID: 34266315 DOI: 10.1177/15385744211028727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Several treatment options exist for acute intra-abdominal arterial thromboembolic events, including systemic thrombolytics, endovascular therapy, and less commonly surgery. A novel alternative treatment intervention for acute intra-abdominal arterial thrombus is the use of stent retriever (SR) devices, tools traditionally applied for treatment of acute vascular thrombosis in stroke patients. This brief report presents two cases of acute intra-abdominal arterial thrombosis successfully managed by deployment of SRs. Furthermore, it details the history, device mechanism, and design of SRs and describes cases in literature involving effective extracranial SR application.
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Affiliation(s)
- Jacxelyn Moran
- Icahn School of Medicine, Mount Sinai West Hospital, NewYork, NY, USA
| | | | - Mona Ranade
- David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
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Norton EJ, Sheikh N. Splenic Infarct Due to a Patent Foramen Ovale and Paradoxical Emboli Post-COVID-19 Infection: A Case Study. Cureus 2021; 13:e14887. [PMID: 34109076 PMCID: PMC8180182 DOI: 10.7759/cureus.14887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Hypercoagulability is now a recognized complication of COVID-19 infection. Despite this, splenic infarction remains rare and is often found incidentally, radiologically, or at autopsy. We report a case of symptomatic splenic infarction with superimposed infection, secondary to COVID-19-induced hypercoagulability in a young patient with paradoxical emboli due to an undiagnosed patent foramen ovale (PFO). This multifactorial case should prompt a level of suspicion of the patient with unexplained abdominal pain and recent COVID-19 infection.
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Affiliation(s)
- Emma J Norton
- Gastroenterology Department, West Suffolk NHS Foundation Trust, Bury St Edmunds, GBR.,Division of Anaesthesia, University of Cambridge, Cambridge, GBR
| | - Nadim Sheikh
- Gastroenterology Department, West Suffolk NHS Foundation Trust, Bury St Edmunds, GBR
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Clinical characteristics and outcomes of splenic infarction in cancer patients: a retrospective, single center report of 206 cases. J Thromb Thrombolysis 2021; 52:854-862. [PMID: 33765243 DOI: 10.1007/s11239-021-02428-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
Cancer patients have a high risk of thromboembolic events including splenic infarct (SI). However, risk factors for SI in cancer patients are poorly understood, and the utility of systemic anticoagulation in such patients is uncertain. We performed a retrospective cohort study of all cancer patients with SI treated at Yale New Haven Hospital from 2008 to 2017. Central review of radiology imaging was performed to confirm the diagnosis of SI. Baseline differences in variables among patients with and without recurrent SI were compared using Fisher's exact test, Pearson's χ2 test, and t-test. Multivariable regression models were conducted to identify factors associated with recurrent SI. Of 206 patients with cancer and SI, 42 had a prior venous thromboembolic event, while 29 had atrial fibrillation/flutter. At a median follow-up of 11.4 months (range: 0-142.3 months), 152 patients underwent follow-up imaging, with only 6 having recurrent SI. The use of anticoagulation after initial SI was associated with a nonsignificant increase in recurrent SI (p = 0.054) and was not associated with development of venous thromboembolism after SI (p = 0.414). In bivariate analyses, the risk of recurrent SI showed a significant association with lower platelet counts (p < 0.001) and with atrial fibrillation/flutter (p = 0.036). In a multivariable logistic regression model, no variables were identified that were associated with a higher risk of recurrent SI. SI in cancer patients is typically an isolated event with low recurrence risk. Anticoagulation use should be guided by other thromboembolic risk factors.
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Nadeau Nguyen MC, Woronow D, Binks B, Nayernama A, Jones SC. Cisplatin-Associated Aortic Thrombosis: A Review of Cases Reported to the FDA Adverse Event Reporting System. JACC: CARDIOONCOLOGY 2021; 3:165. [PMID: 34396320 PMCID: PMC8352039 DOI: 10.1016/j.jaccao.2020.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pajak A, Li JC, Liu A, Nazare S, Smith B. Hemoglobin SE Disease Presenting as a High-Altitude Massive Splenic Infarction Complicated by Hemorrhagic Conversion and Splenectomy. Cureus 2020; 12:e10321. [PMID: 33052282 PMCID: PMC7546589 DOI: 10.7759/cureus.10321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hemoglobin SE (HbSE) disease is a hemoglobinopathy resulting from the combination of hemoglobin S (HbS) and hemoglobin E (HbE) genotypes. It may present as a vaso-occlusive crisis (VOC) in the setting of an acute stressor. Herein, we present a case of undiagnosed HbSE disease presenting as a massive splenic infarct in the setting of high-altitude exposure. A 55-year-old female of South Asian descent presented with acute left upper quadrant abdominal pain after hiking in the Swiss Alps four days previously. Laboratory testing revealed that she had hemolytic anemia, and computed tomography (CT) imaging showed a greater than 50% splenic infarction. After the initiation of anticoagulation, she experienced a hemorrhagic conversion of the initial splenic infarct resulting in acute hemodynamic decompensation. She initially underwent vascular intervention with arterial plugging, coiling, and embolization but ultimately required a splenectomy and partial colectomy upon developing a large splenic hematoma. Hemoglobin electrophoresis was consistent with hemoglobin SE disease. Hemoglobin variants, especially combined heterozygosity, are rare and have the potential to present as a vaso-occlusive crisis in the setting of acute chemical and physiological stresses. Only 43 cases of hemoglobin SE disease have been previously reported and one other occurrence in the setting of high altitude. Conservative management is recommended when a diagnosis of sickle cell trait (SCT) is definite, in comparison with cardioembolic phenomena, in which antiplatelet and anticoagulant therapy should be initiated. Hemoglobin SE disease is a rare heterozygous hemoglobinopathy resulting from the combination of hemoglobin variants geographically separated by thousands of miles. Currently, there are no strict guidelines supporting anticoagulation for the management of VOC in hemoglobinopathies. Splenic infarct in HbSE disease should be managed similarly to SCT/sickle cell disease (SCD) with fluids and analgesia, and anticoagulation should be limited to confirmed thromboembolic events and with the insight of an anticoagulant specialist.
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Affiliation(s)
- Andrew Pajak
- Internal Medicine, Christiana Care Health System, Newark, USA
| | - Jonathan C Li
- Internal Medicine, Christiana Care Health System, Newark, USA
| | - Alice Liu
- Internal Medicine, Sidney Kimmel Jefferson Medical College, Philadelphia, USA
| | - Shaina Nazare
- Internal Medicine, Christiana Care Health System, Newark, USA
| | - Bruce Smith
- Internal Medicine, Christiana Care Health System, Newark, USA
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Acute Splenic Artery Thrombosis and Infarction Associated with COVID-19 Disease. Case Rep Crit Care 2020; 2020:8880143. [PMID: 32934849 PMCID: PMC7479473 DOI: 10.1155/2020/8880143] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/21/2020] [Accepted: 08/30/2020] [Indexed: 12/15/2022] Open
Abstract
Coronavirus 2019 disease (COVID-19) is a viral illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It emerged in Wuhan, China, in December 2019 and has caused a widespread global pandemic. The symptoms of COVID-19 can vary from mild upper respiratory symptoms to severe pneumonia with hypoxemic respiratory failure. Multiple studies and reports have reported a hypercoagulable state associated with this disease, and various recommendations have emerged to guide the use of anticoagulants for prophylaxis. We are reporting a case of symptomatic acute splenic thrombosis causing splenic infarction in a patient suffering from a severe case of COVID-19 and despite the use of an intermediate dose of low-molecular-weight heparin (LMWH). The patient was treated with full-dose anticoagulation and was eventually discharged home on a direct oral anticoagulant.
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