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.