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Roels E, Pierrot E, Porsmoguer C, Herrmann A, Fastrès A, Bolen G. Ultrasonographic and CT-scan findings of splenic active chylous effusion and postlymphangiography enhancement in a cat with chylothorax associated with splenic angiosarcoma. Vet Radiol Ultrasound 2024. [PMID: 38804245 DOI: 10.1111/vru.13387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
A 12-year-old domestic shorthair cat was presented with relapsing noncardiogenic chylothorax. CT-lymphangiography of the thorax confirmed bilateral pleural effusion without evidence of an underlying intra-thoracic origin. Abdominal CT-lymphangiography revealed a 2.6 cm diameter splenic mass surrounded by chylous effusion actively collecting during ultrasonographic assessment. Following splenectomy, histopathological analysis revealed that the splenic mass exhibited characteristics indicative of splenic angiosarcoma. This case report highlights the utility of advanced thoracic and abdominal imaging, notably CT-lymphangiography, in the diagnostic evaluation of chylothorax in cats. The identification of a splenic mass encased in chylous effusion should prompt a proactive case management strategy.
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Affiliation(s)
- Elodie Roels
- Department of Clinical Sciences, Fundamental and Applied Research for Animals & Health (FARAH), Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Emilie Pierrot
- Department of Clinical Sciences, Fundamental and Applied Research for Animals & Health (FARAH), Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Charles Porsmoguer
- Department of Clinical Sciences, Fundamental and Applied Research for Animals & Health (FARAH), Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Annika Herrmann
- VPG Histopathology, Veterinary Pathology Group (VPG), Exeter, United Kingdom
| | - Aline Fastrès
- Department of Clinical Sciences, Fundamental and Applied Research for Animals & Health (FARAH), Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Géraldine Bolen
- Department of Clinical Sciences, Fundamental and Applied Research for Animals & Health (FARAH), Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
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2
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Gupta S, Thameem D. Spontaneous Resolution of Recurrent Pleural Effusion in Atraumatic Splenic Rupture. Cureus 2023; 15:e40232. [PMID: 37435245 PMCID: PMC10332821 DOI: 10.7759/cureus.40232] [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: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
Spontaneous splenic rupture is an uncommon cause of acute-onset left-sided pleural effusion. It is often immediate with a high preponderance for recurrence, sometimes even requiring splenectomy. We report a case of spontaneous resolution of recurrent pleural effusion presenting a month after the initial atraumatic splenic rupture. Our patient was a 25-year-old male without significant medical history who was taking Emtricitabine/Tenofovir for pre-exposure prophylaxis. He presented to the pulmonology clinic for left-sided pleural effusion, diagnosed in the emergency department a day prior. He had a history of spontaneous grade III splenic injury one month before, where he was diagnosed with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) co-infection on polymerase chain reaction (PCR) testing and was managed conservatively. The patient underwent thoracentesis in the clinic, which showed exudative lymphocyte predominant pleural effusion and no malignant cells. The remainder of the infective workup was negative. He was readmitted two days later with worsening chest pain, and imaging revealed re-accumulation of pleural fluid. The patient declined thoracentesis, and a chest X-ray was repeated a week later, showing worsening pleural effusion. The patient insisted on continuing conservative management, and he was seen a week later with a repeat chest X-ray that showed near resolution of pleural effusion. Splenomegaly and splenic rupture can lead to pleural effusion due to posterior lymphatic obstruction, which can be recurrent. There are no current guidelines on management, and treatment options include watchful monitoring, splenectomy, or partial splenic embolization.
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Affiliation(s)
- Sushan Gupta
- Internal Medicine, Carle Foundation Hospital, Champaign, USA
| | - Danish Thameem
- Pulmonary and Critical Care Medicine, Carle Foundation Hospital, Champaign, USA
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3
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Patel VG, Eltayeb OM, Zakaria M, Fortson JK, Weaver WL. Spontaneous Subcapsular Splenic Hematoma: A Rare Complication of Pancreatitis. Am Surg 2020. [DOI: 10.1177/000313480507101217] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Subcapsular hematoma of the spleen is a rare complication of pancreatitis despite its close proximity to the pancreas. Pancreatic pseudocyst involving the tail of the pancreas may erode into the splenic hilum causing hilar vessel bleeding with subcapsular dissection and hematoma formation. The management of such complication is still controversial. It has been suggested that most of these complications spontaneously regress and therefore can be managed conservatively. A case of spontaneous splenic subcapsular hematoma resulting from pancreatitis was managed conservatively with a good outcome.
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Affiliation(s)
| | - Osama M. Eltayeb
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - Majed Zakaria
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - James K. Fortson
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - William L. Weaver
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
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4
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Akhtar J, Hendry GM, McKenzie S, Mackinlay GA. Paediatric splenic trauma: Its management and the role of ultrasonography in its follow-up. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709409152994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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5
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Konde LJ, Wrigley RH, Lebel JL, Park RD, Pugh C, Finn S. SONOGRAPHIC AND RADIOGRAPHIC CHANGES ASSOCIATED WITH SPLENIC TORSION IN THE DOG. ACTA ACUST UNITED AC 2005. [DOI: 10.1111/j.1740-8261.1989.tb00751.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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6
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Peddu P, Shah M, Sidhu PS. Splenic abnormalities: a comparative review of ultrasound, microbubble-enhanced ultrasound and computed tomography. Clin Radiol 2004; 59:777-92. [PMID: 15351243 DOI: 10.1016/j.crad.2004.01.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2003] [Revised: 01/14/2004] [Accepted: 01/20/2004] [Indexed: 01/08/2023]
Abstract
The ultrasound appearances of abnormalities of the spleen are reviewed and images compared with computed tomography. Focal lesions, both benign and malignant, trauma, infarction and congenital abnormalities are presented. The use of microbubble ultrasound contrast media as an aid to identifying and characterizing abnormalities is discussed.
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Affiliation(s)
- P Peddu
- Department of Radiology, King's College Hospital, London, UK
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7
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Görg C, Cölle J, Görg K, Prinz H, Zugmaier G. Spontaneous rupture of the spleen: ultrasound patterns, diagnosis and follow-up. Br J Radiol 2003; 76:704-11. [PMID: 14512330 DOI: 10.1259/bjr/69247894] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Spontaneous rupture of the spleen is an extremely rare complication usually of infectious diseases or disorders of the haematopoietic system and has been described mostly in case reports. The incidence, symptoms, causes, therapy, and prognosis are poorly defined. From July 1985 to January 2000 41 patients with spontaneous splenic rupture were diagnosed by abdominal ultrasound and confirmed by splenectomy (n=12), CT (n=15), and ultrasound follow up (n=26). An ultrasound grading system was retrospectively established based on the degree of splenic injury (grade 0-2=low grade injury, grade 3=high grade injury) and correlated with surgical procedures. 30 day mortality rate was studied in relation to underlying disorders, ultrasound grades and treatment decisions. 21 patients had underlying malignant disorders (group I) and 20 patients had benign diseases (group II). Between group I and II we observed a highly significant difference in 30 day mortality rates (n=7; 38.1% vs n=1; 5%, p<0.01), but no significant difference in high grade injury rate (n=3; 14.3% vs n=2; 10.0%; p=ns) and surgical treatment rate (n=5; 23.8% vs n=7; 35.0%; p=ns). Depending on ultrasound grades the surgical procedures were 0% for grade 0, 16.7% for grade 1, 30.4% for grade 2, and 60% for grade 3. There were no significant differences between patients, who died within the first 30 days (n=9) and those who survived more than 30 days (n=32) regarding high grade splenic injury rate (n=0; 0% vs n=5; 15.6%; p=ns), and surgical treatment rate (n=2; 22.2% vs n=10; 31.2%; p=ns). Spontaneous rupture of the spleen is an extremely rare event. It is associated with a high mortality rate within 30 days in patients with malignant disease. Sonomorphologic grading is helpful for treatment decisions. 30 day mortality rate is correlated with neither ultrasound grades, nor surgical treatment rates.
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Affiliation(s)
- C Görg
- Zentrum für Innere Medizin, Klinikum der Philipps-Universität, Baldingerstrasse, 35043 Marburg, Germany
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8
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Emery KH, Babcock DS, Borgman AS, Garcia VF. Splenic injury diagnosed with CT: US follow-up and healing rate in children and adolescents. Radiology 1999; 212:515-8. [PMID: 10429711 DOI: 10.1148/radiology.212.2.r99au25515] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine if pediatric splenic injury healing observed during ultrasonography (US) is related to the computed tomographic (CT) grade of injury severity, to review any delayed complications, and to formulate a grade-specific timetable for follow-up imaging. MATERIALS AND METHODS Sixty-eight children and adolescents with CT-documented blunt splenic injury underwent US at approximate 6-week intervals to document injury healing (normal parenchyma or linear echogenic "scar"). Medical records of those not followed up to complete healing were reviewed. RESULTS Forty-eight patients were followed up to complete injury healing: 14 of injury grade 1 (mean, 7 weeks; range, 4-12 weeks), 24 of injury grade 2 (mean, 9.5 weeks; range, 6-17 weeks), and 10 of injury grade 3 (mean, 16 weeks; range, 6-29 weeks). The difference in mean time to healing among all grades was significant (P < .02). Only two cysts were found; one decreased in size over time. No complications occurred in the 68 study patients. CONCLUSION The time course to US-documented healing of blunt pediatric splenic injury is related to injury severity. This information can be used to tailor follow-up imaging and provide cost savings.
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Affiliation(s)
- K H Emery
- Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
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9
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Fernandez L, McKenney MG, McKenney KL, Cohn SM, Feinstein A, Senkowski C, Compton RP, Nunez D. Ultrasound in blunt abdominal trauma. THE JOURNAL OF TRAUMA 1998; 45:841-8. [PMID: 9783637 DOI: 10.1097/00005373-199810000-00047] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L Fernandez
- Department of Surgery, University of Miami School of Medicine, Veterans Administration Medical Centers, Florida, USA
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10
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Abstract
Cavitary parenchymal lesions are composed of varying amounts of soft tissue, fluid, and/or gas. These cavitary lesions are focal or multifocal and therefore readily detected ultrasonographically. The ultrasonographic appearance of cystic and noncystic cavitary lesions are described. Differential diagnoses for these cavitary lesions in abdominal organs are listed.
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Affiliation(s)
- H M Saunders
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, USA
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11
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Krupnick AS, Teitelbaum DH, Geiger JD, Strouse PJ, Cox CS, Blane CE, Polley TZ. Use of abdominal ultrasonography to assess pediatric splenic trauma. Potential pitfalls in the diagnosis. Ann Surg 1997; 225:408-14. [PMID: 9114800 PMCID: PMC1190749 DOI: 10.1097/00000658-199704000-00010] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the accuracy of abdominal ultrasonography (US) for screening and grading pediatric splenic injury. SUMMARY BACKGROUND DATA The use of abdominal US has increased rapidly as a method of evaluating organ damage after blunt abdominal trauma. Despite US's increasing use, little is known about its accuracy in children with splenic injury. METHODS Children (N = 32) suffering blunt abdominal trauma who were diagnosed with splenic injury by computerized tomography (CT) scan prospectively were enlisted in this study. Degree of splenic injury was evaluated by both CT and US. The ultrasounds were evaluated by an initial reading as well as by a radiologist who was blinded as to the results of the CT. RESULTS Twelve (38%) of the 32 splenic injuries found on CT were missed completely on the initial reading of the US. When the ultrasounds were graded in a blinded fashion, 10 (31%) of the splenic lacerations were missed and 17 (53%) were downgraded. Seven (22%) of the 32 splenic fractures were not associated with any free intraperitoneal fluid on the CT scan. CONCLUSIONS This study has shown that US has a low level of sensitivity (62% to 78%) in detecting splenic injury and downgrades the degree of injury in the majority of cases. Reliance on free intraperitoneal fluid may be inaccurate because not all patients with splenic injury have free intra-abdominal fluid. Based on these findings, US may be of limited use in the initial assessment, management, and follow-up of pediatric splenic trauma.
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Affiliation(s)
- A S Krupnick
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, USA
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12
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Abstract
Management of splenic injuries in children has evolved over the past two decades. Splenectomies or splenorrhaphies are now performed infrequently, with the majority of hemodynamically stable children with splenic injuries managed nonoperatively. This article reviews the imaging features of acute splenic injuries in children as well as the appearance of healing splenic injuries. Follow-up evaluation and outcomes in children with splenic injuries also are addressed.
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Affiliation(s)
- E C Benya
- Department of Radiology, Wyler Children's Hospital, University of Chicago, IL 60637, USA
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13
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Hanson JA, Penninck DG. ULTRASONOGRAPHIC EVALUATION OF A TRAUMATIC SPLENIC HEMATOMA AND LITERATURE REVIEW. Vet Radiol Ultrasound 1994. [DOI: 10.1111/j.1740-8261.1994.tb02072.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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14
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Siniluoto TM, Päivänsalo MJ, Lanning FP, Typpö AB, Lohela PK, Kotaniemi AE. Ultrasonography in traumatic splenic rupture. Clin Radiol 1992; 46:391-6. [PMID: 1493652 DOI: 10.1016/s0009-9260(05)80685-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ultrasound (US) findings and their significance for the clinical outcome were studied in a series of 56 patients hospitalized with a diagnosis of splenic trauma. US was abnormal in 50 cases (89.3%) on admission, revealing intraperitoneal fluid in 41 (73.2%) and a splenic parenchymal injury and/or subcapsular haematoma in 35 (62.5%). US was abnormal in 24/25 patients undergoing urgent surgery, 23/26 undergoing successful non-surgical treatment and 2/5 patients undergoing delayed surgery within 1 to 3 days of a repeat US (abnormal in all five). The presence of intraperitoneal haemorrhage preoperatively was shown accurately by US in 29 cases (96.7%), and the splenic origin of the haemorrhage in 19 (63.3%). Repeat US was of most value for confirming the diagnosis by demonstrating splenic lesions not visible initially. The need for laparotomy could not be predicted on the basis of the US findings alone, however.
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Affiliation(s)
- T M Siniluoto
- Department of Diagnostic Radiology, Oulu University Central Hospital, Finland
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15
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Berman BM, Nagle CE, Jafri SZ, Morden RS, Nagle CE. Spleen Injury in Sports. PHYSICIAN SPORTSMED 1992; 20:168-79. [PMID: 27438645 DOI: 10.1080/00913847.1992.11710255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In brief Following injury, stabilized patients who might have suffered significant trauma to the spleen require ongoing clinical assessment coupled with radiographic imaging. CT is the initial method of choice, although radionuclide scintigraphy may be indicated for pregnant patients and for those who have an iodine allergy. The roles of ultrasound, angiography, and abdominal plain film radiography are limited. Abnormalities demonstrated on contrast-enhanced CT studies include spleen laceration, subcapsular hematoma, and hemoperitoneum. Radionuclide scintigraphy will help diagnose splenosis.
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17
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Booth AJ, Bruce DI, Steiner GM. Ultrasound diagnosis of splenic injuries in children--the importance of free peritoneal fluid. Clin Radiol 1987; 38:395-8. [PMID: 3304789 DOI: 10.1016/s0009-9260(87)80235-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Three cases of injury to the spleen in children are presented. The value of ultrasound in the diagnosis and monitoring of treatment of such splenic injuries is described, and the importance of free peritoneal fluid is stressed. Since splenectomy disturbs the immune mechanisms of the body, treatment should, if possible, be medical.
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Abstract
With the advent of real-time sonography of the upper abdomen, the spleen is no longer an inaccessible organ. Real-time imaging is preferable to other conventional diagnostic methods because of its simplicity and accuracy in evaluation of the spleen and the determination of its relationship to other organs. This review of the literature details the diagnosis of splenic pathology by sonography and includes a discussion of the significance of these findings.
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Wiig JN, Solheim K, Nygaard K, Anda O, Runden TO, Halvorsen JF, Andenaes K, Dahl S, Danielsen S, Giercksky KE. Splenic injury--a prospective multicentre diagnostic study. Injury 1987; 18:89-92. [PMID: 3334048 DOI: 10.1016/0020-1383(87)90179-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
One hundred and forty-seven patients with splenic injury were entered in a prospective multicentre study including 18 hospitals. The diagnosis was made by scintigraphy in 55 patients, ultrasonography in 51 and computed axial tomography in 31. Exploratory laparotomy was performed in 52 patients, in 23 of these after a positive peritoneal lavage. Splenic injury was found in 33 per cent of the ultrasound examinations, indicated in another 20 per cent and not indicated in 16 per cent. In 31 per cent increased intraperitoneal effusion was the only finding. There was a tendency towards an underestimation of the injury by ultrasonography. Peritoneal lavage was positive in all examinations.
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Affiliation(s)
- J N Wiig
- Regionsykehuset i Trondheim, Norway
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20
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Abstract
The first task of radiocolloid spleen imaging, after trauma, is to determine if the organ is functioning. If this cannot be demonstrated, splenic avulsion must be considered. The second task is to document splenic injury (not to suggest splenectomy, but to serve as a baseline for following later healing). Failure to heal may be a risk factor for subsequent splenic rupture. The third task of spleen imaging is to determine if accessory splenic fragments are present and functional. The radiocolloid spleen scan facilitates the successful accomplishment of all of these tasks.
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