Case 23-1968

Presentation of Case First admission. A sixty-year-old woman was admitted to the hospital because of splenomegaly.During the year before entry soreness in the right lower quadrant of the abdomen occurred intermittently. A week before admission her physician found that the spleen was enlarged. She had had no skin rash, abnormal bruising or tendency to bleed. For many years there had been pain and limitation of motion in the neck, shoulder, first finger and thumb.The neck was normal; the cervical, axillary and inguinal lymph nodes were not enlarged. The lungs were clear. The point of maximum cardiac impulse . . .