Spleen lesion

 

Ambarish Bhattacharya

tf5 oFemStbptruary gndon20hoal19sorcendic  · 

55 yrs lady presenting with AF presented with Pain abdomen. USG showed ?? lesions in spleen. Urine shows Protien 1+ but no cells or casts or organism.

CT abdomen showed Splenic and Renal infarcts. Problem is patient had Temperature of 100F and TLC 21000 mainly Neutrophils, ESR 120 and CRP 170. Next day she developed cerebral infarction. But Echo is normal. ProCal is normal.

Currently she is on Meropenem + Teicoplanin + Enoxaparin + Amiodarone.

Any ideas regarding way forward?

4Rakesh Biswas and 3 others

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• Rakesh Biswas

  Admin

  What's her respiratory rate and other features of SIRs? Even if she doesn't have macrothrombi it could still be microthrombi?

  

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• DrDeepanjan Bhattacharya

  Anticoagulation and antiplatelet should be started

  Ct angio of abdomen and mr angio of brain would be informative

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  •  · 2 y
• Rakesh Biswas

  Admin

  He's already been started on anticoagulants. In case of non atherosclerotic plaque related thrombi would there be an additional role for antiplatelets? Off course this could be an atherosclerotic plaque related thrombi.

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  • Rakesh Biswas

    Admin

    Please check if your lab can do the blood viscosity test. "The clinical triad of mucosal or skin bleeding, neurological deficits, and visual disturbances suggests HVS." https://www.ncbi.nlm.nih.gov/books/NBK518963/

    

    NCBI.NLM.NIH.GOV

    Hyperviscosity Syndrome

    Hyperviscosity Syndrome

    

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• Amit Taneja

  Need TEE if available-IE is possible. TTE can miss thrombi and vegetations. If low platelets, evaluation for TTP or HITT etc is needed.

  

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• Rakesh Biswas

  Admin

  Great to hear from you 

  Amit Taneja

   after what seems more than a year's hiatus. 

  

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• Ambarish Bhattacharya

  Chances of Septic embolism vs Thromboembolism?

  

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• Rakesh Biswas

  Admin

  Can you share some more history? How many days back was she completely alright? What was her first symptoms that she noticed? etc

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  Ambarish Bhattacharya replied

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• Indradip Maity

  Looks like a case of infective endocarditis ...tee would e much more informative

  

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  •  · 2 y
• Rakesh Biswas

  Admin

  Could we localize her sepsis? Can you share the fever graph?

  

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  •  · 2 y
  Ambarish Bhattacharya replied

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• Ambarish Bhattacharya

  Diagnosis confirmed: HOCM with layered thrombus

  

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• Rakesh Biswas

  Admin

  Can you share her echo video and her EcG

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• Ambarish Bhattacharya

  

  

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• DrDeepanjan Bhattacharya

  Was the previous echo fallacious?

  

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• Rakesh Biswas

  Admin

  Lot of illustrious conference participants here 

  Avinash Kumar

  ? Now how do we distinguish between conference vs workshop when it comes to patient centered research or for that matter any research learning activity?