title: Diffuse cavernous hemangioma of the spleen with Kasabach-Merritt syndrome misdiagnosed as idiopathic thrombocytopenia in a child.
abstract: BACKGROUND
  Most cavernous hemangiomas in the spleen are small lesions that are found incidentally and patients usually present with no symptoms. Imaging is able to detect the lesions that are considered as diagnostic evidence. But some patients with diffuse cavernous hemangioma may present with anemia, thrombocytopenia, coagulopathy and bleeding, which might be misdiagnosed as idiopathic thrombocytopenia with disseminated intravascular coagulation (DIC). Splenectomy is the most effective therapy for diffuse cavernous hemangiomas with symptoms.
  
  
  METHODS
  The history, imaging results, pathologic findings, diagnosis and treatment of a 34-month-old boy with severe petechiae were reviewed.
  
  
  RESULTS
  The boy was diagnosed as having refractory idiopathic thrombocytopenia (ITP) because of low platelet count and bleeding at a local hospital. He had no response to a full-dose of corticosteroid and a high-dose of immunoglobulin (2 g/kg). Huge splenomegaly and DIC were found after 7 months. Diffuse cavernous hemangioma of the spleen was highly suspected, but it was not confirmed by B ultrasound, enhanced CT or MRI. DIC and bleeding were solved by low molecular weight heparin, supplement of fibrinogen and prothrombin complex. A diffuse cavernous hemangioma involving the whole spleen was confirmed pathologically following a successful splenectomy. The boy recovered completely without any complication after the operation.
  
  
  CONCLUSIONS
  Diffuse cavernous hemangioma of the spleen should be differentiated from ITP associated with splenomegaly. Radiological and overall physical examination should be emphasized for refractory ITP cases.
authors.affiliation: Hematology/Oncology Department, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China. yantfk@online.sh.cn
authors.forename: Jing-Yan
authors.initials: JY
authors.lastname: Tang
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.forename: Ci
authors.initials: C
authors.lastname: Pan
authors.forename: Min-Zhiyin
authors.initials: MZ
authors.lastname: Yin
authors.forename: Min
authors.initials: M
authors.lastname: Zhu
mesh_terms: D001778:Blood Coagulation Disorders / Q000175:diagnosis*; D002675:Child, Preschool; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis; D006392:Hemangioma, Cavernous / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013156:Splenectomy; D013160:Splenic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D013577:Syndrome; D013921:Thrombocytopenia / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed