The abscess of the spleen is a rare condition with diverse аetiologies and highly polymorphic clinical expression. It is more common in male than female patient, with a wide age range. Regarding varied and often unspecific symptomatology it poses a great problem for diagnostic and overall treatment with a very high mortality rate in untreated patients. Recent diagnosis and treatment are based on modern imaging techniques that enable precise and rapid diagnostics. The following is a presentation of a case that refers to a young male patient with splenic abscess. CASE REPORT. A 37-year-old patient with a history of hypertensive crisis and multiple previous admittances to the emergency room regarding acute attacks of pancreatitis and persistent reduction in body weight was admitted to the emergency room with nonspecific symptoms of abdominal pain, more prominent in the upper left quadrant. Laboratory findings revealed leukocytosis and elevated levels of CRP. Infective panel for hepatitis and HIV was negative. Additional ultrasound investigations were made which revealed hypoechogenic lesion in the spleen, clearly demarcated from the neighboring parenchyma and partially encapsulated, with near proximity to the tail of the pancreas. Hospitalization with additional MRI and surgical treatment was advised, but the patient refused and contrary to the advice of the doctor decided to leave the hospital. After 10 days he was again admitted to the emergency room with persistent leukocytosis and elevated CRP. Because of the worsening condition, he accepted the previously proposed treatment and was hospitalized. The conducted MRI investigation revealed three cystic lesions with dense content in the spleen, measuring from 5x3sm to 2sm in diameter with propagation towards the tail of the pancreas. Surgical splenectomy with partial pancreatectomy was performed, and the surgical specimen was forwarded for histopathological examination. The microscopic examination on the selected specimens revealed severe stasis in the splenic parenchyma with subcapsular abscess formation, and also confirmed the chronic pancreatitis condition. The postoperative course went well without any complications, as well as on the following regular checkups. DISCUSSION. Splenic abscess is very uncommon entity associated with versatile etiologies which covers primary immunocompromised patients, trauma or patients with infective endocarditis. As a potentially life-threatening condition it is essential to emphasize the need for fast detection and splenectomy as a choice of treatment. But also it is very important as a potential aetiology to have in mind other chronic conditions like pancreatitis, especially in young male patients, given that management of the underlying disease is of great importance.

Determining the etiology of a pleural effusion can present a major problem for the clinician. Diagnostic evaluation of pleural effusions should include relevant history, clinical course, radiographic abnormalities, and take into account the patient’s desire and consent for further invasive investigations. The seventies were dominated by specific pleural effusions, but in the last three decades effusions of malignant etiology have dominated. Despite advances in diagnostics, about 20% of pleural effusions remain etiologically unexplained. Objective: we present data on the diagnostic contribution and complications when using a Ramel‘s needle (Wolf’s set) in investigating the nature of pleural effusions from an etiopathogenetic aspect. Methods: This retrospective study included 284 transparietal closed pleural biopsies performed between January 2011 and December 2020. Local anesthesia with 2% lidocaine was applied to the skin and subcutaneous tissue in all subjects (premedication with 1 mg of atropine or 10 mg of apaurin was sporadically applied); a chest radiograph was taken immediately before and within 4 to 12 hours after the procedure to rule out complications. The diagnostic positivity, accuracy and complication rate of the technique were evaluated. Results: 175 men and 109 women (median age 60 years, range 19–88) underwent transparietal pleural biopsy with a Ramel‘s needle, 96% of pleural effusions were unilateral (53% in the right hemithorax). Pleural tissue was obtained in 98%. The most common histological diagnosis included: malignancy (34.7%), nonspecific inflammation and mesothelial hyperplasia (32.3%), chronic inflammation with fibrosis (23.5%), granulomatous disease (4.3%), normal pleura and striated muscle (5.2%). Microbiological examination was performed in 24 samples (8.4%): Mycobacterium tuberculosis was present in 1 case, Escherichia Coli in one and Candida albicans in another patient. No pathogenic bacteria or fungi were identified in the rest of the examined. The procedure was well tolerated. Complications occurred in 7 (2.4%): pneumothorax in 4 patients (1.4%), vasovagal reaction in 2 cases (0.7%), local hematoma (0.3%). Conclusion: closed (percutaneous, blind) pleural biopsy with a Ramel‘s needle appears to be a simple technique, well tolerated, with a low complication rate and high diagnostic efficiency. Closed pleural biopsy has a relatively high sensitivity in the diagnosis of exudative pleural fluid, especially in tuberculous pleurisy and may provide an alternative technique in clinical practice. It can be applied to any unexplained pleural effusion, in cooperative patients with no coagulation abnormalities, in relation to standard biochemical, microbiological and cytological investigations, especially in hospital units without thoracoscopy. In our series, nonspecific inflammation was the most common histological diagnosis, and repeated biopsies significantly increased the diagnostic contribution.