Such impairment may be caused by liver disease, portal vein or splenic vein pathology, constrictive pericarditis, or congestive cardiac failure. Find out information about congestive splenomegaly. Most common cause of splenectomy was traumatic spleen followed by fibro congestive splenomegaly. Other functions include filtering senescent and defective red blood cells, presenting antigens to the immune system, and destroying.
Red pulp congestion with presence of neoplastic cells. One classical analysis of 86 spleens, representing chronic cases of portal hypertension due to different etiologies, showed. The spleen can be a troublesome specimen for the surgical pathologist, not only because experience with the range of normal splenic histology is limited by its rarity but also because there is an often a frustrating discordance between the patients clinical condition and the perceived findings. As a corollary of this, it has been felt further that if the spleen is palpable in a case of heart failure, some complication should be suspected. The red pulp expands as neutrophils accumulate in the spleen and encroaches on the lymphoid follicles. Rarely, cases of portal hypertensionassociated splenomegaly have no discernible cause and are termed idiopathic portal hypertension. Histopathological study on chronic congestive splenomegaly. The term splenomegaly generally denotes a palpably enlarged spleen. It is the largest lymphoid organ and thus the largest filter of blood in the human body. Probably because the findings tend to be repetitive and non. Final histopathology of the spleen showed lymphoma in 15 37%, tuberculosis in five 12% and other lesions in five 12% patients.
Sixteen 39% patients had only congestive splenomegaly. A wide variety of diseases can lead to splenic enlargement. Pdf in course of experimental prehepatic portal hypertension in the rat, the most. Pathology of congestive heart failure dr sampurna roy md. Splenomegaly general presentation the spleen is a hematopoietic organ supporting the megakaryotic, lymphoid, erythroid, myeloid, and reticuloendothelial systems. Splenomegalya problem in differential diagnosis sciencedirect. Histology of cvc lung alveolar septa are widened due to. Get a printable copy pdf file of the complete article 976k, or click on a page image below to browse page by page.
Clinically it is useful to classify splenomegaly by size. A complete workup may require laboratory tests, lymph node histology, bone marrow histology, and liver histology. The spleen has a unique location, embryological development and histological structure that differs significantly from other lymphoid organs special histological features define several important functions of the spleen. Chronic venous congestion of lung,spleen and kidney authorstream presentation. Jan 09, 2018 the most common complaint in patients with splenomegaly is mild, vague, abdominal discomfort. Anatomy develops from condensations of mesoderm in the dorsal mesogastrium. Congestive splenomegaly splenomegaly is an enlargement of the spleen that often results from bloodborne infections. The spleen is a functionally diverse organ with active roles in immunosurveillance and hematopoiesis. Splenic pathology has not been much studied in our region. Portal hypertension ultimately results in congestive splenomegaly. Splenomegaly, hypersplenism, and hereditary disorders with. The microvascular architecture of spleen in congestive splenomegaly. In one, the patient presented with splenic rupture, and the clinical impression was of probable acute infectious mononucleosis, which could not be substantiated on morphology or phenotyping.
A high proportion of patients presenting with idiopathic splenomegaly will have underlying haematological malignancies even in tropical. Clinical vignette 65 year old man with alcoholic cirrhosis and portal hypertension. Morphology large follicles with prominent germinal centres appear to bulge against a collar of small b lymphocytes. Splenomegaly is defined as enlargement of the spleen measured by. The spleen has long been a mysterious organ whose function was unknown. Other articles where congestive splenomegaly is discussed. Splenomegaly can be found in 3% of the normal population. Splenic circulatory dynamics in congestive splenomegaly. A billable code is detailed enough to be used to specify a medical diagnosis.
We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. The spleen becomes enlarged under a great variety of circumstances, so that to unravel the cause of the splenomegaly in a given case is often a difficult but nevertheless a fascinating exercise. In the past, splenomegaly was a clinical finding, but in recent years, imaging studies have also helped to assess for or confirm mild splenomegaly. Jun 18, 2007 the level of hepatic involvement correlates poorly with serum liver function tests. Splenomegaly is defined as enlargement of the spleen, measured by size or weight. Chronic venous congestion of lung, liver and spleen. The nodules of white pulp are wellspaced and have germinal center formation. Top 5 causes of splenomegaly in dogs clinicians brief. So far the histopathology of congestive splenomegaly has been little explored.
Congestive splenomegaly due to hepatic cause is likely to be the major cause in our setting. It is a reservoir for platelets and a site for the proliferation of blymphocytes. Treatment of the underlying disease in these con ditions may relieve or reduce splenomegaly. Find out information about chronic congestive splenomegaly. Early satiety from gastric displacement occurs with massive splenomegaly. Massive splenomegaly is enlargement of the spleen beyond the umbilicus. Get a printable copy pdf file of the complete article 1008k, or click on a page image below to browse page by page. Histopathology of the spleen in the socalled congestive splenomegaly has been little explored. Histopathology with extensive sectioning showed changes identical to those seen in people diagnosed with idiopathic splenomegaly. Splenomegaly is an exception rather than the rule, and the hematologic profile is that of selective absence or reduction in the number of neutrophils, while monocytes, eosinophils, and basophils are either normal or increased.
All the pathological spleens show the picture of congestive splenomegaly. Increased systemic hydrostatic pressure from rightsided congestive heart failure or increased splenic vein hydrostatic pressure because of thrombosis may cause splenic congestion. Other differentials for generalised splenomegaly include splenic torsion excluded in this case during surgery, portal hypertension leading to congestive splenomegaly excluded in this case by intraoperative measurement of portal blood pressure and massive extramedullary haematopoiesis for which no evidence was found on histopathology of the. Chronic venous congestion of lung,spleen and kidney. Thank you for your interest in spreading the word about the bmj. In one form of the disorder, called congestive splenomegaly, the spleen becomes engorged with blood because of impaired flow through the splenic vein, which empties into the portal vein. Germinal centreslympho in varying stages blast transform. The spleen usually lies in the left upper quadrant luq of the human abdomen. Most of the cases are due to the fall of myocardial contractile function systolic dysfunction. Caused by portal hypertension, which may be due to buddchiari syndrome thrombosis of hepatic veins, cirrhosis, congestive heart failure, portal vein stenosis, thrombosis of.
Histopathological study and audit of the spleen in nigerians. Full text full text is available as a scanned copy of the original print version. Liver test results are diffusely abnormal in congestive splenomegaly with cirrhosis. Congestion splenic vein thrombosis, portal hypertension, congestive heart failure. The difference between splenomegaly and hypersplenism depends on the nature of the abnormality. Patients can present with fulminant liver failure, intrahepatic cholestatic jaundice and ascites, or intraparenchymal haemorrhage. Congestive splenomegaly due to pancreatic cystadenoma. Splenomegaly in children see approach to the child with an enlarged spleen.
Disease bioinformatics research of congestive splenomegaly has been linked to hypertension, portal, hypertensive disease, liver cirrhosis, hypersplenism, varicosity. However, the underlying cause of the hypersplenism will most likely remain. Bantis syndrome congestive splenomegaly with hypersplesim occurring in cirrhosis and portal hypertension 14. May 17, 2017 splenomegaly may be caused be increase in portal venous pressure, infiltrative conditions or when the spleen function needs to increase. Gross description diffuse enlargement of spleen with firm, dark red congested cut surface. The study of congestive splenomegaly has been mentioned in research publications which can be found using our bioinformatics tool below. Definition of cirrhosiscirrhosis is derived from greek word kirrosorange or tawny and osisconditionwho definition. Elsherif fromthe medical unit, fouadfust university, cairo receivedoctober 10, 1949 it is generally stated that the spleen rarely if ever enlarges sufficiently to become palpable in uncomplicated congestive heart failure. Caused by portal hypertension, which may be due to buddchiari syndrome thrombosis of hepatic veins, cirrhosis, congestive heart failure, portal vein stenosis, thrombosis of splenic veins, other thrombosis. The causes of splenomegaly vary between hospitals in the same country,12 but differences between developing and developed countries are even more striking. Most cases are the result of splenic, hepatic, or portal vein thrombosis, congestive heart failure, or cirrhosis. In many laboratories routine histopathological evaluation of the spleen. Splenomegaly is a feature of a broad range of diseases, and presents to clinicians in many fields.
Patients may also experience pain,which may be referred to the left shoulder. Fineneedle aspiration of the spleen as an aid in the. Caused by portal hypertension, which may be due to buddchiari syndrome thrombosis of hepatic veins, cirrhosis, congestive heart failure. Splenomegaly was present in 79% of these patients, and splenic masses were present in 15%. Most common diagnosis made after microscopy and correlating clinical and radiological findings was fibrocongestive splenomegaly 67%, which was most. The present study included 65 cases, out of which 45 were males and 20 were females. Splenomegaly is typically caused by discrete nodules or diffuse enlargement. Patients presented with hemoabdomen are often collapsed and in. This topic provides an overview of normal splenic size and function and an approach to evaluating splenic abnormalities in adults. Pathology research and practice volume 174, issues 12. Splenomegaly is one of the four cardinal signs of hypersplenism which include. Ive also included some notes from first aid 2010 on the slides. In congestive splenomegaly, an obstruction of venous outflow from the spleen leads to an increase in the amount of red pulp.
Chronic congestive splenomegaly article about chronic. Congestive heart failure chf is the condition in which heart is unable to maintain an output sufficient for the metabolic functions of the tissues and organs of the body. Spectrum of disease entities in splenectomy specimen. This condition has not been reported in dogs, but people normally presented with varying cytopenias and splenomegaly of. Heart objectives normal effects of aging on the heart pathology heart failure leftsided heart failure rightsided heart failure congenital heart disease ischemic heart disease hypertensive heart disease 1 dr. The spleen is a fist sized organ located in the left upper quadrant of the abdomen. Links to pubmed are also available for selected references. The evaluation of splenomegaly in children and considerations related to elective or traumatic splenectomy are discussed separately. Splenomegaly occurs with diseases of the spleen, with general infections, with. Pathology of the spleen in hepatosplenic schistosomiasis. Probably because the findings tend to be repetitive and non specific. Portal hypertension an overview sciencedirect topics. However, it may also refer to an enlarged spleen detected by an imaging test. Tropical splenomegaly massive splenomegaly occurring in people of endemic area for malariakalaazar.
Splenomegaly a problem in differential diagnosis william dameshek, m. The second, who had crohn disease, had massive splenomegaly. At point b, thrombosis of his shunt was suspected because. Jan 09, 2018 splenomegaly is defined as enlargement of the spleen, measured by size or weight. Anatomic descriptions of the spleen are found in the works of aristotle, hippocrates, in the talmud and the bible 1, but its function has only been investigated and understood in the last hundred years. The common conditions that result in isolated splenomegaly. Surgical indications in idiopathic splenomegaly hematology. On the other hand, as the spleen progressively and. Fineneedle aspiration an aid in the diagnosis deborah a. Microscopy radiopath haematolymphoid system museum home.
In normal individuals or in patients with mild splenomegaly, the spleen generally retains its usual tetrahedral shape and there appears to be a good cor relation between measurements whether by mr, ct or ultrasound 1. On histopathology, the patients predominantly had congestive splenomegaly 34. Splenomegaly in congestive heart failure annals of. Full text is available as a scanned copy of the original print version. Fundamental liver pathology part 2 duke university. The most common complaint in patients with splenomegaly is mild, vague, abdominal discomfort. Congestive splenomegaly with hypersplesim occurring in cirrhosis and portal hypertension 14. This statement was made by held 1 in his discussion on splenomegaly, and the same opinion was voiced by rolleston. Fibrocongestive splenomegaly definition of fibrocongestive.
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