Splenic rupture and mediastinal mass associated with rare TdT-negative T-LBL/T-ALL lead to sudden death of a juvenile

Excerpt

A 17-year-old male complained about nausea and indisposition during sporting activities. He then had to vomit several times. When emergency paramedics arrived, the patient was still conscious and was able to note slight indisposition for 3 weeks and a slight headache for 3 days. Shortly afterward, he suffered from sinus bradycardia and a weak pulse. Immediately, an automatic mechanic cardiopulmonary resuscitation (CRP) device was applied, and the patient was taken to the hospital while continuous resuscitation measures were applied. After the patient arrived at the hospital clinic, he suffered from circulatory arrest. A contrast-enhanced trauma room computed tomography (CT) examination was performed using a 128-slice scanner (Somatom Definition Flash, Siemens Medical Solutions, Forchheim, Germany), which revealed an undefined mediastinal mass and an enlargement of the lymph nodes. Furthermore, collapsed pulmonary arteries, a collapsed aorta in the region of the diaphragm, and a potential pericardial effusion (0.6 cm) were noted. The detection of increased ascites and abdominal bleeding resulted in an emergency surgery that included a splenectomy as splenic rupture was detected. Despite blood and volume substitution and continuous resuscitation measures, the patient did not exhibit the reactivation of his own circulation and was pronounced dead approximately 90 min after the incident. …