Congestion
Congestion

• Cross-section of a spleen showing a congested, dusky interior.

• The white flecks within this tissue represent the white pulp or Malpighian bodies.

• The spleen also appears to be somewhat fibrotic at this power.


(Image Contrib. by:Saint Francis Hospital)(Description by: T.V.Rajan, M.D.)
T07000D08280
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Congestion
Etiology

• Any abnormality leading to elevated splenic vein pressures

• Cirrhosis of the liver with portal hypertension, heart failure with systemic venous hypertension, portal or splenic vein thrombosis

• Sepsis may result in acute congestion of spleen


Pathogenesis

• Elevated venous pressure results in higher sinusoidal pressures

• Fibroses over time with increased pressure


Epidemiology

• Common finding in patients with congestive heart failure (up to 500 g) or cirrhotic liver disease


Clinical

• Enlarged spleen is vulnerable to trauma

• Persistent enlargement may lead to RBC destruction


General Gross Description

• Enlarged reddish purple spleen

• Longer the spleen is congested the more firm it becomes


General Micro Description

• Red pulp sinusoids filled with blood

• Over time fibrosis of the sinusoid walls secondary to increased pressures with dilatation

• Hemosiderin deposition following RBC destruction in dilated sinusoids

• Nodules of hemosiderin-laden macrophages with calcium deposition and fibrosis are Gandy-Gamma nodules


Reference

• Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th edition. Philadelphia, W.B. Saunders, 1994, pp. 670.


• Current literature from PubMed at National Library of Medicine


Synopsis by: Melinda Sanders M.D., UCHC
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