Partial splenic embolization treats recurrent left pleural effusions in a patient with portal venous system thrombosis

Mohamed, Ahmed-Zayn; Jazayeri-Moghaddas, Omeed; Markovitz, Michael; DeClue, Christopher; Barakat, Elie; Davis, Clifford

doi:10.1016/j.radcr.2021.04.051

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…Our patient refused any invasive management after the initial thoracentesis and opted for conservative management. While no strong evidence exists to guide management in these cases, splenectomy and partial splenic embolization have been described for recurrent pleural effusion seen with splenomegaly of varying etiologies [2,12,13]. The pleural effusion in our patient almost entirely resolved spontaneously after the initial recurrence, suggesting physicians can consider watchful monitoring in these cases after discussing with the patient.…”

Section: Discussionmentioning

confidence: 68%

Spontaneous Resolution of Recurrent Pleural Effusion in Atraumatic Splenic Rupture

Gupta¹,

Thameem²

2023

Cureus

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Spontaneous splenic rupture is an uncommon cause of acute-onset left-sided pleural effusion. It is often immediate with a high preponderance for recurrence, sometimes even requiring splenectomy. We report a case of spontaneous resolution of recurrent pleural effusion presenting a month after the initial atraumatic splenic rupture. Our patient was a 25-year-old male without significant medical history who was taking Emtricitabine/Tenofovir for pre-exposure prophylaxis. He presented to the pulmonology clinic for left-sided pleural effusion, diagnosed in the emergency department a day prior. He had a history of spontaneous grade III splenic injury one month before, where he was diagnosed with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) co-infection on polymerase chain reaction (PCR) testing and was managed conservatively. The patient underwent thoracentesis in the clinic, which showed exudative lymphocyte predominant pleural effusion and no malignant cells. The remainder of the infective workup was negative. He was readmitted two days later with worsening chest pain, and imaging revealed re-accumulation of pleural fluid. The patient declined thoracentesis, and a chest X-ray was repeated a week later, showing worsening pleural effusion. The patient insisted on continuing conservative management, and he was seen a week later with a repeat chest X-ray that showed near resolution of pleural effusion. Splenomegaly and splenic rupture can lead to pleural effusion due to posterior lymphatic obstruction, which can be recurrent. There are no current guidelines on management, and treatment options include watchful monitoring, splenectomy, or partial splenic embolization.

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Section: Discussionmentioning

confidence: 68%

Spontaneous Resolution of Recurrent Pleural Effusion in Atraumatic Splenic Rupture

Gupta¹,

Thameem²

2023

Cureus

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“…The microsphere with the size of 300-500 um can reach the distal end of the blood vessel and achieve the terminal embolization, which is not easy to form collateral circulation and reduce the recurrence of hypersplenism. The common side effects and complications of partial splenic embolization include post embolization syndrome (such as abdominal pain, fever, vomiting), portal vein thrombosis, liver failure, pleural effusion, ascites and splenic abscess [38,[50][51][52][53]. Gabriele Piffaretti et al [54] reported that postembolization syndrome is common and has been reported as 30% but generally resolving without sequelae.…”

Section: Discussionmentioning

confidence: 99%

Quantitative splenic embolization possible: application of 8Spheres conformal microspheres in partial splenic embolization (PSE)

Zheng

Liang

et al. 2021

BMC Gastroenterol

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Background To investigate the safety and efficacy of 8Spheres in partial splenic embolization. To explore the possibility of accurate control of splenic embolic volume by quantifying the number of microspheres used during PSE. Method The data of 179 patients who underwent PSE were collected. The patients were divided into two groups: 300–500 um microsphere group (N = 83) and 500–700 um microsphere group (N = 96). The spleen volume before PSE, infarct volume and infarct rate of the spleen after PSE, changes in peripheral blood cells after PSE, postoperative adverse events and incidence of infection were compared between the two groups. Results 300–500 um group vs 500–700 um group: postoperative spleen volume (cm3): 753.82 ± 325.41 vs 568.65 ± 298.16 (P = 0.008); spleen embolization volume (cm3): 525.93 ± 118.29 vs 630.26 ± 109.71 (P = 0.014); spleen embolization rate: 41.1 ± 12.3% vs 52.4 ± 10.1% (P = 0.021). Leukocytes and platelets were significantly increased after PSE in both groups; leukocyte, 1 month: 4.13 ± 0.91 vs 5.08 ± 1.16 (P = 0.026); 3 months: 4.08 ± 1.25 vs 4.83 ± 0.98 (P = 0.022); platelet, 1 month: 125.6 ± 20.3 vs 138.7 ± 18.4 (P = 0.019); 3 months: 121.8 ± 16.9 vs 134.3 ± 20.1 (P = 0.017). Incidence of abdominal pain after PSE, 72 (86.7%) vs 69 (71.9%), P = 0.027. The incidence of other adverse events and infections after PSE was not statistically different. Conclusion PSE with 8Spheres is safe and effective. The use of 500–700 um microsphere for PSE can make the increase of peripheral blood cells more stable. Each vial of 8Spheres corresponds to a certain volume of splenic embolization, so it is possible to achieve quantitative embolization in PSE.

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Partial splenic embolization treats recurrent left pleural effusions in a patient with portal venous system thrombosis

Cited by 2 publications

References 11 publications

Spontaneous Resolution of Recurrent Pleural Effusion in Atraumatic Splenic Rupture

Spontaneous Resolution of Recurrent Pleural Effusion in Atraumatic Splenic Rupture

Quantitative splenic embolization possible: application of 8Spheres conformal microspheres in partial splenic embolization (PSE)

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