Abstract：
Isolated splenic peliosis is an extremely rare condition characterized by the presence of multiple blood-filled cavities, occasionally resulting in non-traumatic splenic rupture with fatal bleeding. In our case, a 64-year-old man was brought by ambulance due to weakness and abdominal pain without nausea or febrility. On clinical examination, the patient was sensitive to palpation with significant tenderness over the abdomen but no associated features of peritonitis. He collapsed during the imaging examination and became unconscious and asystolic. Cardiopulmonary resuscitation was not successful. The patient died approximately within 2 hours of admission to the hospital. Postmortal examination showed 2800 ml of intraperitoneal blood with clots and a laceration of the lower pole of the spleen. Macroscopic examination of the spleen revealed huge nodular splenomegaly, measuring 21 cm x 19 cm x 5 cm, weighing 755 g. On the cut surfaces, multiple randomly distributed blood-filled cavities ranging from 0,5 to 2 cm in diameter were seen. At microscopic examination, the specimens showed multiple irregular haemorrhagic cyst-like lesions that were not lined by any epithelium or sinusoidal endothelium, consistent with the diagnosis of peliosis lienis. Although the condition is often clinically silent, the forensic pathological significance arises from the differential diagnosis of resultant intraperitoneal haemorrhage and sudden death, mimicking a violent death.
摘要：
孤立性脾水肿是一种极其罕见的疾病，其特征是存在多个充血腔。偶尔会导致非创伤性脾破裂伴致命性出血。在我们的案例中,一名64岁的男子因虚弱和腹痛而被救护车送来，没有恶心或发热。在临床检查中，患者对触诊敏感，腹部有明显压痛，但无腹膜炎的相关特征。他在影像学检查过程中昏倒，变得昏迷和心搏。心肺复苏不成功。患者在入院后约2小时内死亡。死后检查显示2800ml腹膜内血，凝块和脾脏下极撕裂。脾脏的宏观检查显示巨大的结节性脾肿大，尺寸为21厘米x19厘米x5厘米，重755克。在切割表面上，看到多个随机分布的充满血液的空腔，直径从0.5到2厘米不等。在显微镜检查时，标本显示多个不规则出血性囊肿样病变，没有任何上皮或窦状内皮衬里，与lienis的诊断一致。尽管这种情况在临床上通常是沉默的，法医病理学意义来自于结果性腹膜内出血和猝死的鉴别诊断，模仿暴力死亡。
