[Diagnosis of splenic diseases].
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Five patients in the blastic phase of chronic granulocytic leukemia with massive splenomegaly were treated by intraarterial splenic artery infusion of cytosine arabinoside. All patients had massive splenomegaly associated with pain and/or hypersplenism and were refractory to previous therapy. All 5 patients demonstrated responses to treatment, with reduction in spleen size as well as symptomatic relief. Systemic toxicity was minimal in 4 of the 5 patients.
Although it is well known that biliary sludge can produce fine diffuse echoes within the gallbladder, it is less commonly appreciated that other cystic structures may contain echogenic fluid and therefore be mistaken sonographically for solid lesions. In this article three cases of splenic cysts and one case each of pyrometrocolpos, hydroureter, and pyonephrosis presented with diffuse fine echoes in the fluid. Three of these cases were misinterpreted as a result of this echogenic appearance. These cases serve to emphasize the need for awareness of the echogenicity of some types of fluid and the value of other signs of cystic lesions besides absence of internal echoes.
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After a brief review of the literature concerning scintigraphy of the spleen, its vascular system is described. The presence of numerous anastomoses makes it likely that occlusion of the splenic vein will usually not lead it any parenchymal damage. In five patients with angiographically confirmed spenic vein thrombosis it was shown that radio-colloid scans always demonstrate an enlarged spleen. Poor colloid uptake was thought to be due to a venous reflex mechanism leading to a reduction in the arterial blood supply. The statement found in the literature, that the spleen cannot be shown scintigraphically if the vein is thrombosed, has not been confirmed by us. We tend to the view that the apparent absence of a splenic scan was due to geometric causes.
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In four patients, each of whom had a different type of splenic cyst, 99mTc-sulphur colloid images revealed non-specific, intrasplenic "cold" lesions. The rim of splenic tissue surrounding the cyst was incomplete in three out of four patients and caused appearances similar to those of splenic infarction. Repeat spleen imaging with 99mTc-RBC revealed an additional cyst in one out of four patients. 113m indium blood pool images provided preoperative information on lesion vascularity. The scintigraphic diagnosis of splenic cysts should ideally combine 99mTc-sulphur colloid imaging, 99mTc-RBC imaging, and 113m Indium blood pool imaging.
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This is a presentation of 10 unusual cases of hydatid cyst beyond the pulmonary sieve. One of these cases has not been described previously. Some comments and a discussion are included.
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Although splenic cysts are benign, a gradual increase in volume of the liquid mass often leads to diagnosis owing to the large volume. The two cases reported are an example of this. A cure was obtained by splenectomy. It is usually easy to carry out and the prognosis is benign.
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It is important to separate splenic vein obstruction from other causes of variceal bleeding. The authors provide a diagnostic sequence for avoiding errors of management, citing a case to illustrate.
After explaining the principle of whole body computer tomography the field of indication is outlined with reference to some of our own experiences. Up to now, it has proved its value in the following indications: preoperative diagnosis, supplementing pulmonary radiodiagnosis, substitution of invasive diagnostic procedures in mediastinal diseases, clarification of diseases of the abdominal cavity, of space-occupying processes in the kidney, in the true pelvis, and detection of retroperitoneal processes. The financial expenditure for this novel method of investigation is described according to a formula. The cost of given or estimated numerical values show the importance of adequate usage. The added costs for a second personnel shift for an examination rate of more than 7 patients a day are trivial because of the high basic expenditure.