375
E3018822701004177122
|325227010043
VNITŘNÍ4268043010746106127172220280301
LÉKAŘSTVÍ748804301074185130188236280325378400
/11688043010757
Vnitř12458043010771118137165191
Lék1456804301074083122
2022;68(2):E29-E311597804301074487129172188233278301344366381423468511540584629667
/22848043010757
www.casopisvnitrnilekarstvi.cz442680430107651332012142542953293774274464795215705896176436927117307748128548809159449871007102310631101
KAZUISTIKY42522701004696138190209248289309356404
Rare42536701004178104141
cause58836701003169108139177
of78736701003961
spontaneous87036701003070111151180218258295337377407
spleen12993670100307087125163202
bleeding:15233670100395794132173190230270290
a1835367010036
case188936701003169100137
report204836701002562102143170201
and227036701003676116
literature2408367010016336299126163191232258295
review272436701002663101119156211
the42562301072875118
internal5626230107176490131157205245263
clinic8446230107385673120138177
for10406230107216894
substitutional115362301073177126159187205232279306324371419459477
treatment16496230107255193132158232275322348
and201662301073986134
differential21696230107476588114157182224272298315355373
diagnosis.256162301074764104152199247279297329344
Due425763010758106149
to59276301072470
persisting68076301074690115148166197225243290338
abdominal103776301073785134181254272319358376
pain143276301074686104150
with160176301076179106153
negative177376301074487136176202220260302
X-ray20947630107456894135173
of228576301074467
abdomen,237176301073685134181254297344359
contrast-enhanced2749763010736811294259030107285494127155178224271318358405445486535
CT97990301074892
examination109090301074078119191209256296322340387435
was1544903010761101134
performed.169790301074590115141188214287331380395
CT211190301074792
showed222190301073077125188231280
a2520903010737
hemoperitoneum,25769030107448816020825730142510430107274572117165208255327342
hematoma786104301074487160200226271344384
in1189104301071562
the1269104301072471115
spleen140210430107307897140184231
with1651104301076180107154
active1824104301073776105123163206
arterial204810430107376393134160178217235
bleeding2302104301074664107151200218264313
(Figures263410430107195977125171197239271
No.14251183010757105119157
and601118301074289137
2).75711830107456678
The854118301074392135
patient1008118301075091117135178225251
has1278118301074989121
repeatedly1418118301072870118162202228270319337376
denied1813118301074993140157200249
recent2081118301072870110152199225
injury232511830107196684130156198
or2542118301074975
trauma.263511830107295596142215255270
Subsequently,425132301074187135166209257303345392417435473484
she927132301072975117
was1063132301076099131
moved12121323010769116155196244
to1475132301072368
the1561132301072470113
surgical169213230107297499145163201241259
department1969132301074487134174199229301343390415
and2402132301073683130
referred255113230107226385127152178219267
to2837132301072368
acute425146301074180126153195
surgical638146301072975100147165204244262
exploration.918146301073978127145192218258284302348396411
Laparotomy1347146301073677126166191237263308381418
verified1784146301073678103121144163205254
a20561463010737
hemoperitoneumwith2112146301074486159206255298323342368414461504550622702720746793
approximately425160301074189138164211248266338378404446464503
500ml947160301074082127201219
of1184160301074467
blood1270160301074665112160209
and1498160301073784132
coagulum,1649160301073682123171218236282354369
with2037160301076179106154
a22091603010737
5cmhematoma2265160301074079151215258330370396442515555
of2839160301074467
the425174301072875118
spleen56117430107307796139182229
with809174301076078105152
superficial980174301072975123167192218237276293332350
rupture1349174301072269117144190216257
and1625174301073683131
leakage177517430107155897133174222265
of2059174301074366
blood.2144174301074564111158207222
A23851743010748
splenectomy245217430107297796138185228268297343415453
was4251883010765105137
performed.581188301074690115141187213286330379394
During9931883010754102127145192240
awakening12521883010737100141177219267284331379
from165018830107194692165
anaesthesia,1834188301073683123166199227274317349367406421
the2273188301072471114
patient2406188301074686112130173220246
had2670188301074584133
an2821188301073784
episode425202301074492111142190239282
of726202301074871
hemoptysis.816202301074992165212262288330363380412428
In1263202301071966
the1348202301072876119
context1486202301074086134160201240270
of1775202301074871
this186520230107287593125
information,200920230107196688135161234274300318365413428
we24562023010765108
began2582202301075094144183231
to2831202301072974
search425216301073477116142180227
the671216301072573116
pathological806216301074788114161209228275324342381422440
conditions.1265216301073883131179197224242289337369385
She1669216301073986130
made18172163010772112160203
a20392163010739
good2097216301074694142191
recovery2307216301072466107152192234259302
without2627216301076382109156204251278
any425230301074187124
other568230301074369116159184
complications.770230301073681153201220237276316342359406453484500
We12882303010770110
performed1416230301074589114140186211284327375
a18102303010736
complex1865230301073581153201219262300
differential218423030107446284110152177219266291309348365
diagnosis,2568230301074462100148195242274291322337
examination425244301074484125199217265305332351399447
of892244301075478
blood,989244301075675123172223238
urine124624430107548099147191
(with1456244301073094112140188
the1664244301073482126
finding180924430107305097147165213262
of2091244301075478
erythrocyturia),2188244301075076119150198224271312355386434460478519540553
and2761244301074795144
autoantibodies.425258301074187115160201248274292341389438456499532547
Hemato-oncological9912583010762105178218244290318368415455501519567616634673714732
malignancies17412583010779119137154203250290337376394437470
and2230258301074593141
inflectional239025830107247193115158198227245293340380398
diseases2807258301075472425272301073477116148192225
like66827230107183673115
EBV,802272301074184129138
CMV9592723010750120164
were11422723010764107132174
excluded.1335272301074382120138184233276325340
Definitive16942723010757101124143190208235253293335
histology204827230107476597125170189236286325
has2392272301074787119
shown2530272301073379127191239
the2788272301072674117
picture425286301075068107137184209251
of695286301075275
necrotising789286301075195135161207233251283300347396
eosinophilic1203286301074896128146193240289337355373390430
granulomatosis1651286301075378119166213231278351391417463496513545
arteritis,2215286301074470100141167185212230262277
which25112863010769116134173221
may27502863010778118155
correspond304762301074086112138180213261310357406
with347262301076988115162
a3653623010746
diagnosis371762301075472111160207255287304336
of407262301075376
Churg-Strauss4167623010756103149175222249288313339379426458491
syndrome467662301073979127176201247320364
(Figures50596230107286886134181206248281
No.35359623010762110124168
and304776301074087134
4).31997630107395971
Patient328876301074179105122164210235
was354276301076099131
immediately369176301071486157199248265303329369387425
referred41357630107226385127152177218266
to442076301072368
rheumatological450676301072269111157228267293338356402450467506546563
examination.508776301073977117188205251290316333379426440
Discussion30471014013872105157207271323375408470534
Atraumatic3187118301075377102142188259298324341379
rupture3584118301072672120146192217258
of3860118301074669
the3946118301072774116
spleen408011830107328098140183229
is4327118301071849
an4394118301073986
extremely4498118301074280109134175247289307345
rare486111830107256590131
condition,5010118301073984131178195221238285331345
with5373118301076481108154
an3047132301074188
estimated3153132301074981109126199238264305354
prevalence3525132301075581122162202219262309348389
of3933132301075375
0,1-0,54027132301074962100121167180224
%,4269132301077287
twice4374132301073399117156197
more45891323010779127152194
common4801132301074591164236284331
in5150132301072471
men52391323010779122169
(3).542613230107297090102
Risk304714630107456394130
factors3194146301072566104133178203235
include3447146301072066105122168215258
splenomegaly,3723146301073482100142188235307350398437454492502
hemato-oncological4243146301074992164203228273300349396434479497543592608647687704
diseases,496514630107506798140178210252284298
and5281146301074289136
infections,54351463010720663047160301072465105133150196243274289
such3354160301073075114160
as3532160301073769
malaria36191603010770109126165189207245
or3882160301074570
infectious397016030107156183125164192209256302333
mononucleosis43211603010770117164211257303342359401448480496527
(4).48661603010721608091
Splenic4975160301073986104146192209248
ruptures5241160301072369117143189214255287
are3047174301074165107
extremely3171174301074078107132173245288305343
rarely353217430107236387128146184
described3734174301074587119158183200248291339
in4091174301071561
autoimmune4170174301073783110154172243315361407449
diseases,463717430107456293136174205248280294
such4949174301072975113160
as5127174301073768
Wegener52131743010770110158201247289314
granulomatosis,3047188301074974113160205222269341380405450482498529543
lupus3608188301071964112159190
erythematosus,3816188301074367109138184227299338363408439485516530
and4364188301074086134
polyarteritis4516188301074996114152192217246287311329355372403
nodosa4937188301074894142189221261
(5).52161883010723638496
There5330188301074189131156197
has3047202301074887119
been3184202301075093136182
no3384202301074996
reported3498202301072768116163188217258306
case3822202301074181112155
of3995202301074870
spontaneous4083202301073482129176201241287329376423454
splenic455520230107348299142188205243
rupture4816202301072774122147194218259
as5093202301074273
a51842023010742
first524320230107254367100127
manifestation53882023010774113304721630107486587129161188227253270316363
of3428216301074668
Churg-3514216301075096142166213239
Strauss377121630107406489129175206237
syndrome4026216301073272119166191236309351
so4395216301073279
far.44912163010722638798
Of4607216301075982
course,4707216301073984130155187229242
the4967216301072673115
possibility5100216301074895127159175223240257274300341
of5459216301074668
an3047230301074187
injury315223030107176380125150191
that3361230301072673112137
the3516230301072672115
patient3649230301074787113130172218243
is3910230301071748
not3976230301074693118
aware41122303010739102141166207
of4337230301074668
must44232303010772118149176
also461723030107395687134
be4769230301074791
taken4878230301072665101143189
into508523030107176388133
account.5236230301073978115159206252277292
Churg3187244301075096141166212
-34172443010722
Strauss345724430107376186126171202234
syndrome3709244301072867114162186231303345
(also407224430107195573103150
known4240244301073380127189236
as4494244301073567
eosinophilic4579244301073885117133179225273320337354371409
granulomatosis5006244301074468108154199216262334373398442474491521
with3047258301076583110157
polyangiitis)3222258301074694112151191238286304321348366398418
is3658258301071546
a37232583010737
very3778258301073779104146
sporadic3943258301072977125151191239257296
condition4257258301073682129177195222240286334
presented4609258301074672113146189236261303351
as4979258301073769
disseminated506625830107456394126169242259306345371413461
necrotizing3047272301074892132157204230248284302349397
vasculitis3463272301074485118157204222240267285316
and3798272301074592140
extravascular3957272301074786116142182221262294334381399438464
granulomas4440272301075278118166212230277351390423
(6).488227230107276890102
This5003272301074594112143
syndrome5165272301073777126174200246319362
typically3047286301072870121139179221239257297
occurs3363286301075495134181207241
in3623286301072573
patients3715286301075697124142186234260294
with4029286301077190117165
preexisting4214286301075682125169209227260288307354403
asthma4637286301074780108156230270
and4926286301074795144
eosinophilia5090286301074998131149197245295343361380397437
Fig.425576301134873125152
3,604576301135480
4.711576301135481
Fibroid819577201073957102128172191236
necrosis1071577201074685122148191222239268
of1355577201074568
medium14395772010772110156174219290
large174657720107186389132171
vessel1933577201073875106136174192
(left,214157720107244280104133148
HE2306577201075494
200X)2416577201074182125168194
and2626577201074591137
hemoragic2779577201074684156201227270315333371
infarction316657720107186487130156192219237282329
of3511577201074568
spleen359557720107327694133171217
due3828577201074691129
to3974577201072669
necrotizing4060577201074684122147191217235270288334379
vasculitis4456577201073781111148193211230255273303
(right,477557720107244765110157182198
HE4989577201075494
40x)5099577201074284121144
Fig.425307201134873125152
1,604307201135479
2.710307201135481
Active818308101074886113131169206
arterial1040308101074671100136162180225244
bleeding1300308101074564102140186204250295
in1611308101071965
spleen169230810107317594132170217
(contrast1925308101072459102148174199242272298
enhanced2239308101073885131176222259296341
CT,2596308101074991102
arterial271430810107457199136162180225243
phase)2973308101074692137167205227