PMC8054788_01
(a-c) Contrast-enhanced computed tomography abdomen, coronal section showing (a) multiple, tiny hypodense splenic lesions (thin arrow) with clustered pattern of distribution in subcapsular location and perisplenic extension (curved arrow). Magnetic resonance imaging abdomen, axial section showing T2-weighted image (b) and diffusion-weighted imaging (c) showing multiple T2 hyperintense lesions with diffusion restriction in the spleen
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F1
A thin rim of perisplenic fluid was noted near the subcapsular lesions, suggesting contained rupture [Figure 1a]. Magnetic resonance imaging (MRI) abdomen showed multiple T2W hyperintense splenic lesions with T2W hypointense rim [Figure 1b]. Diffusion-weighted imaging showed restricted diffusion in these lesions, suggesting abscesses [Figure 1c].
PMC8054788_02
(a-c) Contrast-enhanced computed tomography abdomen, coronal section showing (a) heterogeneous hypoenhancement in the tail of the pancreas (arrow). (b) Nonenhancing thrombus involving the splenic vein (thick arrow) from the confluence till the intraparenchymal branches with enhancing thickened wall of the splenic vein (thin arrow). (c) Magnetic resonance imaging abdomen, axial section showing diffusion restriction with corresponding low apparent diffusion coefficient in the distal body of the pancreas and in the splenic vein thrombus
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F2
CECT abdomen revealed mildly bulky distal body and tail regions of pancreas with peripancreatic fat streakiness [Figure 2a]. The retro-pancreatic portion of the splenic vein was distended with non-enhancing intraluminal thrombus and vessel wall enhancement, suggestive of acute thrombosis [Figure 2b]. The retro-pancreatic portion of the splenic vein showed T2 hyperintense thrombus with restricted diffusion [Figure 2c].
(a and b) Bacterial colony morphology of pus and blood culture. (a) MacConkey agar showing typical nonlactose-fermenting, metallic sheen appearing colonies. (b) Gram smear revealing characteristic bipolar Gram-negative bacilli (x100)
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F3
Blood culture from this patient revealed a safety pin appearance of Gram-negative bacilli in the routine Gram staining [Figure 3a], and colonies showed a metallic sheen on MacConkey's agar plate [Figure 3b].