Waqar S N, Jindani S, Baig N S, Waqar M A, Ismail F W, Tariq M.
Banti`s Syndrome: Case Report and Review of Literature.
J Pak Med Assoc Jan ;54(2):99-101.

A 20 year old female was referred for the evaluation of symptomatic anemia. She also complained of longstanding dull, dragging left sided abdominal pain. Review of systems revealed menorrhagia. On examination she was a lean, pale-looking girl. There was no lymphadenopathy or icterus. She was afebrile, her vitals were stable and cardiovascular examination revealed a systolic flow murmur in the mitral area. Her liver was not palpable, however, she had massive splenomegaly with the splenic edge reaching just below the umbilicus. Laboratory data revealed pancytopenia (Hb=8.4 gm/dl, WBC=2200/mm3 with 67% PMN and 22% lymphocytes, Platelet = 35,000/mm3) and peripheral blood film showed anisocytosis and hypochromic microcytic anemia. Her coagulation profile was normal, as were her liver function tests. Anemia workup revealed iron deficiency and five serial malarial parasite tests were negative. Coomb`s test and autoimmune profile were negative and hypercoagulable states were ruled out. Her hepatitis serology was negative and she had normal ceruloplasmin and alpha-a antitrypsin levels. Her bone marrow revealed a cellular specimen showing all hematopoeitic cell lines and massive splenomegaly was confirmed on CT Abdomen, which demonstrated a splenic size of 21.7cm. Moreover, it showed larged varices in the splenic hilum, gastro-splenic and gastropancreatic ligaments and cavernous transformation of the portal vein, indicative of portal hypertension. Her liver size and texture was normal on CT Scan and there was no evidence of cirrhosis. Ultrasound color Doppler demonstrated numerous patent collaterals resulting from this cavernous transformation, with a hepatoportal flow velocity of 24cm/sec. Esophagogastroduodenoscopy had sigmoidoscopy were normal. A presumptive diagnosis of Banti`s syndrome was made.

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