Compromiso hepatoesplénico, un hallazgo inusual secundario a enfermedad por arañazo de gato: a propósito de un caso / Hepato-splenic involvement, an unusual finding secondary to cat-scratch disease: a clinical case

La infección por Bartonella henselae (BH) que causa la enfermedad por arañazo de gato puede cursar de manera asintomática, así como presentar manifestaciones locales y sistémicas. El objetivo de este caso es documentar que el compromiso hepatoesplénico es poco habitual en este tipo de infección y el tratamiento, que debe ser personalizado, aún genera controversia. Se presenta un caso de una paciente de 11 años con fiebre de origen de desconocido con hallazgos en tomografía y ecografía abdominal de abscesos hepatoesplénicos, y confirmación de infección por BH a través de métodos serológicos. Se realiza una revisión bibliográfica donde se evidencia la baja frecuencia de compromiso hepatoesplénico. De esta manera, la anamnesis y el examen físico son fundamentales para realizar un rápido diagnóstico y tratamiento

The infection by Bartonela henselae (BH), the cause of cat scratch disease, it could be asymptomatic or produce local and multisystem illness. The objective of this case report is to document that the hepato-splenic involvement is unusual in BH infection, and the treatment is discussed and individualized in each patient. This case is about an eleven-year girl who presented with findings in abdominal tomography and ultrasound of hepato-splenic abscesses, with later positive serology for BH. In this way, a bibliographic review is carried out to show the low prevalence and incidence of hepato-splenic involvement where the anamnesis and the physical examination are essential to make an early diagnosis and treatment.

Quiste epitelial esplénico gigante, características morfológicas y evolución postoperatoria: reporte de un caso / Epithelial splenic cyst. Morphological characteristics and postoperative evolution: case report

RESUMEN: Los quistes primarios del bazo (QPB), son lesiones poco frecuentes en patología quirúrgica; los mayores de 5 cm o sintomáticos deben ser tratados quirúrgicamente para evitar el riesgo de complicaciones. Se debe realizar un examen histopatológico para confirmar el subtipo de quiste esplénico y descartar una eventual transformación maligna del revestimiento epitelial pluripotencial. El objetivo de este manuscrito fue reportar un caso de QPB intervenido quirúrgicamente y revisar la evidencia existente respecto de sus características morfológicas, terapéuticas y pronósticas. Caso clínico: Se trata de una mujer de 18 años (MAC), que consultó por distensión abdominal progresiva, de varios meses de evolución. La tomografía abdominal reveló la existencia de una masa heterogénea de 21 cm de diámetro mayor, en relación con el colon transverso y la curva mayor gástrica. El examen intraoperatorio reveló una masa sólido-quística que surgía del mesocolon transverso. La cirugía consistió en la esplenectomía y exéresis en bloque del tumor. La paciente evolucionó de forma satisfactoria, dándose de alta al quinto día del postoperatorio. El diagnóstico de quiste epitelial esplénicose estableció en base al examen patológico de la pieza quirúrgica. Cursando su 6º mes postoperatorio sin inconvenientes. Se realizó control tomográfico, que permitió verificar un bazo supernumerario funcionante.

SUMMARY: Primary splenic cysts (PSC) are rare lesions in surgical pathology; those symptomatic, or greater than 5 cm, should be treated surgically to avoid the risk of complications. A histopathological examination should be performed to confirm the splenic cyst subtype and rule out a possible malignant transformation of the pluripotential epithelial lining. The aim of this manuscript was to report a case of PSC who had undergone surgery and to review the existing evidence regarding its morphological, therapeutic and prognostic characteristics. An 18- year-old woman (MAC), consulted for progressive abdominal distention of several months of evolution. Abdominal tomography revealed the existence of a large heterogeneous mass, 21 cm in diameter, in relation to the transverse colon and the greater gastric curve. Intraoperative examination revealed a solid cystic mass arising from the transverse mesocolon. Surgery consisted of splenectomy and in-block excision of the tumor. The patient evolved satisfactorily and was discharged on the fifth postoperative day. Diagnosis of epithelial splenic cyst was established based on the pathological examination of the surgical specimen. At six months postoperative the patient had evolved satisfactorily without complications. Following abdominal tomography control a functioning supernumerary spleen was confirmed.

Value of Contrast Transesophageal Echocardiography in the Detection of Intrapulmonary Vascular Dilatations in Hepatosplenic Schistosomiasis / Valor do Ecocardiograma Transesofágico com Contraste no Diagnóstico da Dilatação Vascular Intrapulmonar na Esquistossomose Hepatoesplênica

Abstract Background: Hepatopulmonary syndrome (HPS), found in cirrhotic patients, has been little studied in hepatosplenic schistosomiasis (HSS) and includes the occurrence of intrapulmonary vascular dilatations (IPVD). Contrast transesophageal echocardiography (cTEE) with microbubbles is more sensitive than contrast transthoracic echocardiography (cTTE) with microbubbles in the detection of IPVD in cirrhosis. Objective: To assess the performance of the cTEE, compared with that of cTTE, in detecting IPVD for the diagnosis of HPS in patients with HSS. Methods: cTEE and cTTE for investigation of IPVD and laboratory tests were performed in 22 patients with HSS. Agitated saline solution was injected in peripheral vein during the cTEE and cTTE procedures. Late appearance of the microbubbles in the left chambers indicated the presence of IPVD. Results of the two methods were compared by the Student's t-test and the chi-square test (p < 0.05). Results: cTEE was performed in all patients without complications. Three patients were excluded due to the presence of patent foramen ovale (PFO). The presence of IPVD was confirmed in 13 (68%) of 19 patients according to the cTEE and in only six (32%, p < 0.01) according to the cTTE. No significant differences in clinical or laboratory data were found between the groups with and without IPVD, including the alveolar-arterial gradient. The diagnosis of HPS (presence of IPVD with changes in the arterial blood gas analysis) was made in five patients by the cTEE and in only one by the cTTE (p = 0.09). Conclusion: In HSS patients, cTEE was safe and superior to cTTE in detecting IPVD and allowed the exclusion of PFO.

Resumo Fundamento: A síndrome hepatopulmonar (SHP), presente em pacientes cirróticos, é pouco estudada na esquistossomose hepatoesplênica (EHE) e inclui a ocorrência de dilatações vasculares intrapulmonares (DVP). O ecocardiograma transesofágico com contraste (ETEc) de microbolhas é mais sensível que o ecocardiograma transtorácico com contraste (ETTc) de microbolhas na identificação de DVP na cirrose. Objetivo: Avaliar o desempenho do ETEc comparado ao ETTc na identificação de DVP para diagnóstico de SHP em pacientes com EHE. Métodos: Incluímos 22 pacientes com EHE submetidos a ETEc e ETTc para pesquisa de DVP, além de exames laboratoriais. Os ETEc e ETTc foram realizados empregando-se solução salina agitada, injetada em veia periférica. A visualização tardia das microbolhas em câmaras esquerdas indicava presença de DVP. Os resultados foram comparados entre os dois métodos pelos testes t de Stu dent e qui-quadrado (significância p < 0,05). Resultados: Todos os 22 pacientes realizaram ETEc sem intercorrências. Foram excluídos três pela presença de forame oval patente (FOP), e a análise final foi realizada nos outros 19. A DVP esteve presente ao ETEc em 13 pacientes (68%) e em apenas seis ao ETTc (32%, p < 0,01). Não houve diferenças significativas nos dados clínicos e laboratoriais entre os grupos com e sem DVP, incluindo a diferença alveoloarterial de oxigênio. O diagnóstico de SHP (presença de DVP com alterações gasométricas) ocorreu em cinco pacientes pelo ETEc e em apenas um pelo ETTc (p = 0,09). Conclusão: Em pacientes com EHE, o ETEc foi seguro e superior ao ETTc na detecção de DVP não identificada ao ETTc, o que possibilitou adicionalmente excluir FOP.

Esplenectomía laparoscópica por quiste hidatídico primario de bazo / Laparoscopic splenectomy by primary hydatid cyst of the spleen

Objetivo: Describir el caso clínico de un paciente con quiste esplénico hidatídico de un año de evolución resuelto por vía laparoscópica. Materiales y Métodos: Mujer de 36 años con dolor en hipocondrio izquierdo por 1 año de evolución. El estudio topográfico objetivó lesión esplénica quística de 67 mm. Se realizó esplenectomía laparoscópica sin incidentes. Resultado: Evolución posoperatoria favorable. Histología compatible con hidatidosis esplénica. Discusión: La incidencia de hidatidosis esplénica es baja, incluso en áreas endémicas, aproximándose al 1-2%. La cirugía es la estrategia terapéutica de elección dado los riesgos de ruptura, sin embargo, no hay consenso respecto a la técnica de elección. Conclusión: La esplenectomía laparoscópica es una herramienta segura y avalada en la literatura.

Objective: Describe a case report of a hydatid splenic cyst of one year of evolution, treated by laparoscopy. Materials and Methods: A 36-year-old woman with left upper quadrant pain for 1 year. The topographic study showed a 67mm splenic cystic lesion. Laparoscopic splenectomy was performed without incident. Result: Favorable post-operative evolution. Histology compatible with splenic hydatidosis. Discussion: The incidence of splenic hydatidosis is low, even in endemic areas, approaching 1-2%. Surgery is the therapeutic strategy of choice, given the risks of rupture. However, there is no consensus regarding the technique. Conclusion: Laparoscopic splenectomy is a safe procedure supported by the literature.

Morbidity of schistosomiasis mansoni in a low endemic setting in Ouro Preto, Minas Gerais, Brazil

Abstract INTRODUCTION: Despite the advances of disease control programs, severe forms of schistosomiasis are prevalent. The prevalence of the disease in areas frequented by tourists urges for permanent prevention and control. The aim of this study was to describe the morbidity of schistosomiasis in the district of Antônio Pereira, Ouro Preto, Minas Gerais, Brazil. METHODS: The proportion of positives was defined by Kato-Katz coproscopy and urinary POC-CCA rapid test. Hepatosplenic form was diagnosed using abdominal ultrasound. RESULTS: Out of 180 participants,97 were examined by Kato-Katz, with 4 (4.1%) being positive. Thirty-four (22.1%) out of 154 were positive by POC-CCA. Five (2.8%) of 177 examined by ultrasound had hepatosplenic form. One of them had undergone splenectomy. One (0.6%)participant had myeloradiculopathy. CONCLUSIONS: Severe forms of schistosomiasis are still prevalent in low endemic areas and should be thoroughly investigated.

Pseudocisto esplênico não parasítico: um relato de caso / Non-parasitic splenic cyst: a case report

Os cistos esplênicos são raros, podem ser congênitos ou adquiridos e são encontrados, muitas vezes, em exames incidentais. Aparecem como tumorações na topografia do hipocôndrio esquerdo, associados a sintomas obstrutivos e dor abdominal. Os pseudocistos são formados por uma camada de tecido fibroso, sem revestimento epitelial, e têm como fator etiológico mais provável o trauma esplênico prévio. Atualmente, o ultrassom abdominal é o método mais importante para o diagnóstico de cisto esplênico, pois evita a realização de exames mais agressivos. Para o tratamento de cisto esplênico sintomático de grande tamanho, não parasítico, com risco aumentado de ruptura e etiologia desconhecida, a indicação de escolha é a esplenectomia. Este relato objetiva apresentar essa doença incomum, ressaltando seu quadro clínico, métodos diagnósticos e tratamento (AU)

Splenic cysts are rare, can be congenital or acquired, and are most often found in incidental exams. They appear as tumors in the left hypochondrium, in association with obstructive symptoms and abdominal pain. Pseudocysts are formed by fibrous tissue layer, without epithelial coating, and their most probable cause is previous splenic trauma. Nowadays, abdominal ultrasound is the most important method for the diagnosis of splenic cyst, avoiding more aggressive exams. For symptomatic, large, non-parasitic splenic cysts with high risk of rupture and unknown etiology, splenectomy is indicated. This report intends to present this uncommon disease, emphasizing its clinical condition, diagnostic methods, and treatment (AU)

Neonate subcapsular splenic hematoma.

Splenic hematoma is an unusual event in newborn babies. The present study report a two day old infant who presented to us in shok with severe pallor and abdominal distension. Initially ultrasonography of evaluation by ultrasound (US) revealed a left adrenal hemorrhage but was subsequently confirmed to be a subcapsular splenic hematoma by computed tomography (CT) scan of the abdomen. This article highlights the utility of CT scan in diagnosis although review of literature shows ultrasonography to be primary screening investigative modality for abdominal visceral bleeds in the neonatal period.

Partial splenectomy for splenic cyst: a case report and literature review.

Splenic cysts are very rare. They were traditionally treated by splenectomy. The recognition of post-splenectomy complications has led to emphasis on conservative techniques. We present a thirteen year old girl with epithelial splenic cyst treated by partial splenectomy. The post-operative CT scan after two weeks confirmed the residual splenic tissue.

Tuberculosis: a rare cause of splenic abscess.

Splenic abscess is a rare condition associated with septicemic conditions. Splenic abscess due to tuberculosis is still rarer, mostly diagnosed in immuno-compromised hosts. A case of tubercular splenic abscess without any underlying disease is reported.

Splenic abscess.

We report a splenic abscess in an elderly diabetic female. Awareness of the disease is emphasised.