Case introduction
The patient, a 31-year-old woman, presented for 2 months due to intermittent left abdominal discomfort, and had no obvious history of past illness and surgery. The patient reported being accidentally kicked in the abdomen by his own child a few months ago, but had not suffered any serious injuries as a result. Physical examination reveals no abdominal tenderness and organ enlargement. Laboratory tests are also not markedly abnormal.
Plain x-ray of the abdomen shows a calcification of the left upper quadrapate. CT of the abdomen and pelvis shows splenic cystic lesions of 6.1 x 5.5 x 5.4 cm in size with marginal calcification and thin internal separation. There is no lesion in other parts of the abdomen. Stool tests negative for eggs, cysts, or parasites, and negative for echinococcosis serology.
Based on the above results, what is the most likely diagnosis?
Diagnostic results
Pseudosplenal cysts, possibly secondary to previous abdominal trauma.
Knowledge Class: Spleen Cyst
Splenic cysts are relatively rare, and their cause is not fully understood. The pathology of splenic cysts is divided into two categories: non-parasitic and parasitic, and non-parasitics can be divided into pseudocysts and epithelial cysts according to the presence or absence of lining epithelium, and the vast majority are pseudocysts.
1. Clinical manifestations
The clinical presentation of splenic cysts lacks specificity, and diagnosis relies mainly on imaging. Clinical manifestations are related to the size, location, and growth rate of the cyst. Cysts are small in size and may not show any manifestations; large cysts can compress surrounding organs and digestive tract, causing nausea, vomiting, epigastric discomfort, diarrhea, etc.; and even cause the diaphragm to rise, and symptoms such as dyspnea, cough, and tachycardia can occur. Most patients present with a left upper quadrant mass, which can be palpable in the left upper quadrant or under the ribs as a smooth, cystic mass.
2. Diagnosis
When there is discomfort or palpable mass in the left upper quadrant or left quarter, ultrasound, CT scan, flat chest and abdomen, and gastrointestinal barium meal should be performed in time to confirm the diagnosis in time. CT is currently the most valuable imaging method for diagnosing splenic cysts, which can clearly show the location, morphology, size and relationship with surrounding organs of the lesion, and its qualitative diagnosis has a high rate of conformity, which can be used as the preferred examination method for splenic cysts.
3. Treatment
Once a splenic cyst is definitively diagnosed, treatment should be selected based on the size and clinical presentation of the cyst.
Small (<2 cm in diameter), asymptomatic splenic cysts generally do not require surgery but should be followed up regularly. Symptomatic splenic cysts or larger cysts (≥5 cm in diameter) should be treated surgically. The traditional procedure is total splenectomy. With the deepening of the understanding of spleen function, especially the anti-infection and anti-tumor functions of the spleen, the spleen should be preserved as much as possible.
bibliography:
[1] tan hl, kam jh, kabir t. a surprise in the spleen in a young female[j]. gastroenterology
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Zhang Xianping, Zhang Xiaoguo, Yang B, et al. Diagnosis and treatment of spleen cysts (with 9 case reports)[j]. Hainan Medical Journal, 2006(12):21-22.
ZHANG Fujun. A case of splenic cyst[j]. Chinese Journal of Clinicians (Electronic Edition), 2011,5(03):916-917.
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