Validation of 2d ultrasound and volume estimation formulae for volume assessment of kidneys and spleens: an in-vitro study / alidación de la fórmula de estimación de volumen y ultrasonido 2D para la evaluación del volumen de los riñones y el bazo: un estudio in vitro

The accuracy of internal organ volume estimation done with ultrasound (US) was found to be multifactorial. Hence, we aimed to describe and validate the volume assessment of ultrasound and standard volume estimation formulae for different shaped intra-abdominal organs using spleens and kidneys.Dissected cadaveric kidneys (n=25) and spleens (n=29) were scanned to obtain linear measurements and ultrasound auto-generated volumes (USV). Linear measurements were used to calculate the volumes manually with ellipsoid, prolate, and Lambert volume estimating formulae. The actual volumes (AV) of organs were obtained by the water displacement method. Volume assessment accuracy of USV and different formulae were compared by comparing bias, precision and Bland-Altman plot analysis. The US linear and volume measurement procedure was reliable with high inter and intra-observer agreements (linear: Chronbach's α=0.983 to 0.934; volumes: Chronbach's α=0.989). USV estimates were accurate with a high correlation to AV and low estimation bias (-5.9%). Also, prolate (bias=-0.75%) and ellipsoid formulae (bias=-3.75%) were reliable with a negligible bias in estimated volumes. Contrary, the Lambert formula was unreliable due to a high bias (41.6%). For all evaluated methods, the estimation error found to be related to the organ size (T=3.483; p=0.001), mainly when the assessed organ is larger than 50 ml. Also, the shape related estimation error found to be related to the volume estimation formula used.This study has validated the USV for kidney and splenic volume assessments while describing volume-calculating formula employed, organ size and shape as significant contributors for volume estimation accuracy.

Se encontró que la precisión de la estimación del volumen de órganos internos realizada con ultrasonido (US) es multifactorial. El objetivo fue describir y validar la evaluación de volumen mediante ecografía y las fórmulas estándar de estimación de volumen para órganos intraabdominales de diferentes formas utilizando bazos y riñones.Se evaluaron riñones cadavéricos disecados (n = 25) y bazos (n = 29) para obtener medidas lineales y volúmenes autogenerados por ultrasonido (USV). Se utilizaron medidas lineales para calcular los volúmenes manualmente con fórmulas de estimación de volumen elipsoide, prolate y Lambert. Los volúmenes reales (AV) de los órganos se obtuvieron mediante el método de desplazamiento de agua. Se comparó la precisión de la evaluación del volumen de USV y diferentes fórmulas comparando el sesgo, la precisión y el análisis de la gráfica de Bland-Altman. El procedimiento de medición lineal y de volumen mediante US fue confiable con alta concordancia inter e intraobservadores (lineal: α de Chronbach = 0,983 a 0,934; volúmenes: α de Chronbach = 0,989). Las estimaciones de USV fueron precisas con una alta correlación con AV y un bajo sesgo de estimación (-5,9%). Además, las fórmulas prolate (sesgo= -0,75%) y elipsoide (sesgo = -3,75%) fueron confiables con un sesgo insignificante en los volúmenes estimados. Por el contrario, la fórmula de Lambert no fue confiable debido a un alto sesgo (41,6%). Para todos los métodos evaluados, se encontró que el error de estimación estaba relacionado con el tamaño del órgano (T = 3.483; p = 0.001), principalmente cuando el órgano evaluado es mayor de 50 ml. Además, se encontró que el error de estimación de forma está relacionado con la fórmula de estimación de volumen utilizada.Este estudio ha validado el USV para evaluaciones de volumen renal y esplénico al mismo tiempo que describe la fórmula de cálculo de volumen empleada, el tamaño y la forma de los órganos como contribuyentes significativos de la precisión de la estimación de volumen.

O índice esplênico como preditor de sangramento e recidiva varicosa no seguimento tardio de paciente esquistossomóticos após tratamento endoscópico exclusivo / The splenic index as predictor of bleeding and variceal recurrence in the late follow-up of schistosomotic patients after exclusive endoscopic treatment

RESUMO - RACIONAL: O tratamento endoscópico das varizes esofágicas tem sido utilizado como principal intervenção em pacientes com hipertensão portal secundária à esquistossomose, mas com taxas significativas de recorrência de varizes esofágicas e ressangramento. Os resultados em longo prazo do tratamento endoscópico exclusivo são pouco estudados quanto à relação das dimensões esplênicas neste contexto. OBJETIVO: Avaliar, por meio da ultrassonografia, o índice esplênico e a dimensão longitudinal (craniocaudal) do baço como preditores de ressangramento e recorrência de varizes no seguimento tardio de pacientes esquistossomóticos não operados, após erradicação endoscópica das varizes esofágicas. MÉTODOS: Estudo observacional retrospectivo por meio da análise de prontuários de pacientes com diagnóstico de esquistossomose hepatoesplênica. A curva ROC foi usada para determinar o melhor ponto de corte para o índice esplênico médio como preditor de recorrência e sangramento. RESULTADOS: Foram analisados 54 pacientes, durante o período de 2002 a 2018. O tempo médio de seguimento foi de 8 anos. O índice esplênico provou ser um teste sensível em valores acima de 144 como preditor de ressangramento. Na análise da dimensão longitudinal, o valor acima de 20 cm apresentou teste estatisticamente significativo para recorrência de varizes e valor acima de 19 cm apresentou-se como teste muito sensível e estatisticamente significativo para ressangramento. CONCLUSÃO: A análise do índice esplênico e da dimensão craniocaudal, obtidos por ultrassonografia, podem predizer recorrência de varizes e ressangramento após erradicação endoscópica exclusiva.

ABSTRACT - BACKGROUND: Endoscopic treatment for esophageal variceal has been used as the main intervention in patients with portal hypertension secondary to schistosomiasis, but with significant rates of recurrence of esophageal variceal and rebleeding. The long-term results of exclusive endoscopic treatment are poorly studied as the relationship of the splenic dimensions in this context. AIM: The aim of this study was to identify, through ultrasonography, whether the splenic index and the longitudinal (craniocaudal) dimension of the spleen are the predictors of rebleeding and variceal recurrence in late follow-up of patients with nonoperated schistosomiasis, after endoscopic eradication of esophageal variceal. METHODS: This is a retrospective and observational study analyzing the medical records of patients diagnosed with hepatosplenic schistosomiasis. The receiver operating characteristic curve was used to determine the best cutoff point for the mean splenic index as a predictor of recurrence and bleeding. Results: A follow-up of 54 patients were analyzed during the period from 2002 to 2018. The mean follow-up time was 8 years. The splenic index with value >144 was proved to be a sensitive test for rebleeding. In the analysis of the longitudinal dimension, the spleen length of >20 cm showed a statistically significant test for recurrence of variceal and a length >19 cm presented as a very sensitive and statistically significant test for rebleeding. CONCLUSION: Splenic index and craniocaudal dimension analysis, obtained by ultrasonography, can predict recurrence of varicose veins and rebleeding after exclusive endoscopic treatment.

Clinical, laboratory, ultrasonographic, and anatomopathological aspects of 30 cases of traumatic reticulosplenitis in cattle / Aspectos clínicos, laboratoriais, ultrassonográficos e anatomopatológicos de 30 casos de reticulo-esplenite traumática em bovinos

Ingestion of metallic and/or sharp foreign bodies triggers cases of traumatic reticuloperitonitis and its sequelae in cattle. Among these sequelae, we can highlight traumatic reticulosplenitis, that has high mortality, although its frequency in the ruminant medicine is low. Therefore, based on the scarcity of information on this disease, the current study aimed to evaluate the clinical, laboratory, ultrasonographic, and pathological findings of 30 adult cattle diagnosed with traumatic reticulosplenitis. Clinical, ultrasound, and anatomopathological findings were analyzed using descriptive statistics and laboratory data were evaluated using measures of central tendency. Clinically the animals presented dehydration and alterations in behavior, appetite, and ruminal motility. Hematological findings revealed neutrophilic leukocytosis (37077.17±25004.59cell/µL) with regenerative left shift and hyperfibrinogenemia (1130±364.98mg/dL). The ultrasound examination enabled visualization of mobile and echogenic filaments that corresponded to the presence of fibrin adhesions. Displacement of the reticulum and irregularity in its contour, as well as alterations in the quantity, pattern, and amplitude of reticular contractions were also observed. Splenic alterations such as abscesses were found, characterized as circular structures of varying sizes delimited by capsules containing variable echogenicity. Splenic vein thrombosis and spleen folding were also observed. The results obtained in the current study indicated that traumatic reticulosplenitis causes nonspecific clinical signs, severe laboratory alterations and, mainly, that ultrasound is an efficient method for the diagnosis of this disease, since the anatomopathological lesions confirmed the ultrasound findings.(AU)

A ingestão de corpos estranho de origem metálica e/ou pontiagudos desencadeia em bovinos, quadros de Reticuloperitonite Traumática e suas sequelas. Dentre as quais podemos destacar a retículo esplenite traumática cuja letalidade é elevada, embora a mesma apresente uma baixa frequência na clínica de ruminantes. Portanto, baseado na escassez de informações sobre esta enfermidade, este trabalho teve por objetivo avaliar os achados clínicos, laboratoriais, ultrassonográficos e anatomopatológicos de 30 bovinos adultos diagnosticados com retículo esplenite traumática. Os achados clínicos, ultrassonográfico e anatomopatológico foram analisados por meio de estatística descritiva, e os dados laboratoriais foram avaliados utilizando-se as medidas de tendência central. Clinicamente os animais apresentaram desidratação e alterações no comportamento, apetite e na motilidade ruminal. Os achados hematológicos revelaram leucocitose (37077.17±25004.59cell/µL) por neutrofilia com desvio à esquerda regenerativo e hiperfibrinogenemia (1130±364.98mg/dL). O exame ultrassonográfico possibilitou a visualização de filamentos móveis e ecogênicos que corresponderam à presença de aderências fibrinosas, observou-se também, deslocamento do retículo e irregularidade no seu contorno além das alterações na quantidade, padrão e amplitude das contrações reticulares. Permitiu ainda, a constatação de alterações esplênicas como abscessos que foram caracterizados como estruturas circulares de variados tamanhos delimitada por capsula contendo no seu interior conteúdo de ecogenicidade variável. Trombose da veia esplênica e dobramento do baço. Os resultados obtidos nesse trabalho, indicaram que a retículo esplenite traumática causa sinais clínicos inespecíficos, severas alterações laboratoriais e principalmente que a ultrassonografia é um método eficiente para o diagnóstico dessa enfermidade uma vez que as lesões anatomopatológicas confirmaram os achados ultrassonográficos.(AU)

Presencia y biometría de bazo accesorio en individuos chilenos: estudio por tomografía computarizada / Presence and biometry of accessory spleen in Chilean individuals: study by computerized tomography

El bazo se localiza en el cuadrante superior izquierdo del abdomen, relacionándose posteriormente con la 9a a 11a costilla, de las que se separa por el diafragma y el receso costodiafragmático, se localiza por detrás del estómago y lateralmente al riñón izquierdo. Por alteraciones en su desarrollo pueden generarse bazos accesorios (BA), considerándose un tejido ectópico del bazo. Se consideran tejido normal, con los mismos procesos fisiológicos que el bazo principal. Con el propósito de localizar y determinar aspectos biométricos de los mismos, se realizó un estudio de corte transversal y de carácter descriptivo, sobre una muestra de 220 exámenes de TC pertenecientes a pacientes mayores de 18 años del Hospital Regional Hernán Henríquez Aravena, Temuco, Chile. Para este estudio se excluyeron toda aquellas TC con antecedentes de esplenectomía y lesiones de Bazo o peri-esplénicas. El análisis de los datos mostró una prevalencia de 32,3 % de BA, pudiendo ser de una única presencia, dos e incluso tres BA por paciente.De un total de 71 personas que tienen al menos un BA, 34 (47,89 %) fueron de sexo femenino y 37 (52,11 %) de sexo masculino. Hubo 56 pacientes (78,9 %) con un BA, 29 (40,85 %) del sexo femenino y 27 (38,03 %) del masculino; 15 (21,1 %) presentaron más de un BA, 5 (7,04 %) de sexo femenino y 10 (14,08 %) de sexo masculino, si bien se puede observar variación en la cantidad de BA según sexo, no existe una relación estadísticamente significativa entre dichas variables. La ubicación más frecuente encontrada en el plano axial fue la zona antero-medial con 59 casos (66,29 %); asimismo, en el plano sagital, la localización más frecuente fue en el polo inferior con 40 casos (44,44 %). Datos biométricos de estos BA son mostrados en Tablas. Esta información será de gran valor morfológico y médico debido a la escasa literatura existente sobre esta materia en individuos chilenos.

The spleen is located in the upper left quadrant of the abdomen, subsequently related to the 9th to 11th rib, from which it is separated by the diaphragm and the cost-diaphragmatic recess, it is located behind the stomach and laterally to the left kidney. Due to alterations in its development, accessory spleens (AS) can be generated, being considered an ectopic tissue of the spleen. The AS are considered normal tissue, with the same physiological processes as the main spleen. With the purpose of locating and determining biometric aspects of them, a cross-sectional and descriptive study was carried out on a sample of 220 CT scans belonging to patients over 18 years of age at the Hernán Henríquez Aravena Regional Hospital, Temuco, Chile. For this study, all CT scans with a history of splenectomy and spleen or peri-splenic lesions were excluded. The analysis of the data showed a prevalence of 32.3 % of AS, being able to be of a single presence, two and even three AS per patient. Of a total of 71 people who have at least one AS, 34 (47.89 %) were female and 37 (52.11 %) male. There were 56 patients (78.9 %) with a one AS, 29 (40.85 %) of the female sex and 27 (38.03 %) of the male; 15 (21.1 %) presented more than one AS, 5 (7.04 %) female and 10 (14.08 %) male, although variation in the amount of AS according to sex can be observed, no there is a statistically significant relationship between these variables. The most frequent location found in the axial plane was the anteromedial zone with 59 cases (66.29 %); also, in the sagittal plane, the most frequent location was in the lower pole with 40 cases (44.44 %). Biometric data of these AS are shown in tables. This information will be of great morphological and medical value due to the limited existing literature on this subject in Chilean individuals.

Torção esplênica primária em um cão: relato de caso / Primary splenic torsion in a dog: case report

A torção esplênica isolada ou primária é uma enfermidade de ocorrência rara em cães, caracterizada pela torção do pedículo esplênico, sem que haja outra enfermidade concomitante. Os sinais clínicos e os exames laboratoriais são inespecíficos, porém a ultrassonografia, juntamente com o uso de Doppler colorido, tem sido importante para sugerir o diagnóstico, que é confirmado por meio de laparotomia exploratória. Este estudo relata o caso de um cão da raça Bulldog campeiro, cinco anos de idade, muito ativo, que recebia alimentação apenas uma vez ao dia. Este foi atendido no Hospital Veterinário da Universidade Luterana do Brasil (HV-Ulbra), com histórico de prostração, emagrecimento e anorexia intermitente havia 10 dias. Neste caso relatado, o exame ultrassonográfico com Doppler colorido foi imprescindível para o diagnóstico, que pôde ser confirmado posteriormente pela laparotomia exploratória. Na celiotomia, observou-se o baço aumentado e rotacionado, envolto com o omento, e ambos encontravam-se desvitalizados. Por essa razão, foram realizados os procedimentos de esplenectomia total e omentectomia parcial da porção acometida.(AU)

The individual or primary splenic torsion is a rare disease occurrence in dogs characterized by twisting the splenic pedicle, without any other concomitant disease. Clinical signs and laboratory tests are nonspecific, however, ultrasonography, along with the use of color Doppler, has been important to suggest the diagnosis is confirmed through exploratory laparotomy. This study reports the case of a 5-year-old very active male Bulldog Campeiro, who received food once a day, which was attended at the Veterinary Hospital of Universidade Luterana do Brasil (HV ULBRA) with a history of prostration, weight loss and intermittent anorexia during 10 days. Ultrasonography with color Doppler exam was essential for the diagnosis, which could be confirmed later by exploratory laparotomy. In celiotomy it was observed the spleen increased in size and rotated, wrapped with omentum and both were found devitalized. For this reason, the procedures of total splenectomy and partial omentectomy of the affected portion were performed.(AU)

Intra-Individual, Inter-Vendor Comparison of Diffusion-Weighted MR Imaging of Upper Abdominal Organs at 3.0 Tesla with an Emphasis on the Value of Normalization with the Spleen

OBJECTIVE: To compare the apparent diffusion coefficient (ADC) values of upper abdominal organs with 2 different 3.0 tesla MR systems and to investigate the usefulness of normalization using the spleen. MATERIALS AND METHODS: Forty-one patients were enrolled in this prospective study, of which, 35 patients (M:F, 27:8; mean age ± standard deviation, 62.3 ± 12.3 years) were finally analyzed. In addition to the routine liver MR protocol, single-shot spin-echo echo-planar diffusion-weighted imaging using b values of 0, 50, 400, and 800 s/mm2 in 2 different MR systems was performed. ADC values of the liver, spleen, pancreas, kidney and liver lesion (if present) were measured and analyzed. ADC values of the spleen were used for normalization. The Pearson correlation, Spearman correlation, paired sample t test, Wilcoxon signed rank test and Bland-Altman method were used for statistical analysis. RESULTS: For all anatomical regions and liver lesions, both non-normalized and normalized ADC values from 2 different MR systems showed significant correlations (r = 0.5196-0.8488). Non-normalized ADC values of both MR systems differed significantly in all anatomical regions and liver lesions (p < 0.001). However, the normalized ADC of all anatomical regions and liver lesions did not differ significantly (p = 0.065-0.661), with significantly lower coefficient of variance than that of non-normalized ADC (p < 0.009). CONCLUSION: Normalization of the abdominal ADC values using the spleen as a reference organ reduces differences between different MR systems, and could facilitate consistent use of ADC as an imaging biomarker for multi-center or longitudinal studies.

Sonographic determination of normal spleen size in Turkish adults / Determinación ecográfica del tamaño normal del bazo en adultos turcos

The current study was undertaken to determine normal spleen dimensions and anthropometric evaluation by ultrasonography from females and males in our population. These measurements were taken using an ultrasonography. The mean values of the age, height, weight and body mass index (BMI) of subjects, spleen width (SW), spleen length (SL), spleen thickness (ST) and spleen volume calculated with elipsoid formula; length x width x thickness x 0.524 were taken. These measurements were found to be 36.37±10.83 years, 164.22±4.72 cm, 60.26±7.11 kg, 22.30±2.09 kg/m2, 7.58±1.56 cm, 9.87±1.28 cm, 3.34±0.79 cm and 136.05±61.14 cm3 in females respectively. Additionally, in males same dimensions were 40.50±12.77 years, 174.41±6.57 cm, 76.33±8.54 kg, 25.06±2.10 kg/m2, 8.75±1.84 cm, 11.01±1.186 cm, 4.12±1.09 cm and 220.70±115.35 cm3 respectively. The observations presented in this report have defined anatomic parameters about spleen size that need to be taken into consideration for reference data to determine population discrepancies and helpful for radiologists and clinicians.

El objetivo fue determinar las dimensiones normales del bazo y realizar una evaluación antropométrica mediante ecografía en mujeres y hombres turcos. Fueron calculados los valores medios de edad, altura, peso, índice de masa corporal (IMC), ancho del bazo (AB), longitud del bazo (LB) y grosor del bazo (GB), junto al volumen del bazo mediante la fórmula elipsoide (largo x ancho x grosor x 0,524). Las mujeres presentaron una edad de 36,37±10,83 años, altura de 164,22±4,72 cm, peso de 60,26±7,11 kg, IMC de 22,30±2,09 kg/m2, AB de 7,58±1,56 cm, LB de 9,87±1,28 cm, GB de 3,34±0,79 cm y volumen del bazo de 136,05±61,14 cm3. Los hombres presentaron una edad de 40,50±12,77 años, altura de 174,41±6,57 cm, peso de 76,33±8,54 kg, IMC de 25,06±2,10 kg/m2, AB de 8,75±1,84 cm, LB de 11,01±1,186 cm, GB de 4,12±1,09 cm y volumen del bazo de 220,70±115,35 cm3. Nuestras observaciones han definido parámetros anatómicos sobre el tamaño del bazo, los cuales deben ser considerados como datos de referencia para determinar las discrepancias en la población, de utilidad para radiólogos y clínicos.

Biometria do fígado e do baço em pacientes com lúpus eritematoso sistêmico de início pediátrico / Liver and spleen biometrics in childhood-onset systemic lupus erythematosus patients

RESUMOObjetivoAvaliar as dimensões do fígado e do baço em pacientes com lúpus eritematoso sistêmico de início pediátrico (LESp) e controles saudáveis.MétodosForam submetidos a uma ultrassonografia do abdome 30 pacientes com LESp e 30 voluntários saudáveis controle. Foram feitas duas medições do fígado no lobo hepático esquerdo (craniocaudal e anteroposterior) e três no lobo hepático direito (LHD) (craniocaudal posterior [CCP-LHD], craniocaudal anterior e anteroposterior). Foram também avaliadas três medidas das dimensões do baço: longitudinal, transversal e anteroposterior. Foram avaliados dados demográficos, clínicos e laboratoriais, SLEDAI-2K, ECLAM, SLAM e tratamento.ResultadosA idade média foi semelhante nos pacientes com LESp e controles (170,31 ± 27,81 vs. 164,15 ± 39,25 meses; p = 0,486). A média da dimensão CCP-LHD foi significativamente maior no grupo LESp em comparação com os controles (13,30 ± 1,85 vs. 12,52 ± 0,93, p = 0,044). Não houve diferenças nos outros parâmetros biométricos do fígado e do baço (p > 0,05). Uma análise especifica realizada apenas nos pacientes com LESp de acordo com a dimensão CCP-LHD ≥ 13,3 cm versus < 13,3 cm mostrou que a mediana do SLEDAI-2K [8 (0-18) vs. 2 (0-8), p = 0,004], ECLAM [4 (0-9) vs. 2 (0-5), p = 0,019] e SLAM [5 (1-13) vs. 2 (0-14), p = 0,016] era significativamente maior em pacientes com maior dimensão CCP-LHD, do mesmo modo que a frequência de nefrite (77% vs. 29%, p = 0,010). As enzimas hepáticas foram semelhantes nos dois grupos (p > 0,05). Foi observada uma correlação positiva entre o SLEDAI-2K e a dimensão CCP-LHD (p = 0,001, r = +0,595). Evidenciou-se uma correlação negativa entre a duração da doença e a dimensão longitudinal do baço (p = 0,031, r = −0,394).ConclusãoOs dados levantam a possibilidade de que a atividade da doença pode levar a uma hepatomegalia subclínica e localizada durante o curso da doença. A duração da doença resultou em atrofia do baço em pacientes com LESp.

ABSTRACTObjectiveTo evaluate liver and spleen dimensions in childhood-onset systemic lupus erythematosus (c-SLE) patients and healthy controls.Methods30 c-SLE patients and 30 healthy control volunteers underwent abdominal ultrasound. The following two liver measurements were performed in left hepatic lobe: craniocaudal and anteroposterior and three in right hepatic lobe (RHL): posterior craniocaudal (PCC-RHL), anterior craniocaudal and anteroposterior. Three spleen dimension measurements were also evaluated: longitudinal, transverse and anteroposterior. Demographic, clinical and laboratorial data, SLEDAI-2K, ECLAM, SLAM and treatment were assessed.ResultsMean current age was similar in c-SLE and controls (170.31 ± 27.81 vs. 164.15 ± 39.25months; p = 0.486). The mean of PCC-RHL dimension was significantly higher in c-SLE compared to controls (13.30 ± 1.85 vs. 12.52 ± 0.93, p = 0.044). There were no differences between the other hepatic biometrics and splenic parameters (p > 0.05). Further analysis in c-SLE patients according to PCC-RHL dimension ≥ 13.3 cm versus < 13.3 cm showed that the median of SLEDAI-2K [8(0-18) vs. 2(0-8), p = 0.004], ECLAM [4(0-9) vs. 2(0-5), p = 0.019] and SLAM [5(1-13) vs. 2(0-14), p = 0.016] were significantly higher in patients with higher PCC-RHL dimension, likewise the frequencie of nephritis (77% vs. 29%, p = 0.010). Liver enzymes were similar in both groups (p > 0.05). Positive correlation was observed between SLEDAI-2K and PCC-RHL (p = 0.001, r = +0.595). Negative correlation was evidenced between disease duration and longitudinal dimension of spleen (p = 0.031, r = −0.394).ConclusionOur data raises the possibility that disease activity could lead to a subclinical and localized hepatomegaly during the disease course. Long disease duration resulted to spleen atrophy in c-SLE patients.

A Case of Splenic Tuberculosis Forming a Gastro-splenic Fistula / 대한소화기학회지

We report a case of a 61-year-old man who presented with a cough and abdominal discomfort. CT scan of the chest showed two lesions across both lungs, and an abdominal CT scan revealed multiple hypodense lesions in the spleen with cystic lesions on the splenic hilum. Upper gastrointestinal tract endoscopy found creamy yellowish discharge through a fistula between the stomach and splenic hilum. Under fluoroscopic guidance, forceps was inserted into the fistula tract, and forcep biopsy was done. The pathology was consistent with tuberculosis, and a nine-month anti-tuberculosis medication regimen was started. Imaging performed three months after finishing medication indicated improvement of splenic lesions, and the gastro-splenic tract was sealed off. This case is a very rare clinical example of secondary splenic tuberculosis with a gastro-splenic fistula formation in an immunocompetent patient.

Noninvasive prediction of large esophageal varices in chronic liver disease patients

Esophageal varices [EVs] are a serious consequence of portal hypertension in patients with liver diseases. Several studies have evaluated possible noninvasive markers of EVs to reduce the number of unnecessary endoscopies in patients with cirrhosis but without varices. This prospective study was conducted to evaluate noninvasive predictors of large varices [LV]. The study analyzed 106 patients with liver diseases from January 2007 to March 2008. Relevant clinical parameters assessed included Child-Pugh class, ascites and splenomegaly. Laboratory parameters like hemoglobin level, platelet count, prothrombin time, serum bilirubin, albumin and ultrasonographic characteristics like splenic size, splenic vein size, portal vein diameter were assessed. Univariate and multivariate analysis was done on the data for predictors of large EVs. Incidence of large varices was seen in 41%. On multivariate analysis, independent predictors for the presence of LV were palpable spleen, low platelet count, spleen size >13.8 mm, portal vein >13 mm, splenic vein >11.5 mm. The receiver operating characteristic [ROC] curve showed 0.883 area under curve. Platelet spleen diameter ratio 909 had a sensitivity and specificity of 88.5%, 83% respectively. Thrombocytopenia, large spleen size, portal vein size and platelet spleen diameter ratio strongly predicts large number of EVs

Management of splenic abscess in sickle cell disease

Sickle cell disease [SCD] is one of the commonly inherited disea and the Eastern Province of Saudi Arabia where splenomegaly with high frequency in the adolescent, predisposes the patient to have splenic abscess. The present study documents the pathology, clinical picture, investigations and surgical treatment of the splenic abscess. Twenty two cases of sickle cell disease patients complicated with splenic abscess were included in this study during October 2002 December 2007. Splenic abscess is a rare complication of sickle cell disease but is the most serious complication. Splenic infarction is one of the most predisposing cause for splenic abscess. There are different modalities for the management of splenic abscess as ultrasound or CT guided aspiration or splenectomy. Splenectomy remains the treatment of choice in sickle cell disease patient with splenic abscess

A suspected case of Lyme borreliosis in a hunting dog in Korea

A two-year-old male Pointer had been presented with anorexia, cachexia, and weight loss of 10-day duration. Upon physical examination, fever, lethargy, superficial lymph node enlargement, and tick infestation were noted. The only abnormality in CBC and serum chemistry analyses was mild hyperglobulinemia. Spleen was enlarged by radiography, and the lymph nodes showed neutrophilic lymphadenitis by cytological examination. A polymerase chain reaction test for babesiosis and commercial ELISA tests for Ehrlichia canis, heartworm, and Lyme disease was negative except for Lyme disease, which was verified by both an IFA-IgG test and a quantitative C6 assay. Doxycycline was administered for 2 weeks and the recovery was uneventful. Post-treatment C6 titer decreased to within normal limits.

Splenic infarct as a diagnostic pitfall in radiology.

Follow-up of colorectal carcinoma after therapy is based on symptoms, tumor markers, and imaging studies. Clinicians sometimes face diagnostic dilemmas because of unusual presentations on the imaging modalities coupled with rising serum markers. We report a case of colorectal carcinoma that presented with gastrointestinal symptoms 14 months after completion of treatment. Investigations showed rise in carcinoembryonic antigen (CEA). Suspecting disease recurrence, complete radioimaging workup was performed; the only abnormality detected was a smooth, hypodense area in the posterior third of the spleen on contrast-enhanced computed tomography abdomen. In view of the previous diagnosis of carcinoma colon, the symptoms reported by the patient, the elevated CEA, and the atypical CECT appearance, a diagnosis of splenic metastasis was made. The patient was subjected to splenectomy as a curative treatment. However, the histopathological report revealed it to be a splenic infarct. The present case reemphasizes the limitations of radiological studies in the follow-up of carcinoma colon.

The Short-Term Effects of Balloon-Occluded Retrograde Transvenous Obliteration, for Treating Gastric Variceal Bleeding, on Portal Hypertensive Changes: a CT Evaluation

OBJECTIVE: We wanted to evaluate the short-term effects of balloon-occluded retrograde transvenous obliteration (BRTO) for treating gastric variceal bleeding, in terms of the portal hypertensive changes, by comparing CT scans. MATERIALS AND METHODS: We enrolled 27 patients who underwent BRTO for gastric variceal bleeding and they had CT scans performed just before and after BRTO. The pre- and post-procedural CT scans were retrospectively compared by two radiologists working in consensus to evaluate the short-term effects of BRTO on the subsequent portal hypertensive changes, including ascites, splenomegaly, portosystemic collaterals (other than gastrorenal shunt), the gall bladder (GB) edema and the intestinal wall edema. Statistical differences were analyzed using the Wilcoxon signed rank test and the paired t-test. RESULTS: Following BRTO, ascites developed or was aggravated in 22 (82%) of 27 patients and it was improved in two patients; the median spleen volumes increased from 438.2 cm3 to 580.8 cm3, and based on a 15% volume change cut-off value, splenic enlargement occurred in 15 (56%) of the 27 patients. The development of new collaterals or worsening of existing collaterals was not observed in any patient. GB wall edema developed or was aggravated in four of 23 patients and this disappeared or improved in five; intestinal wall edema developed or was aggravated in nine of 27 patients, and this disappeared or improved in five. Statistically, we found significant differences for ascites and the splenic volumes before and after BRTO (p = 0.001 and p < 0.001, respectively) CONCLUSION: Some portal hypertensive changes, including ascites and splenomegaly, can be aggravated shortly after BRTO.

Ultrasonographic measurements of the normal, kidneys, liver, spleen, gallbladder and head of pancreas among radiology department attenders

The purpose of this study was to investigate the ultrasonographic measurements for certain normal abdominal organs. Length and width of gallbladder and length of liver, spleen, kidneys and thickness of the kidneys were measured in a age. And gender-stratified non-consecutive sample of 496 [54.2%] men and 419 [45.8%] women at different ages referred to out ultrasonography unit during one year of daily hospital practice in Kerman, Iran. Findings on ultrasonograms of the kidneys, liver, spleen, gallbladder and head of pancreas were normal in all cases. Patients were scanned by a real time scanner equipped with a 3.5 MHZ medium internal focus transducer. The mean [standard deviation [SDI] liver lengths were 125.6 [8.8] and 119 [7.7] mm, mean [SD] gallbladder length was 49.9 [3.6] and 49.3 [3.5] mm, mean [SD] gallbladder widths were 18.0 [2.3] and 18.2 [1.8] mm and mean [SD] size of pancreatic head was 15.9 [1.6] and 13.8 [1.4] mm in males and females respectively. The mean [SD] renal lengths were 101.5 [5.0] and 98.9 [5.0] mm on the right side and 110.0 [6.3] and 108.0 [6.0] mm on the left side and mean [SD] size of spleen was 93.8 [4.1] and 92.3 [3.2] mm in males and females respectively. The values obtained in this study were slightly lower than those observed in western population

Focal lesions of the spleen in patients with fever of unknown origin: some graphic patterns and diagnosis

A review of ultrasonic scans performed for 811 patients admitted at the Abbassia Fever Hospital between 1990 through 1996 for investigation of fever undiagnosed for over 3 weeks revealed 28 cases of focal splenic lesions. They included lymphoma in sixteen cases, tuberculosis in six cases, echinococcal cysts in three, abscess in two, and infarction in one. Final diagnosis was obtained by correlating the ultrasonography and clinical findings, together with pathologic, bacteridogic, serologic and angiographic data