Freund R, Pichl J, Heyder N, Rödl W, Riemann J F
Am J Gastroenterol. 1982 Jan;77(1):35-8.
A 71-yr-old female patient was admitted for investigation of a massive leukocytosis and loss of weight. Physical examination revealed a reduction in the respiratory excursion of the left lung, a left pleural friction rub located ventrobasally and tension of the upper abdominal wall. Additional diagnostic procedure excluded extrasplenic disease. Ultrasound-guided puncture demonstrated the presence of pus in the splenic bed, and splenic abscess was diagnosed. Subsequent surgery confirmed this diagnosis. Histological findings revealed extensive splenic infarction. Since bacteriological investigation revealed the identical pathogens in the pus obtained with the puncture needle, in the intraoperative swab and in the midstream urine, the splenic abscess was most likely caused by hematogenous spread of a urinary tract infection into the splenic infarction. The postoperative course was uneventful, and the patient was discharged on the 11th postoperative day, free of symptoms. The clinical picture, radiological diagnosis, origin, therapy and course of splenic abscess are discussed with reference to the literature.
一名71岁女性患者因白细胞大量增多和体重减轻入院检查。体格检查发现左肺呼吸动度减弱，左肺基底前部可闻及胸膜摩擦音，上腹壁紧张。进一步的诊断程序排除了脾外疾病。超声引导下穿刺显示脾床有脓液，诊断为脾脓肿。随后的手术证实了这一诊断。组织学检查发现广泛的脾梗死。由于细菌学检查在穿刺针获取的脓液、术中拭子及中段尿中发现了相同的病原体，脾脓肿很可能是由尿路感染经血行播散至脾梗死所致。术后过程顺利，患者术后第11天无症状出院。本文结合文献讨论了脾脓肿的临床表现、影像学诊断、病因、治疗及病程。
