Choriocarcinoma of the spleen a rare cause of atraumatic. Unfortunately, the diagnosis is often missed due to the absence of any history of trauma. It has a high morbidity, as there is often little or no clinical history to suggest its presence, and is generally diagnosed after imaging. An absence of a history of trauma does not rule out splenic rupture and defines the atraumatic entity. Splenic rupture carries a high mortality rate in the absence of an early diagnosis. Know the causes, signs, symptoms, treatment and diagnosis of splenic infarction. The spleen is an organ of the lymphatic system located on the left side of your stomach abdomen under the rib cage and diaphragm in a region that is referred to as the left upper quadrant. Renzulli p, hostettler a, schoepfer am, gloor b, candinas d. First reported by novielle and chambers in 1991, these injuries include vasospasminduced splenic infarct or hematomas with or without rupture. Atraumatic splenic rupture asr is rare but life threatening. The most common mechanism causing rib fractures is blunt trauma. An abdominal ultrasound was suggestive of spontaneous splenic rupture.
A computedtomography scan showed splenic rupture, and the patient was taken for emergency. Spleen surgery is generally safe, but any surgery has risks, such as bleeding, blood clots, infection and pneumonia. In humans, the spleen is about the size of a fist and its primary roles are filtering the bodys blood and helps to fight infection. A ruptured spleen is typically caused by a blow to the left upper abdomen or the left lower chest, such as might happen during sporting mishaps, fistfights and car crashes. Pathology the pathogenesis of atraumatic splenic rupture is not well understood. Infection usually occurs in the form of a secondary infection in an ischemic infarct region or distant metastasis of infective endocarditis.
Spontaneous atraumatic splenic rupture is a rare but dramatic occurrence that is most commonly attributed to infection or neoplasia. Trauma is the most common cause of splenic rupture, while nontraumatic splenic rupture nsr is a rare condition. Smoking of crack cocaine can cause chest pain, wheezing, coughing and hemoptysis. Spontaneous splenic rupture radiology reference article. Atraumatic splenic rupture and ileal volvulus following. Splenic rupture without risk factors or previous disease. Ruptured spleen can be a killer the new york times. Atraumatic rupture of the spleen in adults request pdf. Spontaneous splenic rupture is a lifethreatening abdominal emergency. On the second postoperative day, the patch dislodged, and a spontaneous. Chronic pancreatitis is a rare cause of pathological rupture. We present a case of spontaneous, atraumatic splenic rupture secondary to epsteinbarr virus ebv infection, in a young, female patient.
Cureus delayed splenic rupture resulting in massive. This case report presents one instance of delayed splenic rupture following minor trauma and discusses the need for further investigation in the management of this condition. Spontaneous spleen rupture is a rare complication of infectious diseases and it can become a potentially lifethreatening condition if not diagnosed in time. Spontaneous splenic ruptures are a rare occurrence. Choriocarcinoma of the spleen a rare cause of atraumatic rupture article in annals of the royal college of surgeons of england 903. The spleen weighs between 75 and 150 grams between 0. Ruptured spleen symptoms are detectable and require immediate treatment. Life threatening abdominal complications following cocaine abuse. There are few reported cases of atraumatic splenic injury caused by cocaine abuse. Atraumatic splenic rupture has been reported as a rare occurrence in both haemodialysis and peritoneal dialysis patients. In contrast, the phenomenon of splenic rupture in the absence of these two risk factors is not documented in emergency medicine textbooks 2, 3 and we believe that it is not widely appreciated by emergency physicians.
Sep 20, 2010 any injury to the spleen can result in a serious medical condition called ruptured spleen. In the absence of a clinical history of trauma, the splenic rupture is most likely spontaneous and due to acute splenitis. We report on an atypical presentation of a spontaneous splenic rupture in a 44yearold previously healthy greek male admitted to the emergency department due to leftsided pleuritic thoracic pain in the course of a pneumonia diagnosed 2 days before. It can occur due to both traumatic and nontraumatic causes. In a series of 22 dialysis patients who had splenectomy for atraumatic rupture 1, amyloidosis was the most common underlying pathology 30%, with other underlying pathology including splenomegaly, hemosiderosis, splenic. Atraumatic splenic rupture usually occurs due to infectious, hematological, or malignant infiltration of spleen. The presence of air in the cranial cavity is termed pneumocephalus, and when this benign air causes a pressure e ect, it is called. Cocaineassociated hemoperitoneum following atraumatic. Atraumatic rupture of spleen introduction splenic rupture is a rare life threatening complication usually occurring after trauma.
The rupture of a normal spleen can be caused by trauma, such as a traffic collision. Nonpenetrating injuries are also called blunt injuries. As a possible mechanism in our case, we believe that the. Spontaneous splenic rupture in an intravenous drug abuser. Following crack abuse, the usual cause of an acute abdomen is a prepyloric. It also serves a role in storing and releasing certain types of immune. The liver or spleen may be injured through sport accidents, a motor vehicle incident or during play, such as a fall from a monkey bar. Immediate diagnosis and surgical treatment can be life saving. Clinicians should have a high index of suspicion in diagnosing atraumatic splenic rupture. The clinical presentation of asr was similar to traumatic splenic rupture tsr. Atraumatic splenic rupture, an underrated cause of acute abdomen article pdf available in insights into imaging 74 may 2016 with 63 reads how we measure reads. We report the case of a previously healthy and immunocompetent 52yearold caucasian woman with a remote history of clinically diagnosed infectious.
Atraumatic splenic rupture, an underrated cause of acute. He was found to have atraumatic splenic rupture causing a. Atraumatic splenic rupture precipitated by splenic vein. Occasional abnormal and thickened hilar and intrasplenic blood vessels focally extending into the area of capsular hematoma. Atraumatic splenic rupture secondary to abscess in a. The spleen is an abdominal organ that plays a vital role in fighting infection and filtering blood. A traumatic injury can cause it to rupture, which may result in surgery to remove the organ. Description the spleen is an organ that produces white blood cells, filters the blood 1015%. Atraumatic spontaneous splenic rupture is a rarer entity and can occur in both histologically normal and diseased spleen. The pathophysiology of crack induced gastrointestinal injury is similar to.
Spontaneous splenic rupture ssr or atraumatic splenic rupture is rare, especially when compared to traumatic splenic rupture. A complete blood count revealing a decreased hematocrit and imaging studies, mainly ultrasonography and computed tomography, are. A 74yearold gentleman presented with a history of leftsided pleuritic chest and upper abdominal pain. However, total splenectomy had to be undertaken because of the failure of the initial treatment. Crack cocaine is the most addictive formulation as it has a rapid onset of euphoria. Clinical presentation and management of atraumatic splenic.
Splenomegaly is present in almost all patients 95%, although rupture of normal spleens both in size and underlying histology has been reported 3. Nsr rarely occurs in a histologically proven normal spleen, and in such cases, is called a spontaneous rupture. Department of radiology, luigi sacco university hospital, via g. The best treatment of splenic rupture secondary to infectious mononucleosis has. Atraumatic splenic rupture in young adult following. Partial splenectomy reduces the risk of infection that results from removing the entire spleen.
Seek emergency care after an injury if your signs and symptoms indicate you may have a ruptured spleen. Atraumatic splenic rupture asr accounts for just over 3% of all cases of splenic rupture and is associated with a high mortality rate. Nonpenetrating injuries to the liver or spleen what you. Spontaneous rupture of the spleen as a result of primary splenic figure 1. We present a case report of atraumatic splenic rupture secondary to epsteinbarr virus ebv infection. Evidence for serial ct imaging to document splenic healing prior to resumption of activities is poor and is only recommended in select individuals. Atraumatic splenic rupture after cocaine use and acute. These injuries may lead to internal bleeding due to the organ rupturing bursting or blood vessel problems. Splenomegaly, infiltration of both the spleen and the capsule and consequently a splenic infarct and hemorrhage were set forth as the causes of the rupture of the spleen in lymphomas. Atraumatic splenic rupture secondary to infectious.
Atraumatic splenic rupture as an initial presentation of. In minor injuries with little bleeding, there may be abdominal pain. Additionally, this case illustrates the diagnostic challenge in a patient presenting in atypical manner, with only leftsided pleuritic chest pain, and. The patient has mentioned a history of massage one day ago but referred it was a more relaxing and not strong message.
Atraumatic splenic rupture asr is an ill defined clinicopathological entity. Atraumatic splenic rupture is a rare complication of this hematologic malignancy, and there are almost no reported cases of cml as the underlying cause. A nontraumatic splenic rupture leads to diagnosis of underlying abnormality previous article effects of perinatal mental disorders on the fetus and child a previously healthy 61yearold man was admitted to our hospital in june, 2014, with a 3 week history of lowgrade fever, general fatigue, and dyspnoea on exertion. Splenic rupture is a welldescribed complication of blunt abdominal trauma. A 17yearold greek female presented to the er due to acute abdominal pain, mainly of the left upper quadrant. A ct scan demonstrated free intraperitoneal fluid and. Results we found 6 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical. An abdominal computed tomography scan showed a splenic laceration and large peri splenic haematoma.
Diagnosis and treatment of atraumatic splenic rupture. Atraumatic uncommon and diagnosis is often missed due to the absence of any. Atraumatic splenic rupture and ileal volvulus following cocaine abuse. This is an interesting and rare case of atraumatic splenic rupture asr presented after sniffing cocaine. The pathogenesis of atraumatic splenic rupture is not well understood. Spontaneous splenic rupture without a history of trauma is very uncommon. At the time of the trauma, the liver or spleen may crack and have bleeding inside the organ, or the covering of the spleen or liver may tear, or rupture, resulting in bleeding inside the abdomen. A ruptured spleen accounts for 10% of all abdominal injuries. In the setting of atraumatic splenic rupture precipitated by splenic vein thrombosis, there has been documented utilization of conservative management and eventual regression of a chronicappearing subcapsular splenic hematoma in an otherwise hemodynamically stable patient 19. The spleens in these cases are often not markedly enlarged but presumably soft as a result of the infection allowing for easy rupture. Rupture of the spleen is relatively common both immediately and in a delayed fashion following significant blunt abdominal injury, and this phenomenon is well documented in the scientific literature and textbooks e. Splenic trauma definition of splenic trauma by medical.
Spleen rupture can be caused by severe direct blow. Definition splenic trauma is physical injury to the spleen, the lymphatic organ located in the upper left side of the abdomen just under the rib cage. Deciphering the etiology can be challenging with many cases remaining unclear despite full investigation. Ruptured spleen diagnosis and treatment mayo clinic. Splenic rupture without history of trauma also has been reported. In our patient, spontaneous splenic rupture occurred after a snakebite, and splenic artery embolization was initially performed.
First reported by novielle and chambers in 1991, these injuries include vasospasminduced splenic infarct or hematoma s with or without rupture. However, upon finishing reading the article we thought that general radiologists should be well aware of the condition known as lifethreatening atraumatic splenic rupture asr, which has not yet been presented. It might be possible to remove only part of your spleen, depending on the rupture. Causes the most common cause of a ruptured spleen is blunt trauma to the abdomen. Nov 30, 2014 spontaneous atraumatic splenic rupture is a rare but dramatic occurrence that is most commonly attributed to infection or neoplasia. Splenic rupture in the absence of trauma is exceedingly rare. A lower rib fracture is more likely associated with injuries to the diaphragm, liver or spleen. Atraumatic rupture of the spleen is an uncommon but important clinical entity. Pain in the upper left abdominal quadrant, hypotension, pallor, tachycardia and abdominal distention are main symptoms. In this study, we retrospectively described our experience on the diagnosis and treatment of 8 patients male. Splenic rupture is a rare complication of ebv infection, but is associated with the highest mortality.
Atraumatic splenic rupture is an uncommon and potentially fatal clinical entity. During his stay, pain extended to the epigastric region. Rib fractures the american association for the surgery of trauma. Atraumatic spontaneous rupture of the spleen is an uncommon but fatal case. Blunt injuries to the liver or spleen may include a tear, cut, or bruise to the organ. The clinical presentation and treatment options of atraumatic splenic rupture are often similar to traumatic rupture. Although atraumatic splenic rupture asr is uncommon, it warrants early recognition due to the potentially fatal consequences and thus should be included in the differential diagnosis of patients with left upper quadrant abdominal pain. A splenic injury, which includes a ruptured spleen, is any injury to the spleen. Atraumatic splenic rupture asr can occur in diseased pathologic rupture or normal spleen spontaneous rupture. This case is the first to describe hemoperitoneum of splenic etiology following cocaine use. A nontraumatic splenic rupture leads to diagnosis of. Nsr has been described in the medical literature as a clinical oddity with grave consequences, if unrecognized and untreated.
Acute pulmonary edema, pulmonary hemorrhage and pneumothorax have all been described, but less commonly. On the basis of our personal experience, we strongly agree with the authors when they state that the spleen is an underrated cause of acute abdomen, and that severe morbidity and mortality result from delayed or missed diagnosis of splenic lesions. Splenic rupture occurs when the spleen is placed under intense pressureduress, strong enough to tear or separate the outer lining of the organ. A ruptured spleen causes abdominal pain, usually severe, but not always. Spontaneous atraumatic splenic rupture radiology case. Dec 21, 2011 although a majority of splenic ruptures present acutely with a known mechanism of injury, a minority of patients present days to weeks following trauma with a delayed rupture. It occurs when the capsulelike covering of the organ breaks open, causing internal bleeding. Internal bleeding occurs secondary to a ruptured spleen and can cause blood. Although uncommon, atraumatic splenic rupture should be recognized early because it is potentially fatal. Trivial trauma and delayed rupture of a normal spleen.
These are injuries resulting from a direct force on the abdomen without an open wound. Examination and chest xray findings were suggestive of pneumonia. The signs of atraumatic splenic rupture are abdominal pain, left shoulder pain and, more rarely, shock. Delayed splenic rupture, once thought to be unusual, but now growing in incidence, is an issue that could potentiate severe morbidity and mortality to patients, regardless of the severity of the trauma. A rare case of atraumatic splenic rupture due to ceroid histiocytosis is described in a 56yearold man. During hospitalization, he complained of epigastric pain, which was not associated with. Although splenic abscess has a wide variety of causes, it is most often associated with trauma and infection.
The most common culprit is acute infection with epsteinbarr virus ebv but other documented aetiologies include neoplasia, other viralbacterial infections, acute and chronic pancreatitis, amyloidosis and anticoagulant medications. Splenic rupture most commonly results from a traumatic mechanism. Spontaneous rupture of the spleen masquerading as a. Nontraumatic splenic rupture mdedge emergency medicine. Atraumatic rupture of a normal spleen represents a rare clinical phenomenon. The patient presented with abdominal pain and tenderness with low. Atraumatic splenic rupture after coagulopathy owing to a. The severity and even the location of the pain depend on how badly the spleen has ruptured and how much blood leaks out. The aim was to characterize aetiological and risk factors for asrrelated mortality in order to aid disease classification and treatment. Pdf atraumatic splenic rupture, an underrated cause of. This article is published with open access at dear sir. Surgical management of atraumatic splenic rupture alyssa m. Splenic hematoma or rupture of the spleen is rare in the absence of trauma.
Ruptured spleen, condition that can result from minor injuries, has become. He was found to have atraumatic splenic rupture causing a hemoperitoneum that was managed by. Possible infectious causes of spontaneous splenic rupture. After describing the common injuries from blunt abdominal trauma, this paper comprehensively describes several more or less unusual nontraumatic acute conditions including splenic infarction, aneurysms and pseudoaneurysms, arterial and venous thrombosis, splenic. Other differentials in such a patient would include cardiac ischaemia, pulmonary embolism, pneumonia, peptic ulceration or ruptured sigmoid diverticulitis 6, 7. Also uncommon is the atraumatic rupture, the vast majority of which occur in patients with underlying splenic pathology. E introduction atraumatic splenic rupture asr is a potentially lifethreatening condition that occurs spontaneously, in the absence of trauma. Atraumatic splenic rupture secondary to epsteinbarr virus. Splenic abscess has been reported to develop as a consequence of septic microembolism of the spleen. In the kidneys, it can cause acute kidney injury from rhabdomyolysis and contribute to progression of chronic kidney disease, especially in.
The area of the spleen affected by loss of blood supply or essentially the regions where the tissue death in the spleen has occurred is known as splenic infarct. When a blunt abdominal trauma is present, the spleen is the most frequently and often t. No evidence of splenomegaly or other underlying condition to explain the spontaneous rupture. No aetiology is described in 57% of cases of atraumatic splenic rupture. Atraumatic splenic rupture, an underrated cause of acute abdomen. This case illustrates a splenic rupture of unknown cause, presumed atraumatic. After describing the common injuries from blunt abdominal trauma, this paper comprehensively describes several more or less unusual nontraumatic acute conditions including splenic infarction, aneurysms and pseudoaneurysms, arterial and venous thrombosis. Splenectomy is an appropriate treatment to avoid splenic rupture, splenic vein thrombosis and painful splenomegaly, to circumvent the splenic metastasis being a source of ncbi. A handful of cases of apparently spontaneous rupture of a normal spleen are reported. The is a case of spontaneous splenic rupture seen usually in younger people with an underlying viral illness as as cmv or infectious mononucleosis. The diagnosis of atraumatic splenic rupture asr can be made with the orloff and peskin criteria, which states that asr can be diagnosed when the following four criteria are met.
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