RESUMEN
Splenic infarction in patients with sickle cell trait is usually related to hypoxic conditions, while non-hypoxia-related infarcts are extremely rare. We report on a case of a 17-year-old male patient, living at sea level, who developed a severe left upper quadrant abdominal pain during the course of a febrile episode. On physical examination he had a mildly palpable but extremely painful spleen. A spleen scan revealed 2 areas of impaired radionucleide distribution. Hepatic enzymes were moderately increased and the IgM anti-EBV antibodies positive. Hemoglobin electrophoresis revealed the presence of 42% of hemoglobin S. A probable diagnosis of splenic infarction was established in a patient with sickle cell trait, during the course of infectious mononucleosis. The patient was treated symptomatically. The conditions of splenic congestion induced by the EBV infection and the high-grade fever may have contributed to splenic sequestration and subsequent infarcts.
Asunto(s)
Mononucleosis Infecciosa/complicaciones , Rasgo Drepanocítico/complicaciones , Infarto del Bazo/diagnóstico , Adolescente , Anticuerpos Antivirales/sangre , Fiebre , Hemoglobina Falciforme/análisis , Herpesvirus Humano 4/inmunología , Humanos , Inmunoglobulina M/sangre , Hígado/diagnóstico por imagen , Hígado/enzimología , Masculino , Dolor , Palpación , Cintigrafía , Bazo/diagnóstico por imagen , Infarto del Bazo/etiologíaAsunto(s)
Hepacivirus/clasificación , Hepacivirus/genética , Hepatitis C/virología , Reacción a la Transfusión , Viremia/virología , Talasemia beta/virología , Adolescente , Adulto , Niño , Femenino , Genotipo , Hepatitis C/complicaciones , Anticuerpos contra la Hepatitis C/sangre , Humanos , Masculino , ARN Viral/sangre , Serotipificación , Carga Viral , Viremia/complicaciones , Talasemia beta/complicacionesRESUMEN
BACKGROUND/AIMS: Intrapulmonary vascular dilatations (IPVD) are extrahepatic complications occurring in liver transplant candidates, that can result in severe hypoxemia. The aim of this study was to compare the use of two diagnostic modalities, contrast echocardiography and lung perfusion scan, in detecting IPVD in normoxemic patients with early liver cirrhosis. METHODOLOGY: Fifty-six consecutive outpatients with biopsy-proven cirrhosis had contrast-echocardiography, a lung perfusion scan, pulmonary function tests, and arterial blood gas estimations. All patients were grade A or B according to the Child-Pugh classification. Patients with chronic intrinsic lung disease, heart failure or malignancy were excluded from the study. RESULTS: All patients had normal arterial blood-gas analyses. Eight out of 56 patients (14.3%) had a positive contrast echocardiogram, all with a decreased diffusion capacity (DLCO < 75% of the predicted value). An isolated DLCO impairment was observed in 40% of the patients with normal spirometry. None of the patients with echocardiography-proven IPVD had a positive lung perfusion scan (p<0.005). CONCLUSIONS: In normoxemic cirrhotic patients, subclinical pulmonary vasodilatation and gas-exchange abnormalities can occur. Contrast-enhanced echocardiography is the most valuable screening test in detecting IPVD in the early stages of hepatic insufficiency.
