Imaging findings of extensive splenic infarction after cyanoacrylate injection for gastric varices--a case report

Endoscopic injection of N-Butyl-2-cyanoacrylate is a widely accepted treatment for esophagogastric varices. This procedure is commonly associated with minor complications which include transient pyrexia and abdominal discomfort. Serious vascular complications secondary to systemic embolization of cyanoacrylate have rarely been reported. We describe the CT findings of extensive splenic infarction in a patient following cyanoacrylate injection for gastric varices.

[Splenic infarction. Ergotism induced by ritonavir?]

Ergotism is a clinical condition known since old times and whose main characteristics are ischemia and even limb gangrene. Some drugs have the capacity of interacting with small amounts of ergotamine or its derivatives producing ergotism as a side effect. This is the case of ritonavir, a widely used anti-HIV drug. Here we present a case of ergotism that developed in an HIV positive 39 year old male under treatment with ritonavir, after taking 1 mg of ergotamine tartrate. His clinical picture, apart from showing the basic manifestations of the disease, was associated with splenic infarction. For this reason, we consider important to advise patients about the potential pharmacological interaction between ergotamines and others common drugs and, in particular, ritonavir in HIV positive patients.

[Splenic infarction after warfarin discontinuation during atrial fibrillation]

We describe a case of patient with splenic infarction, admitted to our department for sudden abdominal pain and fever after discontinuation of anticoagulant therapy for atrial fibrillation, complicating a dilated myocardiopathy and mechanical prosthetic valve. Diagnosis of splenic infarction was made by enhanced-contrast computed tomography, while ultrasounds and radiography were negative. Anticoagulant therapy, gold-standard treatment, was followed by fast clinical improvement. Moreover, splenic infarction should be considered in all cases of acute or chronic pain in left hypochondrium and especially in patients with emboligenous cardiopathies or atrial fibrillation, the most common arrhythmia source of peripheral embolism in clinical practice.

Spontaneous splenic infarction associated with sumatriptan use

Triptans are specific agonists of the serotonergic 5-HT_1B/1D receptors that have increasingly been used in the treatment of migraine and cluster headaches. Though they are generally considered safe, there have been a few reports of myocardial infarction and stroke associated with triptan use. We report a patient who developed spontaneous splenic infarction after the use of sumatriptan for the treatment of migraine headache.

Cocaine-associated abscesses with lethal sepsis after splenic infarction in an 17-year-old woman

Well known complications related to cocaine use are myocardial insufficiency, myocardial infarction, myocarditis, aortic dissection, neurologic damages, ischemic colitis, thrombotic phenomenons, renal infarction and acute liver failure. Cases of splenic infarctions related to cocaine use are extremely rare. A 17-year-old drug addict was found by her boy-friend liveless in her bed. She was well known using cocaine since years. Autopsy revealed multiple splenic infarctions with secondary mixed bacterial infection and abscesses. Petechial bleedings were found and microabscesses in the myocardium, the meninges and the kidneys. The absolutely rare bacterial infection of the cocaine-associated splenic infarction leads to sepsis with lethal course.

Extensive splenic infarction, deep vein thrombosis and pulmonary emboli complicating induction therapy with all-trans-retinoic acid (ATRA) for acute promyelocytic leukemia

Bleeding is a common complication during initial induction treatment for acute promyelocytic leukemia (APL). Administration of all-trans-retinoic acid (ATRA), which is in routine use for APL in the past decade improves the bleeding tendency dramatically. Nevertheless, thrombotic events have still been reported in a small proportion of APL patients treated with ATRA. Here we describe a case of splenic infarction and life threatening thrombosis in a young patient with APL treated with ATRA. We review the relevant literature and discuss the pathophysiology, risk factors and treatment of this complication occurring during therapy, for APL.

Coeliac axis thrombosis associated with the combined oral contraceptive pill: a rare cause of an acute abdomen

We report a case of coeliac axis thrombosis and splenic infarction presenting in a girl of 14 years who had been on the oral contraceptive pill (OCP), Marvelon (ethinyloestradiol 30 microg plus desogestrel 150 microg, Organon, Cambridge, UK), for 3 weeks. She had no other risk factors for thrombo-embolism. Diagnosis was made with duplex Doppler ultrasound and confirmed with dynamically-enhanced comput-ed tomography and magnetic resonance angiography, thus avoiding the need for percutaneous arteriography. Though mesenteric thrombo-embolic disease is recognised in association with use of the combined OCP, it has not previously been reported to affect the coeliac axis. Paediatricians and surgeons should be aware of the risks to young girls on the OCP, and consider it in their differential diagnosis of the acute abdomen.

Gastric and splenic infarction: a complication of intraarterial vasopressin infusion

Gastric and splenic infarction following intraarterial infusion of vasopressin in a patient's left gastric artery is reported. None of the previously described factors predisposing to infarction were present and the cause appears to have been hyperconstriction of vessels in response to vasopressin. Computed tomography (CT) scanning was used to confirm the extent of involvement.

Splenic infarction and tissue accumulation of crystals associated with the use of clofazimine (Lamprene; B663) in the treatment of pyoderma gangrenosum

A male patient 68 years, suffering from pyoderma gangrenosum which was resistant to conventional treatment, received clofazimine 400 mg daily for 5 months, then reducing to 300 mg daily for the next 6 months. Eleven months after starting the drug, he was admitted to hospital with severe abdominal pain, laparotomy revealing infarction of the spleen, with violaceous congestion of the small bowel. The spleen was removed and post-operative recovery was satisfactory. Histopathological examination of the spleen (removed at operation) and of tissue from a duodenal biopsy (taken postoperatively) showed large numbers of striations and outlines suggestive of crystal deposition. Mesenteric lymph node revealed a massive accumulation of crystals in cortical and medullary sinuses. The findings emphasize that clofazamine should not be used in high dosage over prolonged periods of time, except under close clinical and laboratory supervision, and for conditions not amenable to other drugs.

Pulmonary and systemic embolism after deliberate intravenous fluorocarbon administration

After intravenous injection of 0.1 ml Fluorocarbon (FC) into the caudal vein of rats clear droplets which are reminiscent of gas emboli appear in the pulmonary and cerebral arteries. These droplets cannot be stained with Azan, haematoxylin-eosin, Nile blue sulfate, Sudan black B, and Sudan III in Paraplast embedded or frozen sections. Gas chromatography of affected lung tissue reveals a high concentration of FC. The clear droplets are the histological correlates of FC emboli which lead to haemorrhagic lung infarction and ischaemic brain infarcts. After intralienal injection FC induces haemorrhagic infarcts of the spleen near the injection site and massive embolization of the intrahepatic portal veins with consequent liver cell necrosis. FC droplets are phagocytosed by hepatic sinusoidal lining cells. Due to the absence of a specific method for identifying FC embolization of renal vessels is difficult to assess.