Pseudocyst of the Spleen vs. Splenomegaly, Sickle Cell Disease
Left picture: The diagnosis is a pseudocyst of the spleen which contains more than 1 litre of muddy fluid as seen in the picture at the bottom; the pseudocyst is a sequel of a severe trauma to the spleen which was not recognized. Right picture: Here a large spleen is presented in the figure at the bottom of the corresponding illustrations with multiple white and speckled focuses corresponding to multiple infarcts. The infarcts and the increased size of the spleen are typical for sickle cell disease. A splenectomy in sickle cell disease should not be performed on the very first consultation because of acute abdominal pain. Therefore, in a case of severe left-sided upper abdominal pain and in black patients, such a differential diagnosis has to be considered, and a pediatric hematologist should be consulted in addition to radiological imaging.
In both girls a mass was seen and palpated in the left upper abdomen during a consultation. Right picture: With this toddler, a consultation was called on account of acute abdominal colics. Left picture: This schoolchild complained of vague abdominal pain; the history tells about a blunt abdominal trauma which occurred some time ago and to which no attention was paid. As the cause of the palpable mass in the left upper belly an organ is presented which reminds of a hydronephrotic kidney because of its grotesque shape. Right picture: The size of the left-sided abdominal tumor can be estimated using the white line on the abdominal wall. Also, the border of the liver is palpable.