Case history
A 55 y/o woman, known case of hairy cell leukemia complained from
intermittent abdominal pain (mainly in left flank), nausea, weight loss
and loss of appetite from 3 months ago. The patient‘s family history was
unremarkable and has undergone chemotherapy treatment from four months
ago. Physical examination positive findings were huge splenomegaly &
cachexia. Her height was 140 centimeter and her weight was 35 kilograms
(BMI=17.85). Vital signs were normal. Laboratory positive finding was:
HB= 8.1 g/dl. Urine analysis was normal.
In abdominal ultrasound, Heterogeneity and increase in splenic
parenchymal echogenicity, huge splenomegaly as spleen span of 210 mm was
detected.
Computerized tomography scan (CT scan) confirmed huge splenomegaly and
heterogeneity of splenic parenchymal density that indicated splenic
infarction. Splenic vein was markedly enlarged in diameter of 19 mm
which had compression effect on LRV. Marked prominency of both gonadal
veins and congestion of pelvic veins bilaterally was detected which
represents that left gonadal vein and bilateral pelvic veins are
drainaged via right gonadal vein and this is secondary to LRV
compression. These findings lead us that NCS had been occurred.
CT scan showed the normal angle and distance between the Abdominal Aorta
and SMA. No retroperitoneal pathology was shown. Both kidneys were
normal. Mild ascites, Mild hepatomegaly and evidence of secondary portal
hypertension were also noticed. The patient was referred to surgery
department for splenectomy to reveal her symptoms.