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1.
Medicine (Baltimore) ; 100(3): e24048, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546004

RESUMO

INTRODUCTION: Uterine rupture during pregnancy is a serious obstetric complication accompanied by a high incidence of maternal morbidity and mortality, and the presence of uterine scars is the main risk factor. In the present case, uterine rupture occurred in an unscarred uterus in a nonlaboring primigravida woman with adenomyosis and twin pregnancy in the third trimester. PATIENT CONCERNS: In this case, the patient suspected to have a history of endometriosis have got twin pregnancies following intracytoplasmic sperm injection, and complained of recurrent lower abdominal pain from 16 weeks to 29 weeks of gestation. DIAGNOSIS: After exploratory laparotomy, the patient was diagnosed with uterine rupture and adenomyosis. INTERVENTIONS: The patient was first administered expectant treatment such as antibiotics, tocolytics, and fluid replacement therapy. Symptoms then appeared repeatedly and worsened, followed by eventual peritoneal irritation, and exploratory laparotomy was performed. OUTCOMES: Two live female fetuses were extracted by cesarean section, and the uterine laceration was repaired. The mother recovered without any postoperative complications, and the babies were discharged after receiving one month of prematurity care without any postnatal complications. CONCLUSION: Adenomyosis and the conception of twins may lead to uterine rupture. For pregnant women with a history of adenomyosis with multiple gestations, close monitoring for signs of uterine rupture is necessary. Single-embryo transfer and multifetal pregnancy reduction should be recommended for infertile patients with adenomyosis.


Assuntos
Adenomiose/complicações , Complicações na Gravidez/etiologia , Gravidez de Gêmeos , Nascimento Prematuro/etiologia , Ruptura Uterina/etiologia , Adulto , Cesárea , Feminino , Humanos , Nascimento Vivo , Gravidez , Terceiro Trimestre da Gravidez , Ruptura Espontânea
2.
Vasc Health Risk Manag ; 17: 37-47, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33603388

RESUMO

Cardiovascular diseases have been recognized as the main cause of death all over the world. Recently, the established cardio-ankle vascular index (CAVI) has become known as an index of arterial stiffness of the arterial tree from the origin of the aorta to the ankle. CAVI reflects the progress of arteriosclerosis, and a rapid rise in CAVI indicates arterial smooth muscle cell contraction. Considering the vasculature of the atheroma where vasa vasorum penetrates the smooth muscle cell layer and supplies blood to the intimal atheromatous lesion, a rapid rise of CAVI means "choked" atheroma. Thus, we proposed a "smooth muscle cell contraction" hypothesis of plaque rupture.


Assuntos
Aterosclerose/diagnóstico , Índice Vascular Coração-Tornozelo , Doenças Cardiovasculares/etiologia , Transtornos Cerebrovasculares/etiologia , Músculo Liso Vascular/fisiopatologia , Placa Aterosclerótica , Rigidez Vascular , Vasoconstrição , Aterosclerose/complicações , Aterosclerose/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Transtornos Cerebrovasculares/fisiopatologia , Humanos , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Ruptura Espontânea , Estresse Psicológico/complicações
3.
Eur J Obstet Gynecol Reprod Biol ; 259: 95-99, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33636621

RESUMO

OBJECTIVE: During the 2020 COVID-19 pandemic there was a decrease in emergency room arrivals. There is limited evidence about the effect of this change in behavior on women's health. We aimed to evaluate the impact of the COVID-19 pandemic on the diagnosis, treatment and complications of women presenting with a tubal Ectopic Pregnancy (EP). STUDY DESIGN: This is a single centre retrospective cohort study. We compared the clinical presentation, treatment modalities and complications of all women presenting in our institution with a tubal EP during the COVID-19 pandemic between 15 March and 15 June 2020, with women who were treated in our institution with the same diagnosis in the corresponding period for the years 2018-2019. RESULTS: The study group included 19 cases of EP (N = 19) that were treated between the 15 March 2020 and 15 June 2020. The control group included 30 cases of EP (N = 30) that were admitted to in the corresponding period during 2018 and 2019. Maternal age, parity, gravity and mode of conception (natural vs. assisted) were similar between the two groups. There was no difference in the mean gestational age (GA) according to the last menstrual period. In the study group more women presented with sonographic evaluation of high fluid volume in the abdomen than in the control group (53 % vs 17 %, P value 0.01). This finding is correlated with a more advanced disease status. In the study group there was a highly statistically significant 3-fold increase in rupture among cases (P < 0.005) and a 4-fold larger volume of blood in the entrance to the abdomen (P < 0.002). We found that there were no cases of ruptured EP in the group of women who were pregnant after assisted reproduction. CONCLUSION: We found a higher rate of ruptured ectopic pregnancies in our institution during the COVID-19 pandemic. Health care providers should be alerted to this collateral damage in the non-infected population during the COVID-19 pandemic.


Assuntos
Gravidez Tubária/epidemiologia , Dor Abdominal/fisiopatologia , Abortivos não Esteroides/uso terapêutico , Adulto , Gonadotropina Coriônica Humana Subunidade beta/sangue , Estudos de Coortes , Diagnóstico Tardio , Feminino , Humanos , Israel/epidemiologia , Laparoscopia , Metotrexato/uso terapêutico , Gravidez , Gravidez Tubária/diagnóstico , Gravidez Tubária/fisiopatologia , Gravidez Tubária/terapia , Técnicas de Reprodução Assistida , Estudos Retrospectivos , Ruptura Espontânea/epidemiologia , Salpingectomia , Ultrassonografia Pré-Natal , Hemorragia Uterina/fisiopatologia
4.
Rev Med Liege ; 76(1): 18-22, 2021 Jan.
Artigo em Francês | MEDLINE | ID: mdl-33443324

RESUMO

We report the case of a 24-year-old female patient with spontaneous rupture of a splenic artery aneurysm in the third trimester of pregnancy. Pregnancy, throughout the physiological and hormonal changes it imposes, promotes the occurrence of aneurysm of the splenic artery and its rupture. Although this is a rare complication, its prognosis is severe and its typical clinical picture associating abdominal pain, hypotension and anemia is misleading for the clinician who likelier evokes a retroplacental hematoma or an uterine rupture. The maternal and foetal survival depends on rapid diagnosis and multidisciplinary management. Thus, it's important for the clinician to consider this differential diagnosis when abdominal pain or hemoperitoneum occurs in pregnant woman, particularly during the third trimester of pregnancy.


Assuntos
Aneurisma Roto , Complicações Cardiovasculares na Gravidez , Adulto , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Terceiro Trimestre da Gravidez , Ruptura Espontânea , Artéria Esplênica/diagnóstico por imagem , Adulto Jovem
5.
Nutr Metab Cardiovasc Dis ; 31(1): 145-152, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33500103

RESUMO

BACKGROUND AND AIMS: Healed plaque is a hallmark of previous regional plaque rupture or erosion. We hypothesized that the plasma level of trimethylamine N-oxide (TMAO) is related to healed culprit plaque in ST-segment elevation myocardial infarction (STEMI) patients. METHODS AND RESULTS: A prospective cohort of 206 patients with STEMI, who were examined by optical coherence tomography (OCT) was enrolled in our study. After exclusion, 156 patients were categorized into healed plaque (n = 54) and nonhealed plaque (n = 102) groups. Plasma TMAO levels were detected by stable isotope dilution liquid chromatography tandem mass spectrometry in these two groups. Increased age and low BMI were more common in patients with healed plaques than in those without healed plaques. Through OCT observation, plaque rupture (81.5% vs. 45.1%, p < 0.001), thin cap fibroatheroma (TCFA) and macrophages (42.6% vs. 20.6%, p = 0.004, 70.4% vs. 26.5%, p < 0.001, respectively) were more frequently seen in patients with healed plaques than in those without healed plaques. The TMAO level in patients with healed plaques was significantly higher than that in patients with nonhealed plaques (3.9 µM [2.6-5.1] vs. 1.8 µM [1.0-2.7], p < 0.001). Furthermore, the receiver operating characteristic curve showed that TMAO can be used as a potential biomarker to predict healed plaque presence with a cutoff value of 2.9 µM (AUC = 0.810, sensitivity: 72.2%, specificity: 81.4%). CONCLUSIONS: Healed plaque in STEMI patients is associated with a high level of plaque vulnerability and inflammation. A high level of plasma TMAO can be a useful biomarker to differentiate STEMI patients with healed culprit plaques.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Metilaminas/sangue , Placa Aterosclerótica , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Tomografia de Coerência Óptica , Cicatrização , Idoso , Biomarcadores/sangue , Cromatografia Líquida , Doença da Artéria Coronariana/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Ruptura Espontânea , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Espectrometria de Massas em Tandem
6.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500302

RESUMO

Salpingitis isthmica nodosa (SIN) is the nodular swelling or diverticulum of the isthmus of the fallopian tube. It is most commonly identified when investigating female infertility or in association with ruptured ectopic pregnancies. We experienced a rare and atypical presentation of SIN. A 33-year-old woman presented with a 1-hour history of acute lower abdominal pain associated with nausea and vomiting. CT and pelvic ultrasound revealed haemoperitoneum with no radiological evidence for its aetiology. Initial beta-human chorionic gonadotropin excluded ectopic pregnancy. A diagnostic laparoscopy was performed following clinical deterioration of the patient. Active bleeding of the right fallopian tube was identified and managed with a right partial salpingectomy, with subsequent histopathology revealing ruptured SIN. There have been no reported cases of SIN being a primary cause for an acute abdomen or haemoperitoneum in the absence of an ectopic pregnancy, making this case a surgical novelty.


Assuntos
Doenças das Tubas Uterinas/complicações , Hemoperitônio/etiologia , Salpingite/complicações , Abdome Agudo/etiologia , Adulto , Doenças das Tubas Uterinas/patologia , Doenças das Tubas Uterinas/cirurgia , Feminino , Humanos , Laparoscopia , Ruptura Espontânea , Salpingectomia , Salpingite/patologia , Salpingite/cirurgia
7.
Nutr Metab Cardiovasc Dis ; 31(1): 344-353, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33500110

RESUMO

BACKGROUND AND AIMS: Cardiovascular disease is the main cause of death worldwide, but the collective efforts to prevent this pathological condition are directed exclusively to individuals at higher risk due to hypercholesterolemia, hypertension, obesity, diabetes. Recently, vitamin D deficiency was identified as a risk factor for cardiovascular disease in healthy people, as it predisposes to different vascular dysfunctions that can result in plaque development and fragility. In this scenario, the fundamental aim of the study was to reproduce a disease model inducing vitamin D deficiency and atheromatosis in ApoE-/- mice and then to evaluate the impact of this vitamin D status on the onset/progression of atheromatosis, focusing on plaque formation and instability. METHODS AND RESULTS: In our murine disease model, vitamin D deficiency was achieved by 3 weeks of vitamin D deficient diet along with intraperitoneal paricalcitol injections, while atheromatosis by western-type diet administration. Under these experimental conditions, vitamin D deficient mice developed more unstable atheromatous plaques with reduced or absent fibrotic cap. Since calcium and phosphorus metabolism and also cholesterol and triglycerides systemic concentration were not affected by vitamin D level, our results highlighted the role of vitamin D deficiency in the formation/instability of atheromatous plaque and, although further studies are needed, suggested a possible intervention with vitamin D to prevent or delay the atheromatous disease. CONCLUSIONS: The data obtained open the question about the potential role of the vitamins in the pharmacological treatments of cardiovascular disorders as coadjutant of the primary drugs used for these pathologies.


Assuntos
Doenças da Aorta/etiologia , Aterosclerose/etiologia , Deficiência de Vitamina D/complicações , Vitamina D/análogos & derivados , Animais , Aorta/metabolismo , Aorta/patologia , Doenças da Aorta/sangue , Doenças da Aorta/patologia , Aterosclerose/sangue , Aterosclerose/patologia , Biomarcadores/sangue , Dieta Hiperlipídica , Modelos Animais de Doenças , Fibrose , Lipídeos/sangue , Camundongos Knockout para ApoE , Placa Aterosclerótica , Ruptura Espontânea , Vitamina D/sangue , Deficiência de Vitamina D/sangue
10.
Br J Radiol ; 94(1117): 20200383, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32822245

RESUMO

Corpus luteum rupture presenting as acute abdomen is an underdiagnosed condition. Though a self-limiting entity, its differentiation from other causes is essential to prevent unnecessary surgical procedures. The radiologist should be aware of the possibility of a ruptured haemorrhagic ovarian cyst in a female of reproductive age group presenting with pelvic pain and a large amount of haemorrhagic ascites. Imaging characteristically reveals a thick-walled cystic structure in the adnexa with internal echoes, focal discontinuity or irregularity of its wall with haemoperitoneum. While sonography is usually indicative of corpus luteum rupture, cross-sectional imaging (CT/MRI) can be used to confirm the diagnosis.


Assuntos
Corpo Lúteo/diagnóstico por imagem , Hemoperitônio/etiologia , Ruptura Espontânea/complicações , Ruptura Espontânea/diagnóstico por imagem , Ultrassonografia/métodos , Abdome Agudo/etiologia , Diagnóstico Diferencial , Feminino , Hemoperitônio/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Imagem Multimodal , Tomografia Computadorizada por Raios X
11.
Rev. cuba. cir ; 59(4): e1015, oct.-dic. 2020. graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1149852

RESUMO

RESUMEN Introducción: La perforación del esófago constituye una de las urgencias más graves y difíciles que ha de afrontar un cirujano por las características y ubicación del órgano. El pronóstico depende sobre todo de la rapidez del diagnóstico y de la elección del tratamiento instaurado en principio. Objetivo: Presentar un caso portador del Síndrome de Boerhaave. Caso clínico: Paciente masculino en la 5ta década de vida que acudió por dolor torácico posterior a cuadro emético. Luego de estudio radiográfico se diagnosticó ruptura espontánea de esófago o síndrome de Boerhaave. Conclusiones: El enfoque terapéutico adecuado asociado al diagnóstico oportuno y precoz del síndrome garantiza mejores índices de sobrevida(AU)


ABSTRACT Introduction: Esophageal perforation is one of the most serious and difficult emergencies that a surgeon has to face due to the characteristics and location of the organ. Such prognosis depends mainly on the speed of the diagnosis and the choice of treatment established initially. Objectives: To present a case with such syndrome and to review the literature to update the therapeutic approach of this entity given its high mortality. Clinical case: Male patient in the fifth decade of life who presented for chest pain after an emetic condition. After a radiographic study, a spontaneous rupture of the esophagus or Boerhaave syndrome was diagnosed. Conclusions: The appropriate therapeutic approach associated with the early and timely diagnosis of the syndrome guarantees better survival rates(AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Emergências , Perfuração Esofágica/diagnóstico por imagem , Esôfago/lesões , Ruptura Espontânea/terapia , Sobrevida
12.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334743

RESUMO

Pheochromocytomas are uncommon tumours that originate in chromaffin cells. They are a representation of 0.1%-1% of all cases of secondary hypertension. Most pheochromocytomas are unilateral and benign, featuring catecholamine production, as well as the production of other neuropeptides. Pheochromocytomas are mostly located in the adrenal gland; the frequency of occurrence is highest between 30 and 50 years of age; however, up to 25% of cases may be linked to multiple endocrine neoplasia type 2, Von-Hippel-Landau disease and type 1 neurofibromatosis in the young.We present a case of ruptured left adrenal pheochromocytoma with an atypical presentation. A 30-year-old male patient presented with severe left flank pain and hypertension. The CT scan of the abdomen showed bleeding from the left adrenal mass, where resuscitation and angioembolisation were done. Embolisation of the inferior and superior arteries was done, but the middle failed. The patient experienced a significant drop in haemoglobin and a haemorrhagic shock post angioembolisation, which called for emergency laparotomy. The patient is currently doing well with an uneventful postoperative course.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Hipertensão/etiologia , Feocromocitoma/diagnóstico , Cólica Renal/etiologia , Ruptura Espontânea/diagnóstico , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/cirurgia , Adulto , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Embolização Terapêutica , Humanos , Hipertensão/tratamento farmacológico , Masculino , Fentolamina/administração & dosagem , Feocromocitoma/complicações , Feocromocitoma/cirurgia , Prazosina/administração & dosagem , Ruptura Espontânea/etiologia , Ruptura Espontânea/terapia , Resultado do Tratamento
16.
BMC Surg ; 20(1): 220, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008424

RESUMO

BACKGROUND: Splenic rupture is an emergency condition and a vast number of cases are secondary to trauma. Several underlying pathologies have also been associated with splenic rupture, such as hematological diseases, malignancies, and infectious and inflammatory diseases. CASE PRESENTATION: The patient was a 52-year-old man who referred to the Poursina Hospital in Rasht while complaining of abdominal pain from the day before hospitalization. The patient reported a history of lethargy, fever, and nausea. In the examinations performed, there was a brief tenderness in the patient's epigastrium. The patient was monitored and about 12 h after hospitalization, ill appearance, respiratory (respiratory distress) symptoms, and high fever were reported for the patient. According to the examination, the patient was immediately transferred to the operating room and underwent laparotomy. During the operation, contrary to our expectations, a lot of blood (about 1000 cc) was observed in the patient's abdomen. After blood suctioning, the left upper quadrant (LUQ) was bleeding and the rupture of the spleen could also be observed. Therefore, a splenectomy was performed. In the examinations performed for the patient, the patient's rtPCR test confirmed COVID-19. CONCLUSION: The evaluation of the spontaneous splenic rupture (SSR) in our case shows that this type of risk should also be considered in patients with COVID-19 who refer to medical centers with abdominal pain, and if more cases are reported, the correctness of this process can be commented on.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Esplenectomia , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/etiologia , Dor Abdominal/etiologia , Infecções por Coronavirus/terapia , Emergências , Hospitalização , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/terapia , Ruptura Espontânea , Ruptura Esplênica/cirurgia
17.
Zhonghua Fu Chan Ke Za Zhi ; 55(10): 691-696, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33120481

RESUMO

Objective: To investigate the clinical characteristics and early identification of spontaneous rupture of uterus caused by placenta percreta. Methods: The clinical data of 12 patients with spontaneous uterine rupture caused by placenta percreta and admitted to the First Affiliated Hospital of Zhengzhou University from June 2014 to December 2019 were collected. The age, gestational age, gestational history, clinical manifestations, diagnostic methods, uterine operation history, rupture location, surgical method, treatment and outcome were analyzed. Results: (1) General condition: the median age of pregnant women was 37 years (range: 30-43 years), and the median gestational week of uterine rupture was 29+6 weeks (range: 18+3-36+3 weeks). (2) Clinical manifestation: among the 12 pregnant women, 9 showed different degrees of abdominal pain; chest distress accompanied by waist soreness, abdominal distension in 2 cases; one asymptomatic pregnant women was found with uterine rupture during elective cesarean section. Preoperative color Doppler ultrasonography indicated that 9 of the 12 pregnant women had peritoneal effusion, and 6 of them underwent diagnostic peritoneal puncture or posterior vault puncture for non-clotting blood extraction. (3) Uterine operation history and rupture location: among the 12 cases of spontaneous rupture of uterus caused by placenta percreta pregnant women, 10 had placenta previa after cesarean section, including 4 cases of rupture at the incision of the original cesarean section, 3 cases of rupture at the penetrating placental implantation of the lower segment of the anterior wall of the uterus, and 1 case of placenta percreta occurred at the myomectomy site of the right angle of the uterus. Among the 2 pregnant women with spontaneous uterine rupture caused by penetrating placental implantation without a history of cesarean section, 1 case with history of multiple abortions, and uterine rupture occurred at the bottom of the palace, 1 had rupture of placental penetrating implantation after hysteroscopic electroresection of endometrial polyps, and the uterine rupture occurred at the anterior wall of the lower segment of the uterus. (4) Maternal and fetal outcomes: 11 pregnant women were injected with suspension RBC and 1 pregnant woman was not injected with blood products. Nine cases underwent hysteroplasty and 3 cases underwent subtotal hysterectomy. There were 11 maternal survivors and 1 maternal death; 7 neonates survived and 6 stillbirths. Conclusions: Uterine rupture caused by placenta percreta is of great harm to mother and infant, due to its heterogeneity in clinical manifestations, which increases the possibility of misdiagnosis. For pregnant women with risk factors of placenta percreta, early diagnosis should be made during pregnancy. For those who have been diagnosed with placenta percreta, when there is typical or atypical uterine rupture, doctors should be alert to the occurrence of uterine rupture.


Assuntos
Placenta Acreta/epidemiologia , Ruptura Espontânea/epidemiologia , Ruptura Uterina/epidemiologia , Adulto , Cesárea/efeitos adversos , Cesárea/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Histerectomia , Lactente , Recém-Nascido , Placenta Acreta/cirurgia , Gravidez , Complicações na Gravidez , Ruptura Uterina/etiologia , Ruptura Uterina/cirurgia
20.
Leg Med (Tokyo) ; 47: 101785, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32977197

RESUMO

Splenic angiosarcoma (SA) is a rare disease that can cause spontaneous splenic rupture leading to unexpected death. The rare incidence and non-specific clinical presentations made the early correct diagnosis of SA impossible in clinical practice. Even with medical intervention, 80% of patients died within 6 months after diagnosis. Here, we report a man who had complained of abdominal distension for 2 weeks and succumbed to the disease nine hours after admission. Diagnosis of hepatic and splenic angiosarcomas was based on post-mortem histopathological examination and immunohistochemistry, and the cause of death was hemorrhagic shock caused by spontaneous splenic rupture secondary to SA. This present case was the first forensic autopsy of spontaneous splenic rupture secondary to SA, which can highlight the diagnosis of rare diseases in forensic practice, and forensic pathologists should bear in mind these rare diseases even in routine practice.


Assuntos
Autopsia , Morte Súbita/etiologia , Morte Súbita/patologia , Patologia Legal , Hemangiossarcoma/complicações , Hemangiossarcoma/diagnóstico , Neoplasias Esplênicas/complicações , Neoplasias Esplênicas/diagnóstico , Ruptura Esplênica/etiologia , Adulto , Evolução Fatal , Hemangiossarcoma/patologia , Humanos , Masculino , Doenças Raras , Ruptura Espontânea , Choque Hemorrágico/etiologia , Neoplasias Esplênicas/patologia
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