Abstract
Spontan dalak infarktı, yaşlı yetişkinlerde nadir görülen karın ağrısı nedenlerinden biridir. Tanı; klinik bulgular ve görüntüleme yöntemleri ile konur. Geçmiş yıllarda ultrasonografi ve bilgisayarlı tomografinin splenik infarkt tanısındaki yeri önem kazanmıştır. Raporlanmış çoğu dalak infarktı fokaldir ve konservatif tedavi edilmektedir. 82 yaşında kadın hasta, 15 gün önce başlayan karın ağrısı nedeni ile başvurdu ve özgeçmişinde meme kanseri, paroksismal atriyal fibrilasyon ve hipertansiyon olduğu
öğrenildi. Fizik muayenede; dalak kot altında palpe edilmekteydi. Bilgisayarlı tomografide; 16 cm uzunlukta ölçülen dalağın içinde subkapsüler infarkt alanları ve periportal alanda 4,5 cm çaplı konglomere lenfadenopati saptandı. Doppler ultrasonografide kama şeklinde infarkt alanları ve heterojen hipoekoik avasküler alanlar olduğu görüldü. Laboratuvar tetkikleri sonrasında altta yatan nedenin marjinal zon lenfoma olduğu saptandı. Hastaya konservatif tedavi verildi ve hematolojik
maligniteye yönelik kemoterapi planı yapıldı. Komorbiditeleri olan yaşlı yetişkinlerde, akut başlangıçlı sol üst kadran ağrısıyla karşılaşıldığında dalak infarktı akılda tutulması gereken bir durumdur.
Keywords
References
- Lyon C, Clark DC. Diagnosis of acute abdominal pain in older patients. Am Fam Physician 2006; 74 (9): 1537-44.
- Lawrence YR, Pokroy R, Berlowitz D, Aharoni D, Hain D, Breuer GS. Splenic infarction: an update on William Osler's observations. Isr Med Assoc J 2010; 12 (6): 362-5.
- Spangler R, Van Pham T, Khoujah D, Martinez JP. Abdominal emergencies in the geriatric patient. Int J Emerg Med 2014; 7: 43.
- Nores M, Phillips EH, Morgenstern L, Hiatt JR. The clinical spectrum of splenic infarction. Am Surg 1998; 64 (2): 182-8.
- Antopolsky M, Hiller N, Salameh S, Goldshtein B, Stalnikowicz R. Splenic infarction: 10 years of experience. Am J Emerg Med 2009; 27 (3) :262-5.
- Vancauwenberghe T, Snoeckx A, Vanbeckevoort D, Dymarkowski S, Vanhoenacker FM. Imaging of the spleen: what the clinician needs to know. Singapore Med J 2015; 56 (3): 133-44.
- Chapman J, Helm TA, Kahwaji CI. Splenic Infarcts. [Updated 2020 Aug 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430902/
- Jaroch MT, Broughan TA, Hermann RE. The natural history of splenic infarction. Surgery 1986; 100 (4): 743-50.
- Goede V. Marginal zone lymphoma in elderly and geriatric patients. Best Pract Res Clin Haematol 2017; 30 (1-2): 158-65.
- Tun NT, Mi K, Smith J. Unusual Course of Splenic Marginal Zone Lymphoma. World J Oncol 2013; 4 (4-5): 205-9.
Abstract
Spontaneous splenic infarction has been rarely reported within aged population. The diagnosis of the condition is based on clinical findings and splenic imaging. In recent years, ultrasonography and computed tomographic scan have gained in popularity for the diagnosis of splenic infarction. Most reported cases are focal infarctions, and treatment is mostly conservative. We described the case of a 82-year-old female with cured breast cancer, paroxysmal atrial fibrillation, hypertension who had left upper quadrant pain within 15 days. Physical examination on admission revealed a palpable splenomegaly. Abdominal computed tomography scan showed many subcapsular infarct zones of the spleen measuring 16 cm in length and 4.5 cm conglomerate lymphadenopathies within periportal region. Doppler ultrasound revealed wedge-shaped heterogeneous hypoechoic avascular areas and lymphadenopathies. After laboratory tests, the underlying cause was found as marginal zone
lymphoma. The patient was treated with conservative management and chemotherapy was planned for specific cause. Splenic infarction must be kept in mind for older patients with underlying comorbidities presenting with acute left upper quadrant pain.
Keywords
References
- Lyon C, Clark DC. Diagnosis of acute abdominal pain in older patients. Am Fam Physician 2006; 74 (9): 1537-44.
- Lawrence YR, Pokroy R, Berlowitz D, Aharoni D, Hain D, Breuer GS. Splenic infarction: an update on William Osler's observations. Isr Med Assoc J 2010; 12 (6): 362-5.
- Spangler R, Van Pham T, Khoujah D, Martinez JP. Abdominal emergencies in the geriatric patient. Int J Emerg Med 2014; 7: 43.
- Nores M, Phillips EH, Morgenstern L, Hiatt JR. The clinical spectrum of splenic infarction. Am Surg 1998; 64 (2): 182-8.
- Antopolsky M, Hiller N, Salameh S, Goldshtein B, Stalnikowicz R. Splenic infarction: 10 years of experience. Am J Emerg Med 2009; 27 (3) :262-5.
- Vancauwenberghe T, Snoeckx A, Vanbeckevoort D, Dymarkowski S, Vanhoenacker FM. Imaging of the spleen: what the clinician needs to know. Singapore Med J 2015; 56 (3): 133-44.
- Chapman J, Helm TA, Kahwaji CI. Splenic Infarcts. [Updated 2020 Aug 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430902/
- Jaroch MT, Broughan TA, Hermann RE. The natural history of splenic infarction. Surgery 1986; 100 (4): 743-50.
- Goede V. Marginal zone lymphoma in elderly and geriatric patients. Best Pract Res Clin Haematol 2017; 30 (1-2): 158-65.
- Tun NT, Mi K, Smith J. Unusual Course of Splenic Marginal Zone Lymphoma. World J Oncol 2013; 4 (4-5): 205-9.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Case Reports |
| Authors | |
| Publication Date | April 19, 2021 |
| Submission Date | January 18, 2021 |
| Published in Issue | Year 2021 |