Splenic vein thrombosis: three cases.

Abstract

Splenic vein thrombosis is rarely diagnosed with certainty prior to surgery or autopsy. From 1944 to 1955, at the Ohio State University Hospital, 1 example was found among 358 splenectomies done for hematologic disorders. In the several large series of splenoportograms reported in the literature since 1952, only single instances of thrombosis of the splenic vein have been demonstrated. In 1956, 3 cases were diagnosed by percutaneous splenoportography among 36 splenectomies done at Ohio State University Hospital for hematologic conditions. This increased discovery rate may be related to the introduction of percutaneous splenoportography, first described by Dreyer and Baudtz-Olsen (10) in 1952 and employed in this institution since 1954. In these 3 cases the venous collaterals of the portal system are strikingly diverse; in 2 of them the unusual appearance gave rise to problems in interpretation. The purpose of this presentation is to call attention to the great variation in anastomotic patterns in splenic vein thrombosis, and to present 1 case in which the enormously dilated esophageal plexus simulated mediastinal tumor on the plain chest film. Our review of the literature up to July 1, 1957, failed to produce a similar recorded example. Case Histories Case I: J. S., a 61-year-old male, was admitted to University Hospital on Feb. 26, 1956, with a history of melena three or four weeks previously. One and one-half years prior to admission he had hematemesis and melena. X-ray examination elsewhere reportedly demonstrated an ulcer. There had been no recent weight loss. In the 1930's x-ray therapy had been given for splenomegaly. The patient appeared to be in no acute distress. The spleen, which was palpable 5 fingers' breadth below the left costal margin, was nontender and mobile. There were bilateral reducible inguinal hernias. Laboratory findings were as follows: proteinuria 20 mg. per cent; stool, guaiac-negative; hemoglobin 12.4 gm.; red blood cells 5,780,000; white cells, 6,250, with 70 per cent neutrophils, 24 per cent lymphocytes, 4 per cent eosinophils, 2 per cent basophils; Van den Bergh reaction 0.4 mg. per cent direct, 1.5 total; Bromsulphalein retention 2.4 per cent; blood urea nitrogen 14 mg. per cent; fasting blood sugar 126 mg. per cent. Gastric analysis and inorganic and alkaline phosphatase determinations were normal. Blood calcium was 9.7 mg. per cent, cholesterol 100 mg. per cent, and platelets 1,800,000 (normal values, Dameshek, 500,000 to 900,000). A bone marrow aspiration showed panhyperplasia, presumably associated with blood loss, and only a mild degree of hypersplenism. The increased platelet count was probably due to the hyperplastic bone marrow after excessive blood loss. During the second admission, in March 1956, esophagoscopy showed esophagitis and small varices.