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Case introduction: A 31-year-old female patient presented to the doctor due to intermittent left abdominal discomfort for 2 months.
She had no obvious medical history and surgical history.
The patient reported that he had been accidentally kicked into the abdomen by his child a few months ago, but he did not suffer any serious injuries.
Physical examination showed no abdominal tenderness and swelling of organs.
The laboratory examination also showed no obvious abnormalities.
The plain radiograph of the abdomen showed: calcification in the lower diaphragm of the left upper abdomen.
CT of the abdomen and pelvis showed cystic lesions of the spleen, measuring 6.
1 x 5.
5 x 5.
4 cm, with marginal calcification and thin internal partitions.
No other parts of the abdomen were affected.
Stool examination was negative for eggs, cysts, or parasites, and serology was negative for Echinococcus.
Based on the above results, what is the most likely diagnosis? The diagnosis result is a pseudosplenic cyst, which may be secondary to previous abdominal trauma.
Knowledge class: Splenic cyst is relatively rare, and its cause is not yet fully understood.
The pathology of splenic cysts is divided into two major categories: non-parasitic and parasitic.
Non-parasitic cysts can be divided into pseudocysts and epithelial cysts according to the presence or absence of lining epithelium.
Most of them are pseudocysts.
1.
Clinical manifestations The clinical manifestations of splenic cysts lack specificity, and the diagnosis mainly depends on imaging examinations.
The clinical manifestations are related to the size, location and growth rate of the cyst.
The cyst is small in size and may have no manifestations; large cysts can compress the surrounding organs and digestive tract, causing nausea, vomiting, upper abdominal discomfort, diarrhea, etc.
; it can even cause the diaphragm to rise, causing symptoms such as difficulty breathing, coughing, and tachycardia .
Most patients have a mass in the left upper abdomen as the main manifestation, and a smooth and cystic mass can be touched in the upper left abdomen or under the ribs.
2.
Diagnosis When there is discomfort or palpable mass in the left upper abdomen or left quarter rib, B-ultrasound, CT scan, chest and abdomen plain film, gastrointestinal barium meal examination should be performed in time to confirm the diagnosis in time.
CT is currently the most valuable imaging method for diagnosing splenic cysts.
It can clearly show the location, shape, size and relationship of the lesion with surrounding organs.
It has a high qualitative diagnosis coincidence rate and can be used as the first choice for splenic cysts.
3.
Treatment of splenic cysts Once the diagnosis is clear, a treatment plan should be selected based on the size and clinical manifestations of the cyst.
Small (diameter <2 cm), asymptomatic splenic cysts generally do not require surgical treatment, but should be followed up regularly.
Symptomatic splenic cysts or large cysts (≥5 cm in diameter) should be treated surgically.
The traditional surgical procedure is total splenectomy.
With the deepening of the understanding of the spleen function, especially the anti-infection and anti-tumor functions of the spleen, the spleen should be protected as much as possible.
References: [1] Tan HL, Kam JH, Kabir T.
A surprise in the spleen in a young female[J].
Gastroenterology.
2021 Mar 4;S0016-5085(21)00472-8.
[2] Zhang Xianping, Zhang Xiaoguo , Yang Bin, et al.
Diagnosis and treatment of splenic cyst (report of 9 cases)[J].
Hainan Medicine, 2006(12):21-22.
[3] Zhang Fujun.
A case of splenic cyst[J].
Chinese Journal of Clinicians (Electronic version), 2011,5(03):916-917.
Contribution email: tougao@medlive.
cn
She had no obvious medical history and surgical history.
The patient reported that he had been accidentally kicked into the abdomen by his child a few months ago, but he did not suffer any serious injuries.
Physical examination showed no abdominal tenderness and swelling of organs.
The laboratory examination also showed no obvious abnormalities.
The plain radiograph of the abdomen showed: calcification in the lower diaphragm of the left upper abdomen.
CT of the abdomen and pelvis showed cystic lesions of the spleen, measuring 6.
1 x 5.
5 x 5.
4 cm, with marginal calcification and thin internal partitions.
No other parts of the abdomen were affected.
Stool examination was negative for eggs, cysts, or parasites, and serology was negative for Echinococcus.
Based on the above results, what is the most likely diagnosis? The diagnosis result is a pseudosplenic cyst, which may be secondary to previous abdominal trauma.
Knowledge class: Splenic cyst is relatively rare, and its cause is not yet fully understood.
The pathology of splenic cysts is divided into two major categories: non-parasitic and parasitic.
Non-parasitic cysts can be divided into pseudocysts and epithelial cysts according to the presence or absence of lining epithelium.
Most of them are pseudocysts.
1.
Clinical manifestations The clinical manifestations of splenic cysts lack specificity, and the diagnosis mainly depends on imaging examinations.
The clinical manifestations are related to the size, location and growth rate of the cyst.
The cyst is small in size and may have no manifestations; large cysts can compress the surrounding organs and digestive tract, causing nausea, vomiting, upper abdominal discomfort, diarrhea, etc.
; it can even cause the diaphragm to rise, causing symptoms such as difficulty breathing, coughing, and tachycardia .
Most patients have a mass in the left upper abdomen as the main manifestation, and a smooth and cystic mass can be touched in the upper left abdomen or under the ribs.
2.
Diagnosis When there is discomfort or palpable mass in the left upper abdomen or left quarter rib, B-ultrasound, CT scan, chest and abdomen plain film, gastrointestinal barium meal examination should be performed in time to confirm the diagnosis in time.
CT is currently the most valuable imaging method for diagnosing splenic cysts.
It can clearly show the location, shape, size and relationship of the lesion with surrounding organs.
It has a high qualitative diagnosis coincidence rate and can be used as the first choice for splenic cysts.
3.
Treatment of splenic cysts Once the diagnosis is clear, a treatment plan should be selected based on the size and clinical manifestations of the cyst.
Small (diameter <2 cm), asymptomatic splenic cysts generally do not require surgical treatment, but should be followed up regularly.
Symptomatic splenic cysts or large cysts (≥5 cm in diameter) should be treated surgically.
The traditional surgical procedure is total splenectomy.
With the deepening of the understanding of the spleen function, especially the anti-infection and anti-tumor functions of the spleen, the spleen should be protected as much as possible.
References: [1] Tan HL, Kam JH, Kabir T.
A surprise in the spleen in a young female[J].
Gastroenterology.
2021 Mar 4;S0016-5085(21)00472-8.
[2] Zhang Xianping, Zhang Xiaoguo , Yang Bin, et al.
Diagnosis and treatment of splenic cyst (report of 9 cases)[J].
Hainan Medicine, 2006(12):21-22.
[3] Zhang Fujun.
A case of splenic cyst[J].
Chinese Journal of Clinicians (Electronic version), 2011,5(03):916-917.
Contribution email: tougao@medlive.
cn