Pancreatitis-associated splenic vein thrombosis with intrasplenic venous thrombosis: a case report

Schwartz, Stephanie A.; Stubbs, Alana Y.; Taljanovic, Mihra S.; Smyth, Sarah

doi:10.1007/s10140-007-0693-y

Cited by 3 publications

(1 citation statement)

References 4 publications

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“…Thrombosis of the splenic vein has been reported in 7–20% of patients with chronic pancreatitis. Additionally, bleeding occurs in approximately 5–10% of patients with chronic pancreatitis [ 7 , 8 , 9 ]. The causes of gastrointestinal bleeding associated with chronic pancreatitis include splenic vein obstruction, sinistral portal hypertension, rupture of a pseudoaneurysm, bleeding from a pseudocyst, and peptic ulcer arising from chronic alcohol use or the loss of exocrine function [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Gastric Varices with Remarkable Collateral Veins in Valpronic Acid-Induced Chronic Pancreatitis

Hattori

Higurashi

Takahashi³

et al. 2008

Case Rep Gastroenterol

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Valproic acid (VPA) is a commonly prescribed and approved treatment for epilepsy, including Angelman syndrome, throughout the world. However, the long-term administration of drugs like VPA is associated with the possible development of gastric varices and splenic obstruction as a result of chronic pancreatitis. Such cases can be difficult to treat using endoscopy or interventional radiology because of hemodynamic abnormalities; therefore, surgical treatment is often necessary.

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Section: Discussionmentioning

confidence: 99%

Gastric Varices with Remarkable Collateral Veins in Valpronic Acid-Induced Chronic Pancreatitis

Hattori

Higurashi

Takahashi³

et al. 2008

Case Rep Gastroenterol

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Nontraumatic splenic emergencies: cross-sectional imaging findings and triage

Tonolini

Bianco

2013

Emerg Radiol

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The spleen is commonly involved in a wide spectrum of hematologic, immunologic, neoplastic, infectious, and vascular systemic disorders. Sometimes overlooked on imaging studies outside the trauma setting, the spleen may harbor severe infections, and occasionally undergoes spontaneous bleeding or rupture. This pictorial essay reviews common and unusual causes of nontraumatic acute abnormalities primarily involving the spleen, and their cross-sectional imaging appearances. Emphasis is placed on multidetector computed tomography (MDCT) imaging, which represents the modality of choice to comprehensively assess acute splenic disorders including partial or complete infarctions, vascular diseases such as venous thrombosis, abscess collections, bleeding, and rupture. State-of-the-art magnetic resonance imaging represents a problem-solving technique. Borrowing from experience with grading abdominal trauma according to the traditional American Association for the Surgery of Trauma scale, spontaneous splenic injuries are confidently detected and characterized at MDCT. Furthermore, MDCT allows to identify or exclude coexistent perisplenic and intraperitoneal hemorrhage, presence and source of active bleeding, and contained vascular injury. Occasionally idiopathic, spontaneous splenic injuries should be suspected when acute abdominal manifestations and signs of hemodynamic compromise occur in a background of acute viral infections, endocarditis or sepsis, malaria, immune suppression, hematological disorders, malignancies, coagulopathy, or therapeutic anticoagulation. These uncommon yet life-threatening conditions require prompt diagnostic evaluation that allows correct triage between conservative, medical, interventional, and surgical treatment, and may obviate splenectomy. Finally, MDCT imaging allows differentiation of splenic rupture from other rare causes of spontaneous hemoperitoneum, and reliable follow-up of nonsurgically treated patients.

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Acute nontraumatic splenic infarctions at a tertiary-care center: causes and predisposing factors in 123 patients

Cox

Desai

et al. 2016

Emerg Radiol

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Acute splenic infarcts classically present with left upper quadrant pain, but may be discovered incidentally in many hospitalized patients with otherwise vague complaints. The purpose of our study was to document causes or predisposing conditions in patients found to have acute splenic infarctions on imaging. Following IRB approval, a retrospective review of an imaging database from May 2008 to May 2015 was performed for cases of acute splenic infarctions. The electronic medical record was then reviewed for potential predisposing factors or known causes. Specific note was made of cases with active malignancy, vascular disorders, or inflammatory conditions with an increased risk of vasculopathy. Echocardiogram and electrocardiogram results were reviewed when available. One hundred twenty-three patients with acute splenic infarcts were identified, 65 female and 58 male. The average age was 57 years (range of 22 to 88). Active malignancy was present in 40 patients or 33 %. The most common malignancy in patient with nontraumatic splenic infarctions was pancreatic cancer, present in 16 patients (13 %). In these patients, splenic infarction was due to direct invasion of vessels in the splenic hilum. Acute pancreatitis (severe) was directly responsible for splenic infarction in seven additional cases (6 %). Additional visceral infarcts were present in 18 patients (15 %), most commonly concomitant hepatic or renal infarcts. Documented atrial fibrillation was present in 12 patients, but only 2 cases of left-sided cardiac thrombi were seen on CT (1 atrial, and 1 ventricular thrombus). Eight cases of endocarditis with valvular vegetations were documented on echocardiography (7 %). Splenomegaly was present in 32 patients (26 %) with acute splenic infarction. In patients with nontraumatic splenic infarctions, there appears to be a relatively high association with active malignancy (up to a third of patients). Pancreatic disorders, malignant and inflammatory, also appear to be an important cause of splenic infarction, presumably due to the close proximity of the pancreas to the splenic vessels.

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Pancreatitis-associated splenic vein thrombosis with intrasplenic venous thrombosis: a case report

Cited by 3 publications

References 4 publications

Gastric Varices with Remarkable Collateral Veins in Valpronic Acid-Induced Chronic Pancreatitis

Gastric Varices with Remarkable Collateral Veins in Valpronic Acid-Induced Chronic Pancreatitis

Nontraumatic splenic emergencies: cross-sectional imaging findings and triage

Acute nontraumatic splenic infarctions at a tertiary-care center: causes and predisposing factors in 123 patients

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