1/16. Laparoscopic splenectomy for a giant splenic epidermoid cyst: report of a case.The use of laparoscopic splenectomy has increased in recent years, primarily for patients with idiopathic thrombocytopenic purpura (ITP). We describe herein the first known case of a laparoscopic splenectomy to be performed in japan for a patient with a giant splenic epidermoid cyst. A 26-year-old woman presented to our hospital with the major complaint of a feeling of abdominal fullness. Prior to surgery, an ultrasound-guided splenic cyst puncture was conducted for diagnostic purposes as well as to reduce the size of the cyst. The carbohydrate antigen 19-9 (CA 19-9) level was found to be elevated in the cystic contents and in the serum. Under laparoscopic guidance, the splenic vessels were ligated using a device for extracorporeal ligation, then divided. After the resected spleen had been placed in a retrieval bag, it was delivered out of the abdominal cavity without fragmentation. Following surgery, the patient's serum CA 19-9 level returned to normal. Splenic epidermoid cysts are most often encountered in young women, and laparoscopic surgery to remove cysts of this type is both minimally invasive and excellent from a cosmetic standpoint. Thus, laparoscopic surgery should be considered as the method of choice for the majority of patients diagnosed with a splenic epidermoid cyst.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/16. Segmental portal hypertension due to a splenic echinococcus cyst.A 60-year-old Libyan woman developed perihilar splenic varices without other signs of portal hypertension. Plain abdominal X-ray examination showed two calcified structures in the left and right hypochondria. Ultrasound examination disclosed a 3-cm diameter, globally calcified hydatid cyst lodged in a critical location at the hilar region of the spleen. The cyst was compressing the hilar vessels which resulted in dilatation and varix formation. Another hydatid cyst measuring 5 cm in diameter, with extensive wall calcification was visualized in the right lobe of the liver. The splenic size was within normal limits. The liver revealed normal texture and size and the portal vein was of normal caliber. The patient underwent an uneventful splenectomy and was well at discharge.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/16. Power Doppler sonographic diagnosis of torsion in a wandering spleen.A wandering spleen is a rare clinical entity resulting from congenital maldevelopment or acquired laxity of the spleen's suspensory ligaments; it may result in torsion of the spleen. We report the gray-scale sonographic, power Doppler sonographic, and CT findings in a case of wandering spleen torsion. The gray-scale sonograms showed a displaced spleen that appeared as a homogeneous, hypoechoic mass suggestive of an enlarged, ectopic spleen in the central abdomen. Power Doppler sonograms showed no blood flow in the parenchyma or hilum of the spleen and were consistent with torsion and infarction in the spleen. Contrast-enhanced CT scans showed a homogeneous, unenhanced mass that was diagnosed as a torsioned wandering spleen. The hilar vessels of the spleen were also unenhanced.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/16. color Doppler sonographic findings in splenic hamartoma.We present the gray-scale and color Doppler sonographic findings in a case of a splenic hamartoma in a 40-year-old man. Gray-scale sonograms showed a 2 x 2 cm, hypoechoic splenic mass that was homogeneous without evidence of cystic change or calcification. color Doppler sonograms showed multiple radial blood-flow signals inside the mass, and spectral analysis confirmed arterial and venous flow. Arteriograms showed multiple small, hypervascular masses with fine tumor vessels and tumor stains within the spleen. Histologic analysis following a splenectomy showed dilated vessels and congestion consistent with the color Doppler sonographic findings.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
5/16. Splenic involvement in Wegener's granulomatosis.OBJECTIVE: A clinicopathologic review of splenic involvement in Wegener's granulomatosis. DESIGN: A retrospective case review, spanning a 10-year period, identified five patients with Wegener's granulomatosis and splenic involvement. SETTING: A large teaching hospital and outpatient clinics. INTERVENTIONS: Cytotoxic therapy (cyclophosphamide and corticosteroids), mechanical ventilation in respiratory failure, renal hemodialysis in renal failure, and general supportive care. RESULTS: Necrotizing granulomatous inflammation and vasculitis with fibrinoid necrosis were found in the spleen in one antemortem case. At autopsy, two cases demonstrated extensive infarction; microscopic examination revealed parenchymal coagulative necrosis, microcalcification, and vascular thrombosis, but no evidence of vasculitis. Two other cases showed nonspecific changes of diffuse hyalinization of blood vessels, vascular congestion, and hemosiderin deposition. CONCLUSIONS: Splenic involvement in Wegener's granulomatosis is rarely diagnosed during life, occurs more frequently than once thought, and can occasionally lead to considerable morbidity.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/16. A novel application of ultrasound contrast: demonstration of splenic arterial bleeding.Recent research in the use of ultrasound contrast agents has found they are able to increase the diagnostic power of ultrasound, to a level that may exceed other imaging modalities, in the diagnosis of liver lesions. Their application in the assessment of haemorrhage following angiographic embolisation has not previously been described. We report on a case where metal coil embolisation of a bleeding splenic artery aneurysm was completed to angiographic satisfaction, but on injection of ultrasound contrast medium, the aneurysm, distal to the embolisation, showed the presence of ultrasound contrast medium within it. We suggest that contrast enhanced ultrasound may be more sensitive than conventional angiography in the assessment of blood flow through intra-abdominal small vessel aneurysms or solid organs.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/16. Portosystemic shunt with polysplenia and hypoplastic left heart syndrome.We report a unique case of portosystemic shunt with polysplenia and hypoplastic left heart syndrome. The abnormal vessel connected the right renal vein and the splenic vein. The shunt flow was from the systemic vein to the portal vein before the Fontan-type operation, but it reversed and ran from portal vein to systemic vein after the Fontan-type operation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/16. Focal lesions in the ultrasonographic examination of the spleen as a symptom of various disease statuses: literature survey and case descriptions.BACKGROUND: ultrasonography (US) is an easy and non-invasive technique of visualizing spleen. Thanks to its repeatability, it plays an important role in the diagnostics of, among others, developmental anomalies, such as supernumerary or lobated spleens, as well as focal lesions. It is also used in monitoring the size of the spleen and it considerably facilitates diagnosis after certain injuries. Thanks to the application of the Doppler method, it also facilitates the diagnostics of pathologies within the spleen's vessels. CASE REPORT: This paper presents six different cases of focal lesions in the spleen, including lesions in the course of histiocytosis, in the course of sarcoidosis, as well as isolated abscesses of the spleen. The authors also present the case of a spleen with numerous metastatic lesions, the case of a near-splenic cyst, and the case of asymptomatic focal lesions of unknown origin. In all the presented cases, the lesions were accidentally revealed during ultrasonographic examination, which was the starting point for further diagnostics. CONCLUSIONS: Though rare, morphologic lesions in the spleen should always be taken into consideration when performing a routine ultrasonographic examination of the abdominal cavity, and the organ itself should not be ignored. US is a widely available, noninvasive, and useful method for diagnosing splenic abnormalities, including focal changes.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/16. A case of splenic inflammatory pseudotumor.Inflammatory pseudotumor of the spleen in a 50-year-old man was encountered in our surgical clinic. This splenic tumor is very rare and in the ninth of the cases in the literature. The removed spleen, weighting 255g, revealed the presence of a firm, circumscribed mass, measuring 4.5 x 4.0 x 4.5 cm, and histologically presenting marked lamination of collagen fibers around the small vessels associated with granulomatous lesions. The implications of its pathogenesis was analyzed with a review of the literature.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/16. Massive haemorrhage in pancreatitis.Massive haemorrhage in pancreatitis is a very rare complication of pancreatitis but it is the most rapidly lethal, haemorrhage being the major cause of death in more than half of the fatal cases. We present three patients who illustrate this rare complication in its diversity of presentation, and advise that doctors should have a keen clinical awareness of this condition if there is to be an effective and expeditious management. An understanding of the condition, coupled with immediate treatment, using embolisation or laparotomy with direct ligation of the bleeding vessel, can be lifesaving.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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