PMC3033349_01
Computed tomography (CT) scan. The CT scan demonstrates hemoperitoneum and a grade IV splenic laceration in our patient, who had no history of trauma.
1752-1947-5-29-1.jpg
PMC3033349_01_1752-1947-5-29-1.jpg
F1
A computed tomography (CT) scan of the abdomen and pelvis revealed an enlarged and fractured spleen with surrounding hematoma, but no evidence of liver laceration, infarct or intra-abdominal abscess (Figure 1).
Initial view of the gross spleen. The enlarged and fractured spleen as seen through a left subcostal incision.
1752-1947-5-29-2.jpg
PMC3033349_01_1752-1947-5-29-2.jpg
F2
A subcostal incision revealed approximately 2L of blood inside the abdominal cavity, an enlarged spleen with grade IV disruption (Figure 2), and an aneurysmal splenic artery.
Gross spleen. The grossly enlarged spleen cut along the short axis with no evidence of abscess formation.
1752-1947-5-29-3.jpg
PMC3033349_01_1752-1947-5-29-3.jpg
F3
When the gross spleen was sectioned along its short axis in the operating room (Figure 3) no abscess was found.
Hematoxylin and eosin staining results. Hematoxylin and eosin stain of splenic tissue at 40 x magnification showing amyloid around a blood vessel (arrow).
1752-1947-5-29-4.jpg
PMC3033349_01_1752-1947-5-29-4.jpg
F4
Staining for amyloid was strikingly positive (Figure 4).
Peri-vascular amyloid. Positive peri-vascular amyloid A immunoperoxidase staining at 40 x magnification.
1752-1947-5-29-5.jpg
PMC3033349_01_1752-1947-5-29-5.jpg
F5
Characteristic talc crystals were observed inside the splenic parenchyma (Figure 5).