Tuberculous abscess of the spleen.
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Four patients with solitary or multiple splenic fluid collections were treated by ultrasound guided percutaneous needle aspiration and drainage. There was one unilocular abscess, three infected hematomas, one large hematoma and a complex lesion with locular and perisplenic involvement. Percutaneous drainage and antibiotics were curative in one patient. Splenectomy was performed because of persistent fever and drainage of pus after 15 days in one case and recurrence of hematoma in an other case. Solitary fluid collection can be effectively treated by ultrasound or computed tomography guided percutaneous drainage. Hematoma represents a cause of failure of percutaneous drainage.
Intravenous inoculation of Mycobacterium bovis, strain bacillus Calmette-Guerin caused infection in the lungs, livers, and spleens of severe combined immunodeficient (SCID) mice and in the same organs in immunocompetent co-isogenic C.B17 mice. However, whereas infection in the latter mice was stabilized and partly resolved, it was progressive in SCID mice and eventually lethal, with the most rapid bacterial growth occurring in the lungs. Histological examination of infected organs showed that well-developed, compact epithelioid granulomas formed at sites of bacterial multiplication in livers, spleens, and lungs of C.B17 mice. Granulomas also formed in the livers and spleens of SCID mice, despite their inability to generate immunity. However, in the lungs of SCID mice, bacillus Calmette-Guerin was regionally distributed mostly in isolated alveolar macrophages and in aggregates of macrophages resembling small granulomas. The possibility that this tendency not to form granulomas in the lung is the reason for the more rapid growth of bacillus Calmette-Guerin in this organ is discussed.
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Miliary hepatic involvement is a frequent finding on autopsy in patients with disseminated tuberculosis. Imaging studies may reveal hepatosplenomegaly and/or parenchymal inhomogeneity and, in a minority of cases, focal lesions, invariably associated with miliary lung disease. An unusual case of disseminated tuberculosis with manifestations of miliary hepatic involvement, abdominal and neck lymphadenopathy on US and CT without any evidence of active disease in the lungs, spleen or other organ, is described.
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