Percutaneous Nonvascular Splenic Intervention: A 10-Year Review

Lucey, Brian C.; Boland, Giles W.; Maher, Michael M.; Hahn, Peter F.; Gervais, Debra A.; Müeller, Peter R.

doi:10.2214/ajr.179.6.1791591

Cited by 97 publications

(57 citation statements)

References 20 publications

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“…According to Lucey et al (1), the most common clinical scenario for which splenic biopsy is performed is a focal splenic lesion in a patient with a known extrasplenic neoplasm ( Figs 3, 4); this was the indication in 10 of 23 patients in that study. Another common indication for splenic biopsy is the discovery of a splenic mass in a patient with known or suspected lymphoma.…”

Section: Biopsymentioning

confidence: 71%

“…The sensitivity of core needle biopsy in making a diagnosis is 88% or better in multiple series in the literature (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). In a study by Muraca et al (4), the biopsy yield in pediatric patients with a focal splenic lesion was 83% with 18-21-gauge needles.…”

Section: Biopsymentioning

confidence: 99%

“…This may be related to the significantly higher number of liver and pancreatic biopsies performed in comparison with other visceral biopsies. In clinical practice, splenic biopsy is successful in 91% of procedures, splenic fluid aspiration in 100%, and splenic fluid drainage in 86% (1). …”

Section: Introductionmentioning

confidence: 99%

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Image-guided Percutaneous Splenic Interventions

Singh

Shankar²,

Gervais

et al. 2012

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In the spleen, image-guided interventional procedures such as biopsy and catheter drainage have not been widely performed because of the perceived increased risk of complications. The ability of image-guided biopsy to allow tissue diagnosis of a focal splenic mass without the need for splenectomy is the driving force behind use of this procedure in oncology patients. The literature on image-guided splenic biopsy suggests that the highest biopsy yield is achieved with core biopsy and the lowest complication rate is achieved with fine-needle aspiration. Image-guided catheter drainage is an effective alternative to splenectomy for management of infected splenic collections. In clinical practice, image-guided splenic biopsy, fluid aspiration, and catheter drainage have high success rates. Image-guided alcohol ablation is effective in treatment of splenic cysts. The literature on splenic radiofrequency ablation (RFA) is sparse; therefore, further studies are needed to determine the role of RFA in management of splenic neoplasms and hypersplenism. Image-guided percutaneous thrombin injection can be used to treat splenic artery pseudoaneurysms. Awareness of the correct interventional techniques and their limitations is important for safe performance of image-guided percutaneous splenic interventions.

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Section: Biopsymentioning

confidence: 71%

Section: Biopsymentioning

confidence: 99%

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Image-guided Percutaneous Splenic Interventions

Singh

Shankar²,

Gervais

et al. 2012

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“…(17) Despite the widespread use of interventional radiology techniques, there has been a reluctance to apply these to spleen, due to concern for bleeding and difficulty in negotiation around colon and pleura. (18) Many recent studies have shown that percutaneous drainge is safe and splenectomy should be reserved for cases in which aspiration failed. Two important cautions must be observed.…”

Section: Percutaneous Drainagementioning

confidence: 99%

Splenic Abscess: Review Article

Datey¹,

Charles²,

Patidar³

et al. 2015

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Case report of splenic abscess in a 35 year old male is presented with review of the literature. The patient was admitted with left sided lower chest pain and fever without any significant abnormality on physical examination and haematological investigations. On imaging studies a large splenic abscess was diagnosed which was initially treated by broad spectrum antibiotics. Aspiration under sonographic control was unsuccessful due to thick pus and debris in the abscess. Open splenectomy was done with a complete recovery of the patient. Splenic abscess is an infrequent clinical entity and carries a very high mortality in the untreated cases. Pathognomic clinical features of left hypochondrial pain, splenomegaly, fever and leucocytosis are present in only one-third of the cases. Diagnosis is mostly done by imaging, either Abdominal Sonography or CT Scan. So far no prospective study has been done to rationalize the management, probably due to paucity of cases. Antibiotics alone or with percutaneous drainage under imaging control are successful in many cases. Failed aspirations and splenic abscesses with concomitant pathologies need splenectomy. Splenectomy and complete removal of the source of the infection is still the mainstay of treatment. Detailed review of the available literature of the clinical problem and various methods of treatment of splenic abscesses are discussed in the article. KEYWORDS: Splenic Abscess, Percutaneous drainage of splenic abscess, Splenectomy. INTRODUCTION:Splenic abscess is an infrequent clinical entity. International literature has less than 600 reported cases so far. (1) Splenic abscesses have a very high mortality in untreated cases. Pathognomic clinical features of left hypochondrial pain, fever, splenomegaly and leucocytosis are present in only one-third of the cases. Diagnosis is mostly done by imaging i. e., Sonography or CT Scan. Various treatment modalities like aspiration under imaging control with appropriate antibiotics and splenectomy by open or laparoscopic approach have been described. So far no prospective study has been done to rationalize the management probably due to the paucity of cases.

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“…Esto conlleva un aumento considerable del tiempo dedicado a tareas de investigación y eso siempre que el ansia de figurar vaya acompañado del deseo propio de investigar, en perjuicio muchas veces de las labores asistenciales que no debemos olvidar conforman la primera y principal obligación de todo médico residente. No obstante e independientemente de eso, se ha generado un gran aumento de publicaciones científi-cas en los últimos años que en muchas ocasiones adolecen de inconsistencia y rigor científico, por no mencionar los múltiples defectos de forma y estilo (8) y que probablemente la única función que posean sea la de ejercitar el intelecto de aquel que las firma (siempre y cuando, claro está, las haya escrito él) (9,10). Y observamos en reuniones, congresos y otros foros de índole diversa autoplagios y publicaciones paralelas de un mismo grupo de trabajo, eso si, colocados los mismos autores de muy variadas formas.…”

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Endocarditis en electrodo de marcapasos de resincronización cardiaca: Tratamiento quirúrgico con circulación extracorpórea

Abad¹,

García²,

Caipe

et al. 2007

An. Med. Interna (Madrid)

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Endocarditis en electrodo de marcapasos de resincronización cardiaca. Tratamiento quirúrgico con circulación extracorpórea Sr. Director: La terapia de resincronización cardíaca (TRC) con marcapaso cardiaco (MC) de Resincronización es una modalidad terapéutica establecida en determinados grupos de pacientes con insuficiencia cardiaca.Presentamos el caso de un paciente con endocarditis tardía y de repercusión, localizada en un electrodo del sistema de MC de resincronización, tratado quirúrgicamente con éxito.Paciente varón de 60 años, portador de un MC tricameral para resincronizacion (Guidant Contact Renewal TR) desde el 19 de abril del 2005, implantado por bloqueo trifascicular, cardiomiopatía dilatada y disfunción ventricular izquierda con fracción de eyección del 24%.El 9 de agosto de 2006 ingresó por fiebre vespertina de 4 semanas de evolución. Antecedentes personales de obesidad, diabetes mellitus no insulinodependiente y disfunción eréctil, por lo que se sometió a cirugía de implantación de prótesis de pene en junio de 2006. Tras su ingreso se realizaron hemocultivos siendo positivos para Staphilococcus epidermidis coagulasa negativo, instaurándose tratamiento antibiótico intravenoso (i.v.). Se practicó un ecocardiograma transtorácico que mostraba imagen compatible con verruga en electrodo de MC. Seguidamente se efectuó un ecocardiograma transesofágico (ETE) que demostraba una verruga grande de 7 x 2 cm en el electrodo ventricular derecho (VD) (Fig. 1). A pesar del tratamiento antibiótico la evolución clínica del paciente fue desfavorable, presentando shock séptico, hipotensión arterial, necesidad de inotrópicos, hemofiltración por fracaso renal e ingreso en la Unidad de Cuidados Intensivos (UCI). Ante los hallazgos y la situación clínica se decidió cirugía.El 7 de octubre de 2006, se intervino quirúrgicamente en situación de urgencia. Se realizó una esternotomía media y bajo circulación extracorpórea (CEC), se retiró el electrodo de electroestimulación del VD con verrugas, electrodo auricular derecho (AD) y electrodo ventricular izquierdo (VI) colocado a través del seno coronario. Además fue extraído el generador situado en región pectoral izquierda. A continuación se implantó en el epicardio de VD, VI y AD tres electrodos epicardicos Medtronic (Medtronic, Inc. USA) que se conectaron a un MC de Resincronización Guidant Contak Renewal TR (Guidant Corporation. Boston Scientific. USA) que se colocó por debajo de la fascia del recto anterior izquierdo del abdomen. La cirugía fue sin incidentes con un tiempo de CEC de 45 minutos y de isquemia miocárdi-ca de 12 minutos. El curso postoperatorio en UCI y sala de hospitalización transcurrió sin complicaciones, siendo dado de alta hospitalaria tras cuatro semanas de tratamiento antibiótico i.v. Desde entonces permanece asintomático y su MC de resincronización funciona correctamente.La TRC es una forma de tratamiento recientemente introducida en la práctica cardiológica y aplicada a grupos seleccionados de pacientes con insuficiencia cardiaca severa y disincronía mec...

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Percutaneous Nonvascular Splenic Intervention: A 10-Year Review

Cited by 97 publications

References 20 publications

Image-guided Percutaneous Splenic Interventions

Image-guided Percutaneous Splenic Interventions

Splenic Abscess: Review Article

Endocarditis en electrodo de marcapasos de resincronización cardiaca: Tratamiento quirúrgico con circulación extracorpórea

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