No abstract

No abstract

No abstract

We recently used both ultrasound and computed tomography (CT) to examine a patient with a large left upper quadrant mass. The CT findings were misleading. The ultrasound images allowed us t o predict correctly the gross appearance of the left upper quadrant mass. But, even knowing both the clinical history and the gross appearance of the mass we were not able to make the precise pathological diagnosis preoperatively because the patient ultimately proved to have a rare primary tumor of the spleen. CASE REPORTA 71-year-old woman presented with a 3-week history of left upper abdominal pain and left chest pain. She had lost 30 lbs. during the previous year.Physical examination revealed a large left upper quadrant mass. Laboratory data were normal except for anemia. Her hemoglobin was 9.4 gm/dl and HCT was 28.4%.A chest radiograph was normal except for elevation of the left hemidiaphragm and a moderate degree of left lower lobe atelectasis. CT scans of the upper abdominal mass revealed what appeared to be a greatly enlarged but only slightly non-homogeneous spleen (Fig. 1). There was a focal low attenuation area surrounded by an enhancing rim arising from the anterior medial aspect of the left upper quadrant mass. Presumptive diagnosis was splenomegaly with a large splenic cyst.A longitudinal sonogram through the lateral aspect of the left upper quadrant mass using a method of "on the fly" photography, which we choose to call the reduced speckle imaging (RSI)