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Background: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an unusual complication related to various injuries or conditions which involve the mitro-aortic region; it communicates with the left ventricular outflow tract and is associated with a high-risk of redoubtable complications or sudden death. The cerebral and splenic localizations are frequently seen as manifestations of systemic embolism in infective endocarditis. Currently, there are no specific recommendations related to the diagnosis, management, treatment, or further evolution of patients with P-MAIVF and concomitant splenic infarction. This paper presents the case of a 43-year-old Caucasian woman with a late diagnosis of mixed bicuspid aortic valve disease, affected by an under-detected and undertreated episode of infective endocarditis leading to asymptomatic P-MAIVF. Prime clinical and imagistic diagnosis of splenic infarction indicated further extended investigations were required to clarify the source of embolism. Methods: Integrated multimodality imaging techniques confirmed the unexpected diagnosis of P-MAIVF. Results: The case had a fatal outcome following an uncomplicated yet laborious cardiac surgery. Patient death was attributed to a malignant ventricular arrhythmia. Conclusion: The present case raises awareness by highlighting an unexplained and unexpected splenic infarction association with P-MAIVF as a result of infective endocarditis related to mixed bicuspid aortic valve disease.

Microscopic polyangiitis (MPA) is an anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The splenic involvement in AAV is known to be rare, and that in MPA has not been reported to date. A 74-year-old woman was admitted owing to left arm numbness and weakness. The patient was diagnosed as MPA with vasculitic neuropathy. Her abdominal computed tomography (CT) revealed splenic infarction incidentally. The splenic infarction had been resolved at follow-up CT after treatment. If splenic involvement of MPA was not considered, treatment may have been delayed in order to differentiate other diseases. Herein, I report the first case of splenic involvement of MPA.

Splenic infarction after contralateral laparoscopic renal surgery has not, to our knowledge, been reported. The spleen is the most affected organ in sickle cell disease and the mechanism of auto infarction is thought to result from the crystallization of abnormal hemoglobin during periods of hypoxia or acidosis resulting in parenchymal ischemia and ultimately tissue necrosis. We report a case of 45 year old female with sickle cell disease who had an unremarkable spleen at the time of a laparoscopic right partial nephrectomy and was subsequently found to have marked diminution in her splenic volume.

Objective: To early recognise and improve the prognosis of children systemic lupus erythematosus (cSLE)-associated pancreatitis by summarising and analysing clinical features and prognosis data from 12 cases., Methods: Retrospective analysis of clinical data from 12 cases of cSLE-associated pancreatitis diagnosed and treated from January 2016 to December 2021 at hospitals such as Children's Hospital of Capital Institute of Paediatrics., Results: The median SLEDAI-2K score for disease activity was 18.00 (range 12.25-21.00) in the case group and 10.00 (range 7.00-18.00) in the control group, with a statistically significant difference (P < 0.05) between the two groups. The case group had a higher proportion of abdominal pain, vomiting, abdominal distension, pleural effusion, Raynaud's phenomenon (RP), splenic infarction, and concurrent macrophage activation syndrome (MAS) than the control group, with a statistically significant difference (P < 0.05). Serum ferritin (SF), alanine transaminase (ALT), aspartate transaminase (AST), lactate dehydrogenase (LDH), amylase, and increased 24-h urine protein levels were statistically different between the two groups (P < 0.05); platelet counts (PLT) reduction was also statistically different (P < 0.05). The case group had a higher proportion of methylprednisolone pulse therapy, cyclophosphamide pulse therapy during remission induction, and therapeutic plasma exchange than the control group, with a statistically significant difference (P < 0.05) between the two., Conclusion: CSLE-associated pancreatitis has a high fatality rate. The presence of RP, splenic infarction, pleural effusion, and MAS warrants attention from clinicians regarding the possibility of pancreatitis. Once pancreatitis is detected, the primary disease needs active treatment for better prognosis., (© 2024. The Author(s).)

• Young adult COVID-19 patient presented with acute abdomen. • Evaluation of patient revealed splenomegaly, splenic rupture and hemoperitoneum. • Patient recover with conservative management. Coronavirus disease (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients commonly present with respiratory tract symptoms and fever. However two third are asymptomatic and unusual presentation is evolving. This has cause management dilemma among physicians. A 32 year young otherwise healthy male presented to emergency department of this institute with fever of 103 °F, abdominal pain, and pancytopenia with progressive fall in hemoglobin level was tested positive for COVID-19. Contrast enhance computed tomography of the patient revealed hemoperitoneum with splenic infarct. He was admitted in intensive care unit and managed with supportive treatment. Respiratory and gastrointestinal symptoms with hematological abnormalities like lymphopenia, thrombocytopenia are common presentation of COVID-19. Although coagulopathy and vasculitis has been a well-documented entity in patients with COIVD-19, visceral infarction leading to spontaneous hemoperitoeum was unusual and rare clinical presentation. A high degree of clinical suspicion and thorough evaluation helps in the diagnosis of COVID-19 and related complications. The management of cases with unusual presentation requires judicious and careful approach. [ABSTRACT FROM AUTHOR]

Isolated spontaneous dissection of the celiac trunk is rarely diagnosed in acute abdominal pain. We present two cases of celiac trunk and splenic artery dissection with splenic infarction. Patients were successfully managed and stabilized by medical treatment. Isolated celiac trunk dissection can be fatal, therefore providers should be careful not to overlook this entity.

Babesiosis, caused by Babesia microti and B. divergens, is transmitted by Ixodid ticks. Symptoms of babesiosis vary from a mild flu-like illness to acute, severe, and sometimes fatal and fulminant disease. In Korea, 7 imported babesiosis cases and 1 endemic case have been reported. We report 2 cases of severe babesiosis initially mistaken as malaria. The first patient was complicated by shock and splenic infarction, the other co-infected with Lyme disease. As the population traveling abroad increases every year, physicians should be aware of babesiosis which mimics malaria, co-infection with other diseases, and its complications. [ABSTRACT FROM AUTHOR]

Background: Babesiosis is a zoonotic parasitic infection transmitted by the tick, Ixodes scapularis. Splenic infarct and rupture are infrequent complications of Babesia parasitemia, and have not been previously reported in the emergency medicine literature.Case Report: We present two separate cases seen within 1 month at our institution: a case of splenic rupture and another case of splenic infarction due to Babesia parasitemia. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Babesia infection in humans is increasingly prevalent in both the United States and worldwide, and clinical manifestations can range from subclinical to fulminant infections. An unusual but potentially fatal complication of babesiosis is splenic infarctions and rupture. Due to the endemicity of this parasite, a careful history and level of suspicion will enable the emergency physician to consider and test for babesiosis in patients with splenic injuries and without obvious traditional risk factors. [ABSTRACT FROM AUTHOR]

Purpose: Splenic infarction may occur if the splenic branches are injured or ligated accidentally during gastrectomy. We used three-dimensional computed tomography (3D-CT) imaging to distinguish the vascular anatomy of the splenic hilum in individual patients, focusing on the splenic polar branches and the gastric branches.Methods: The subjects of this study were 104 patients who underwent computed tomography (CT) with intravenous contrast before gastrectomy. SYNAPSE 3D® (Fujifilm Medical, Tokyo, Japan) was used to generate the 3D-CT images. The total spleen volume and the area supplied by the superior polar artery (SPA) in each patient were estimated using the “liver analysis” function.Results: The SPA without the gastric branch (supplying only the spleen), the SPA with the gastric branch (supplying both the stomach and the spleen), and the posterior gastric artery (supplying only the stomach) were present in 14, 45, and 18% of the patients, respectively. The SPA supplied 12% of the total spleen volume on average; however, it supplied over 30% in two patients.Conclusion: We identified the vascular anatomy around the splenic hilum in over 100 patients. Based on our findings, we recommend preservation of the SPA when it is supplying a large area of the spleen. Preoperative 3D-CT analysis provides useful information to optimize safe gastrectomy. [ABSTRACT FROM AUTHOR]

Introduction: There are insufficient data on the aetiologic factors underlying splenic infarction (SI). Therefore, there is no consensus regarding the appropriate diagnostic approach. Methods: We conducted a retrospective analysis of all patients admitted with SI from January 2004 to December 2014. Medical records were screened for the clinical presentation, underlying causes, associated medical conditions and methods of patient evaluation. Results: We found 89 subjects with 90 episodes of SI. Presentation of SI was characterized by abdominal, flank and chest pain (82.2%, 18.9%, 7.8%, respectively); leukocytosis (in 67% of tested subjects); elevated LDH (72%), CRP (97.5%) and D-Dimer (100%). The main underlying mechanisms were cardioembolic (54.4%), vascular (20%), haematologic disorders (15.6%) and multiple causes (21.1%). Atrial fibrillation and atherosclerosis were common in older patients (age > 70 years) while antiphospholipid syndrome occurred exclusively in younger individuals. SI was the presentation of previously unknown medical conditions in 38% of patients. Abdominal CT, ECG, echocardiography and blood cultures demonstrated the highest diagnostic yield. Conclusions: Contributing factors are identified in the majority of SI patients. We recommend CT, ECG, echocardiography and blood cultures in all cases. Atrial fibrillation should be sought in older patients, while APLS and haematologic disorders should be suspected in younger ones. KEY MESSAGES: There is no consensus regarding the diagnostic approach and management of splenic infarction. Cardiovascular disease and atrial fibrillation are the main causes for SI in elderly subjects while hematological, infectious and other causes are more prevalent in younger ones. Our data strongly suggests a high diagnostic yield for CT scan, ECG, blood culture and echocardiogram in every patient with SI. [ABSTRACT FROM AUTHOR]

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The diagnosis of splenic infarction is rarely reported in pregnant women. Current incidence of splenic infarction, especially during infectious endocardites as well as diagnostic methods used are poorly specified in the literature. We here report the case of a 26-year old woman with no particular previous history or cardiovascular risk factor who, at the end 14 weeks of amenorrhea, presented to the Emergency Department with febrile syndrome evolving over 10 days and abdominal pain of recent onset at the level of the left hypochondre. Clinical examination showed febrile patient with a temperature of 39.5°C, tenderness of the left hypochondre and panaritium at the level of the palm of the left hand and of the sole of the foot. Gynecological examination was strictly normal. Given this clinical picture, abdominal ultrasound showed mediosplenic anechoic area with hilar apex and with peripheral edges, suggesting splenic infarct. Etiological assessment included echocardiography showing thickened and remodeled oslerian graft on the mitral valve with large valve vegetation and MI grade II. Blood cultures were performed during the febrile peaks and were positive for golden staph. Patient's evolution was marked by the occurrence of large ischemic stroke and worsening of neurological condition, leading to death after several systemic emboli. Splenic infarction in a pregnant woman is very rare. However, clinical and radiological examination of the spleen must be performed in patients with acute abdominal pain of the left hypochondre. In the present case, pain of the left hypochondre associated with fever and Osler's false whitlow was found to be splenic infarction associated with infectious endocarditis. Probabilistic antibiotic therapy as first-line therapy is justified during infective endocarditis and should be secondarily adapted to the bacteriological results. Although rare, splenic infarction can have severe consequences such as abscesses or rupture, which must encourage vigilance. [ABSTRACT FROM AUTHOR]

Splenic infarction after contralateral laparoscopic renal surgery has not, to our knowledge, been reported. The spleen is the most affected organ in sickle cell disease and the mechanism of auto infarction is thought to result from the crystallization of abnormal hemoglobin during periods of hypoxia or acidosis resulting in parenchymal ischemia and ultimately tissue necrosis. We report a case of 45 year old female with sickle cell disease who had an unremarkable spleen at the time of a laparoscopic right partial nephrectomy and was subsequently found to have marked diminution in her splenic volume. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Bacterial endocarditis is an infection of the endothelial surface of the heart, including heart valves and is potentially life threatening. Antibiotic prophylaxis is indicated prior to invasive procedures in patients with certain high-risk cardiac conditions and thorough history needs to be elicited prior to performing such procedures. Herein, we present a case of splenorenal infarction secondary to septic emboli in a 42-year-old patient with prosthetic aortic valve who underwent a dental procedure without endocarditis prophylaxis.

This report reviews literature on splenic infarction. It also describes the case of a 27-year-old female who was bedridden because of a muscular disease and who was admitted to the emergency department with chest pain. She experienced continuous squeezing and compressing pain, which originated from the lower left hemithorax and radiated to the left axilla. A splenic infarct was detected after 24 h follow-up in the emergency room. Emergency physicians should keep in mind that chest pain originating from the lower left thorax and radiating to the left shoulder can be a sign of splenic infarction.

Objective: Rare disease Background: Babesiosis is an emerging, tick-borne zoonosis caused by intraerythrocytic protozoa of the genus Babesia. Babesia microti is the main pathogen causing human disease and is endemic in the northeastern and upper midwestern parts of the USA. Severity of infection ranges from mild, self-limited, febrile viral-like illness accompanied by nonspecific symptoms to life-threatening infection complicated by severe hemolytic anemia, disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and renal or/and hepatic failure. Splenic rupture (SR) is a very rare but life-threatening complication of severe B. microti infection. Case Report: A 79-year-old female farmer from Wisconsin, USA was admitted during summer with hemorrhagic shock secondary to spontaneous splenic rupture. She was transfused with 3 units of packed red blood cells (PRBC) and underwent emergent splenectomy. Postoperatively, she recovered well and was discharged on postoperative day 4. However, she was re-admitted on postoperative day 10 for febrile hemolytic anemia. Further exposure history was obtained and was significant for multiple tick bites 8 weeks preceding the index hospitalization. She was promptly diagnosed with babesiosis and Lyme disease co-infection. She responded favorably to 10 days of azithromycin and atovaquone and 21 days of oral doxycycline. Conclusions: Despite its rare occurrence, SR due to B. microti infection is a dreaded complication that can rapidly progress to hemorrhagic shock and death. In contrast to other complications of babesiosis, SR is not correlated with parasite burden or immune status of the affected host. Babesiosis should be considered as part of the differential diagnosis in patients from endemic areas presenting with atraumatic splenic rupture. [ABSTRACT FROM AUTHOR]

Brucellosis is a zoonotic infectious disease that involves the tissues and organs of the reticuloendothelial system. Although splenomegaly may be seen in brucellosis, spleen abscess or spleen infarction has rarely been reported. Left upper quadrant pain and fever are the most common symptoms in splenic infarction. In this article, we present a 79-year-old woman with splenic infarction due to brucellosis; she had splenectomy and was treated with antimicrobial therapy for brucellosis. [ABSTRACT FROM AUTHOR]

We present a patient with scrub typhus complicated with a splenic infarction. A 40-year-old man visited the emergency medical center complaining of fever for the previous week. He had no past medical history, but reported engaging in outdoor activities. Examination revealed a maculopapular rash on his tmnk and an eschar on his epigastrium. Abdominal computed tomography was performed to examine the cause of the tenderness on the left upper quadrant of his abdomen, which revealed a splenic infarct. The patient was diagnosed with scrub typhus based on the results of blood polymerase chain reaction testing, and genetic sequencing confirmed the presence of Orientia tsutsugamushi Boryong. His symptoms improved following doxycycline treatment. [ABSTRACT FROM AUTHOR]

Background: The burden of disease caused by Streptococcus agalactiae has increased significantly among older adults in the last decades. Group B streptococcus infection can be associated with invasive disease and severe clinical syndromes, such as meningitis and endocarditis. Case presentation: We present the case of a 56-year-old man who developed multiple mycotic aneurysms of the right hepatic artery and massive splenic infarction as rare complications of Streptococcus agalactiae infective endocarditis. The patient underwent urgent right hepatic artery ligation and splenectomy. The postoperative course was complicated by an episode of hemobilia due to the rupture of a partially thrombosed mycotic aneurysm into the biliary tree. Thus, selective radiological embolization of the left hepatic artery branches was necessary. Conclusion: To our knowledge, this is the first case reported of infected aneurysms of visceral arteries caused by Group B streptococcus infection. Clinical and laboratory findings were non-specific, while imaging features with computed tomography scan and angiography were highly suggestive. In our case, early recognition, culture-specific intravenous antibiotics and urgent surgical treatment combined with interventional radiology played a decisive role in the final result. [ABSTRACT FROM AUTHOR]

Barlow's disease is echocardiographically characterized by thickened and prolapsed mitral leafl ets due to diffuse excess of tissue caused by myxomatous degeneration. We report the case of a 65-year-old male with lumbar pain as presenting feature of Barlow's disease. The patient was admitted for dyspnoea at rest and reported acute lumbar pain before admission. Clinical examination and EKG changes were consistent with atrial fi brillation with rapid ventricular response. The abdominal-pelvic CT scan showed suggestive aspect of splenic infarction. After admission, the patient suffered an episode of transitory aphasia compatible with a transient ischaemic attack. Echocardiography revealed prolapse of both mitral leafl ets, moderate-severe mitral regurgitation, LVEF of 40% and left atrial enlargement. The transesophageal echocardiography confi rmed Barlow's disease and asserted there were no thrombi in the left appendage. During hospitalization and after discharge the patient received anticoagulation therapy (high molecular weight heparin followed by oral anticoagulant), beta-blocker and angiotensin-converting-enzyme inhibitor. Cardioversion was performed after one month and the patient remained in sinus rhythm during two years follow-up. After cardioversion the LVEF and LV dimensions normalised. The therapeutic approach is mitral valve repair which was temporized due to reversed systolic dysfunction and NYHA class I symptoms. The particularity of the case consists in the presentation with lumbar pain and the reversibility of LV dysfunction to sinus rhythm restoration, proving tachycardiomyopathy [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 72-year-old man underwent video-assisted thoracoscopic left upper lobectomy for small cell lung cancer. After 16 days, he experienced epigastric abdominal pain and vomiting, and was taken by ambulance to our hospital. Contrast-enhanced computed tomography (CT) showed a propagation of thrombus in the stump of the left superior pulmonary vein (LSPV) complicated with splenic infarction. The patient received anticoagulation therapy with heparin and warfarin, and further progression of the thrombus or any systemic embolic event was not observed during hospitalization. Here, we report a patient presenting with LSPV thrombosis complicated with splenic infarction after video-assisted thoracoscopic surgery (VATS), and describe several months follow-up CT imaging results after administration of an oral anticoagulation therapy. < Learning objective: Pulmonary venous thrombosis after lung surgery is a rare, but critical, condition. Only few cases have been previously reported and all cases described LSPV thrombus. We also demonstrated LSPV thrombus after VATS lobectomy, and clearly showed follow-up results after anticoagulation therapy. Our case indicates the need for periodic CT imaging follow-up after left upper lobectomy and may call attention to thoracic surgeons, internal medicine, and cardiology physicians regarding this complication.> [ABSTRACT FROM AUTHOR]

Summary Spontaneous splenic infarction is a relative rare disease and usually happens in patients with some disorders that have potential of thromboembolism formation. The symptoms are often subclinical and non-specific so physicians easily forget this diagnosis. However, splenic infarction could cause destructive consequences such as hemorrhagic shock, especially in old or weak patients. In this article, we present one case with fever and unexplained abdominal pain; the patient was ultimately diagnosed spontaneous splenic infarction. Although early suspicion or diagnosis may be challenged, physicians should remember this disease and arrange associated investigation to make correct management. [ABSTRACT FROM AUTHOR]