Just discharged a 49 yo man presenting with epigastric and upper quadrant pain. Required IV narcotics to control, no peritoneal signs on admission.
WBC 22K, normal diff. Chemistries including amylase were normal. U/S gallbladder normal (?sludge), upper endoscopy normal. CT scan showed inhomogeniety of the spleen with slight enlargement. Also picked up a couple of pleural based lesions in his lungs which on fine needle turned out benign. Finally explored him and found an enlarged spleen with areas of necrosis. Path showed splenic vein thrombosis – pancreas normal at time of surgery. 3 days postop he developed a DVT and then remembered his father and one sister also had suffered DVT’s and PE’s.
Anyone else ever seen splenic vein thrombosis in this type of patient?