title: Massive splenic infarction and splenic venous thrombosis observed in a patient with acute splenic syndrome of sickle cell traits on contrast-enhanced thin-slice computed tomography.
abstract: We report a case of splenic infarction in a patient with sickle cell traits (SCT), focusing on the computed tomography (CT) findings. The patient was an African-American man in his twenties with no past medical history who experienced sudden left upper quadrant pain while climbing a mountain (over 3000 m above sea level). Dynamic contrast-enhanced CT revealed massive non-segmental splenic infarction accompanied with nodule-like preserved splenic tissue. The region of splenic infarction did not coincide with the arterial vascular territory and differed from the features of infarction caused by large arterial embolism. In addition, thrombotic occlusion of the distal splenic vein was depicted on plain and contrast-enhanced thin-slice CT images. Early-phase contrast-enhanced images also showed inhomogeneous enhancement of the hepatic parenchyma. The patient's symptoms improved with conservative therapy. A hemoglobin electrophoresis test confirmed the diagnosis of SCT. SCT is usually asymptomatic, but hypoxic environments may induce acute splenic syndrome, which is commonly manifested as splenic infarction. We observed splenic venous thrombosis and inhomogeneous hepatic parenchymal enhancement in addition to a huge splenic infarction in our patient. To the best of our knowledge, this is the first report describing the specific imaging findings, particularly splenic venous thrombosis and inhomogeneous hepatic parenchymal enhancement, of acute splenic syndrome in a patient with previously undiagnosed SCT. These findings demonstrate the pathophysiology of SCT, and may help with the diagnosis of this disease.
authors.affiliation: Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. yamakawa-cib@umin.ac.jp.
authors.forename: Takana Yamakawa
authors.initials: TY
authors.lastname: Hayashi
authors.affiliation: Department of Diagnostic Radiology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan.
authors.forename: Izuru
authors.initials: I
authors.lastname: Matsuda
authors.affiliation: Department of Diagnostic Radiology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan.
authors.forename: Kazuchika
authors.initials: K
authors.lastname: Hagiwara
authors.affiliation: Department of Radiology, Nerima Hikarigaoka Hospital, 2-11-1 Hikarigaoka, Nerima-ku, Tokyo, 179-0072, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Takayanagi
authors.affiliation: Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Akifumi
authors.initials: A
authors.lastname: Hagiwara
mesh_terms: D006801:Humans; D008297:Male; D012805:Sickle Cell Trait; D013158:Splenic Diseases; D013159:Splenic Infarction; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis
keywords: Sickle cell anemia; Sickle cell trait; Splenic infarction; Splenic vein; Venous thromboembolism