Cross-sectional imaging findings of splenic infections: is differential diagnosis possible?

Karaosmanoğlu, Ali Devrim; Uysal, Aycan; Önder, Ömer; Hahn, Peter F.; Akata, Deniz; Özmen, Mustafa; Karçaaltıncaba, Muşturay

doi:10.1007/s00261-021-03130-8

Cited by 12 publications

(10 citation statements)

References 93 publications

(113 reference statements)

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“…The understanding of splenic function has continued to develop in recent centuries, and numerous diseases are known to affect this solid organ. One rare form of splenic pathology is abscess [ 2 , 3 ].…”

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confidence: 99%

Splenic Abscess in the New Millennium: A Descriptive, Retrospective Case Series

Radcliffe

Tang

Gisriel

et al. 2022

Open Forum Infectious Diseases

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Introduction Splenic abscess is a rare infection often resulting from hematogenous spread. Immunocompromised states are commonly comorbid, and the microbiology is heterogeneous. Methods We conducted a retrospective review of 33 cases identified by convenience sampling. Cases were treated in our institution’s hospital system between May 2012 and February 2021 and classified as proven or probable based on predetermined criteria. Results The median age was 57 years, and 58% were men. Common underlying diseases included diabetes mellitus (30%), pancreatic disease (30%), and hematological malignancy (15%). The most common mechanism of pathogenesis was hematogenous spread (n = 13). Escherichia coli, enterococcal spp., and anaerobes were frequently implicated. One case was discovered at autopsy and excluded from subsequent analyses. The median duration of antimicrobial therapy was 45 days (range 5-525 days), and the median length of index hospitalization was 20 days. Percutaneous drainage by interventional radiology was common (17 of 32; 53%), and six patients underwent splenectomy. Treatment success was achieved in 14 of 32 cases (44%), with clinical stability in 3 of 32 cases (9%). Failures occurred in 41% (13 of 32) cases, two of whom died from splenic abscesses. Two patients (2 of 32) were lost to follow up. Conclusion To our knowledge, this is the largest North American series since the turn of the century and the first to distinguish between proven and probable cases. As reflected in our series, patients with splenic abscess may require prolonged hospitalizations and courses of antimicrobial therapy. Improvements in management are needed.

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confidence: 99%

Splenic Abscess in the New Millennium: A Descriptive, Retrospective Case Series

Radcliffe

Tang

Gisriel

et al. 2022

Open Forum Infectious Diseases

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“…19 It should be noted, however, that these imaging findings may also closely resemble sarcoidosis, candidiasis, and advanced metastatic disease. 15,20 Therefore, it is crucial to consider diagnoses other than CSD by examining coronary artery lesions and verifying the accompanying findings because KD and malignancy can result in severe outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Several cases of atypical CSD that mimic other diseases have been reported in the literature. Other etiologies include metastatic tumors, 15 Epstein-Barr virus infection, 16 and autoimmune diseases. 17 Kara et al reported a suspected case of CSD neuroretinitis, which was eventually diagnosed as systemic lupus erythematosus based on a positive result for antinuclear antibody.…”

Section: Discussionmentioning

confidence: 99%

Atypical Cat Scratch Disease With Splenic Lesion Mimicking Kawasaki Disease in a Healthy 5-Year-old Girl

Ma,

Aoki,

Kitazawa

2023

Pediatric Infectious Disease Journal

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Background: Atypical cat-scratch disease (CSD) and Kawasaki disease (KD) are differential diagnoses of pediatric febrile illnesses. Diagnosing atypical CSD can be challenging because of its wide range of symptoms. However, its similarity to KD has rarely been addressed. Methods: We present the case of a 5-year-old girl with atypical CSD and splenic lesions who fulfilled the diagnostic criteria for KD. We also conducted a literature review of previous cases in which CSD was suspected alongside KD and detailed the diagnosis and treatment processes. Results: A previously healthy 5-year-old girl with prolonged fever and symptoms resembling those of KD was admitted to our hospital. There was no evidence of an abnormal coronary artery, and her condition did not improve after the initial treatment for KD and bacterial infection. A history of contact with cats and multiple granulomatous lesions in the spleen on abdominal ultrasonography led to a clinical diagnosis of atypical CSD. Trimethoprim-sulfamethoxazole treatment resulted in symptom resolution. Elevated serum Bartonella henselae IgG and IgM antibodies confirmed the diagnosis of CSD. In this case, we avoided second-line treatment for KD with an alternative CSD diagnosis. Additionally, we identified 4 documented cases of CSD presenting with KD-like features in the literature. Intravenous immunoglobulin was ineffective in all cases, including the present case. Conclusions: In cases of atypical CSD where KD is suspected, actively seeking organ-specific symptoms may facilitate an early clinical diagnosis of CSD. Adopting this approach could yield multiple advantages, including reduced invasiveness for the patient and decreased healthcare-related expenditures.

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“…Hydatid cysts can also resemble some rare calcifications caused by tuberculosis (Azzaza et al, 2020), but this also tends to generate multiple calcifications with a different morphology (Biehler‐Gomez et al, 2020; Gawne‐Cain & Hansell, 1996). The morphology of calcified abscesses observed in rare cases of brucellosis infection is also very distinct, showing a characteristic snowflake shape or, less commonly, a concentric lamellar pattern with central calcification (Colmenero et al, 2002; Karaosmanoglu et al, 2021; Torres et al, 2015). Fungal infections such as histoplamosis or Pneumocystis carinii can also originate calcifications, but these are multiple and smaller (Consul et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Two cases of cystic echinococcosis reported from al‐Andalus cemeteries (southern Iberia): Insights into zoonotic diseases in Islamic Medieval Europe

López‐Gijón,

Duras,

Maroto‐Benavides

et al. 2023

Intl J of Osteoarchaeology

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The identification of a calcified hydatid cyst in the bioarcheological record is key to the diagnosis of cystic echinococcosis (i.e., hydatid disease), a parasitic infection caused by the tapeworm Echinococcus granulosus. This zoonosis can be linked to human–canid interactions, given the reproductive cycle of the parasite (from canids to herbivores/humans as intermediate hosts), and it is commonly associated with agropastoral communities in both the past and present. However, it is not easy to identify a calcified hydatid cyst in the archeological record because of preservation problems and its similarity with other calcifications of biological and geological origin. We report the presence of two fragmented ovoidal calcified formations associated with human remains in different medieval Islamic cemeteries from the Kingdom of Granada in al‐Andalus (Southern Iberia, 13th–15th centuries AD). These formations were analyzed by scanning electron microscopy and energy‐dispersive X‐ray spectroscopy. The localization, morphology, and composition of the calcifications indicate that they are hydatid cysts caused by E. granulosus, representing the first evidence of cystic echinococcosis in Islamic Medieval Europe. Our results are in line with archeological and historical records of human–animal interactions and agropastoral practices in al‐Andalus, and they highlight the importance of analyzing calcified masses in the osteoarcheological record.

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Cross-sectional imaging findings of splenic infections: is differential diagnosis possible?

Cited by 12 publications

References 93 publications

Splenic Abscess in the New Millennium: A Descriptive, Retrospective Case Series

Splenic Abscess in the New Millennium: A Descriptive, Retrospective Case Series

Atypical Cat Scratch Disease With Splenic Lesion Mimicking Kawasaki Disease in a Healthy 5-Year-old Girl

Two cases of cystic echinococcosis reported from al‐Andalus cemeteries (southern Iberia): Insights into zoonotic diseases in Islamic Medieval Europe

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