Skip to main content

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

In this chapter non-traumatic and traumatic pathology of the spleen will be discussed. A variety of non-traumatic emergencies of the spleen are regularly encountered during emergency imaging of the abdomen. Sometimes diagnostic imaging is performed because the splenic pathology (infarcts, spontaneous rupture, abscess or splenomegaly) causes symptoms, more often these splenic abnormalities are encountered during diagnostic imaging for other indications. We will discuss the most common splenic findings that can be encountered during emergency imaging of the abdomen. The spleen is the most affected organ in patients with abdominal organ injury after blunt trauma. Imaging finding of traumatic injury to the spleen on Ultrasound and CT will be described and shown. The influence of imaging in selecting patients for non-operative management of splenic injuries and the value of the most frequently used grading systems in clinical decision making will be discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abbas MA, Stone WM, Fowl RJ et al (2002) Splenic artery aneurysms: two decades experience at Mayo clinic. Ann Vasc Surg 16:442–449

    Article  PubMed  Google Scholar 

  • Abbott RM, Levy AD, Aguilera NS et al (2004) From the archives of the AFIP: primary vascular neoplasms of the spleen: radiologic-pathologic correlation. Radiographics 24:1137–1163

    Article  PubMed  Google Scholar 

  • Adas G, Karatepe O, Altiok M et al (2009) Diagnostic problems with parasitic and non-parasitic splenic cysts. BMC Surg 29;9:9. doi:10.1186/1471-2482-9-9 http://www.biomedcentral.com/1471-2482/9/9

  • Agrawal GA, Johnson PT, Fishman EK (2007) Splenic artery aneurysms and pseudoaneurysms: clinical distinctions and CT appearances. AJR Am J Roentgenol 188:992–999

    Article  PubMed  Google Scholar 

  • Al-Habbal Y, Christophi C, Muralidharan V (2010) Aneurysms of the splenic artery–a review. Surgeon 8:223–231

    Article  PubMed  Google Scholar 

  • Anderson SW, Varghese JC, Lucey BC et al (2007) Blunt splenic trauma: delayed-phase CT for differentiation of active hemorrhage from contained vascular injury in patients. Radiology 243:88–95

    Article  PubMed  Google Scholar 

  • Antopolsky M, Hiller N, Salameh S et al (2009) Splenic infarction: 10 years of experience. Am J Emerg Med 27:262–265

    Article  PubMed  Google Scholar 

  • Ben Ely A, Zissin R, Copel L et al (2006) The wandering spleen: CT findings and possible pitfalls in diagnosis. Clin Radiol 61:954–958

    Article  PubMed  CAS  Google Scholar 

  • Bert T, Tebbe J, Görg C (2010) What should be done with echoic splenic tumors incidentally found by ultrasound? Z Gastroenterol 48(4):465–471

    Article  PubMed  CAS  Google Scholar 

  • Braat MN, Hueting WE, Hazebroek EJ (2009) Pneumoperitoneum secondary to a ruptured splenic abscess. Intern Emerg Med 4:349–351

    Article  PubMed  Google Scholar 

  • Brink M, de Lange F, Oostveen LJ et al (2008) Arm raising at exposure-controlled multidetector trauma CT of thoracoabdominal region: higher image quality, lower radiation dose. Radiology 249:661–670

    Article  PubMed  Google Scholar 

  • Casadei R, Antonacci N, Calculli L et al (2007) Thrombosed splenic artery aneurysm simulating a pancreatic body mass: can two entities be distinguished preoperatively thus avoiding diagnostic and therapeutic mistakes? JOP 8(2):235–239

    PubMed  Google Scholar 

  • Chang KC, Chuah SK, Changchien CS et al (2006) Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. World J Gastroenterol 12:460–464

    PubMed  Google Scholar 

  • Changchien CS, Tsai TL, Hu TH et al (2002) Sonographic patterns of splenic abscess: an analysis of 34 proven cases. Abdom Imaging 27:739–745

    Article  PubMed  Google Scholar 

  • Clark TJ, Cardoza S, Kanth N (2011) Splenic trauma: pictorial review of contrast-enhanced CT findings. Emerg Radiol 18:227–234

    Article  PubMed  Google Scholar 

  • de Porto APNA, Lammers AJJ, Bennink RJ et al (2010) Assessment of splenic function. Eur J Clin Microbiol Infect Dis 29:1465–1473

    Article  PubMed  Google Scholar 

  • Deunk J, Brink M et al (2010) Predictors for the selection of patients for abdominal CT after blunt trauma: a proposal for a diagnostic algorithm. Ann Surg 251:512–520

    Article  PubMed  Google Scholar 

  • Donnelly LF, Foss JN, Frush DP et al (1999) Heterogeneous splenic enhancement patterns on spiral CT images in children: minimizing misinterpretation. Radiology 210:493–497

    PubMed  CAS  Google Scholar 

  • Duchesne JC, Simmons JD, Schmieg RE Jr et al (2008) Proximal splenic angioembolization does not improve outcomes in treating blunt splenic injuries compared with splenectomy: a cohort analysis. J Trauma 65:1346–1351

    Article  PubMed  Google Scholar 

  • Farahmand N, Sirlin CB, Brown MA et al (2005) Hypotensive patients with blunt abdominal trauma: performance of screening US. Radiology 235:436–443

    Article  PubMed  Google Scholar 

  • Fotiadis C, Lavranos G, Patapis P et al (2008) Abscesses of the spleen: report of three cases. World J Gastroenterol 14:3088–3091

    Article  PubMed  Google Scholar 

  • Giagounidis AA, Burk M, Meckenstock G et al (1996) Pathologic rupture of the spleen in hematologic malignancies: two additional cases. Ann Hematol 73:297–302

    Article  PubMed  CAS  Google Scholar 

  • Goerg C, Schwerk WB (1990) Splenic infarction: sonographic patterns, diagnosis, follow-up, and complications. Radiology 174:803–807

    PubMed  CAS  Google Scholar 

  • Ha JF, Phillips M, Faulkner K (2009) Splenic artery aneurysm rupture in pregnancy. Eur J Obstet Gynecol Reprod Biol 146:133–137

    Article  PubMed  Google Scholar 

  • Haan JM, Biffl W, Knudson MM et al (2004) Splenic embolization revisited: a multicenter review. J Trauma 56:542–547

    Article  PubMed  Google Scholar 

  • Haan JM, Bochicchio GV, Kramer N et al (2005) Nonoperative management of blunt splenic injury: a 5-year experience. J Trauma 58:492–498

    Article  PubMed  Google Scholar 

  • Imbert P, Rapp C, Buffet PA (2009) Pathological rupture of the spleen in malaria: analysis of 55 cases (1958–2008). Travel Med Infect Dis 7(3):147–159

    Article  PubMed  Google Scholar 

  • Jeremitsky E, Kao A, Carlton C et al (2011) Does splenic embolization and grade of splenic injury impact nonoperative management in patients sustaining blunt splenic trauma? Am Surg 77:215–220

    PubMed  Google Scholar 

  • Joazlina ZY, Wastie ML, Ariffin N (2006) Computed tomography of focal splenic lesions in patients presenting with fever. Singapore Med J 47:37–41

    PubMed  CAS  Google Scholar 

  • Karlo C, Gnannt R, Frauenfelder T et al (2011) Whole-body CT in polytrauma patients: effect of arm positioning on thoracic and abdominal image quality. Emerg Radiol 18:285–293

    Article  PubMed  Google Scholar 

  • Krüger C, Malleyeck I, Naman N (2011) Amoebic abscess of the spleen and fatal colonic perforation. Pediatr Infect Dis J 30:91–92

    Article  PubMed  Google Scholar 

  • Ledbetter S, Smithuis RH (2007) Abdominal trauma–role of CT. Radiology assistant. http://www.radiologyassistant.nl/en/466181ff61073#p4661853ae1bd1 Accessed 4 Aug 2011

  • Lubner M, Menias C, Rucker C et al (2007) Blood in the belly: CT findings of hemoperitoneum. Radiographics 27:109–125

    Article  PubMed  Google Scholar 

  • Madoff DC, Denys A, Wallace MJ et al (2005) Splenic arterial interventions: anatomy, indications, technical considerations, and potential complications. Radiographics 25(1):S191–S211

    Article  PubMed  Google Scholar 

  • Marmery H, Shanmuganathan K, Alexander MT et al (2007) Optimization of selection for nonoperative management of blunt splenic injury: comparison of MDCT grading systems. AJR Am J Roentgenol 189:1421–1427

    Article  PubMed  Google Scholar 

  • Miller PR, Croce MA, Bee TK et al (2002) Associated injuries in blunt solid organ trauma: implications for missed injury in nonoperative management. J Trauma 53:238–242

    Article  PubMed  Google Scholar 

  • Miller LA, Mirvis SE, Shanmuganathan K et al (2004) CT diagnosis of splenic infarction in blunt trauma: imaging features, clinical significance and complications. Clin Radiol 59:342–348

    Article  PubMed  CAS  Google Scholar 

  • Moore EE, Shackford SR, Pachter HL et al (1989) Organ injury scaling: spleen, liver, and kidney. J Trauma 29(12):1664–1666

    Article  PubMed  CAS  Google Scholar 

  • Moore EE, Cogbill TH, Jurkovich GJ et al (1995) Organ injury scale: spleen and liver (1994 revision). J Trauma 38:323–324

    Article  PubMed  CAS  Google Scholar 

  • Morgenstern L (2002) Nonparasitic splenic cysts: pathogenesis, classification, and treatment. J Am Coll Surg 194(3):306–314

    Article  PubMed  Google Scholar 

  • Ng CY, Leong EC, Chng HC (2008) Ten-year series of splenic abscesses in a general hospital in Singapore. Ann Acad Med Singapore 37:749–752

    PubMed  Google Scholar 

  • Nores M, Phillips EH, Morgenstern L et al (1998) The clinical spectrum of splenic infarction. Am Surg 64:182–188

    PubMed  CAS  Google Scholar 

  • Nwomeh BC, Nadler EP, Meza MP et al (2004) Contrast extravasation predicts the need for operative intervention in children with blunt splenic trauma. J Trauma 56:537–541

    Article  PubMed  Google Scholar 

  • Omert LA, Salyer D, Dunham CM et al (2001) Implications of the “contrast blush” finding on computed tomographic scan of the spleen in trauma. J Trauma 51:272–277

    Article  PubMed  CAS  Google Scholar 

  • Peitzman AB, Heil B, Rivera L et al (2000) Blunt splenic injury in adults: multi-institutional study of the eastern association for the surgery of trauma. J Trauma 49:177–187

    Article  PubMed  CAS  Google Scholar 

  • Poletti PA, Kinkel K, Vermeulen B et al (2003) Blunt abdominal trauma: should US be used to detect both free fluid and organ injuries? Radiology 227(1):95–103

    Article  PubMed  Google Scholar 

  • Renzulli P, Hostettler A, Schoepfer AM et al (2009) Systematic review of atraumatic splenic rupture. Br J Surg 96:1114–1121

    Article  PubMed  CAS  Google Scholar 

  • Renzulli P, Gross T, Schnüriger B et al (2010) Management of blunt injuries to the spleen. Br J Surg 97:1696–1703

    Article  PubMed  CAS  Google Scholar 

  • Robertson F, Leander P, Ekberg O (2001) Radiology of the spleen. Eur Radiol 11:80–95

    Article  PubMed  CAS  Google Scholar 

  • Safapor F, Aghajanzade M, Kohsari MR et al (2007) Spontaneous rupture of the spleen: a case report and review of the literature. Saudi J Gastroenterol 13:136–137

    Article  PubMed  Google Scholar 

  • Schnüriger B, Inaba K, Konstantinidis A et al (2011) Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis. J Trauma 70:252–260

    Article  PubMed  Google Scholar 

  • Shanmuganathan K, Killeen KL (2003) Imaging of abdominal trauma. In: Mirvis SE, Shanmuganathan K (eds) Imaging in trauma and critical care, 2nd edn. Saunders, Philadephia, pp 387–417

    Google Scholar 

  • Shanmuganathan K, Mirvis SE, Sover ER (1993) Value of contrast-enhanced CT in detecting active hemorrhage in patients with blunt abdominal or pelvic trauma. AJR 161:65–69

    PubMed  CAS  Google Scholar 

  • Shanmuganathan K, Mirvis SE, Sherbourne CD et al (1999) Hemoperitoneum as the sole indicator of abdominal visceral injuries: a potential limitation of screening abdominal US for trauma. Radiology 212:423–430

    PubMed  CAS  Google Scholar 

  • Sharma OP, Oswanski MF, Singer D et al (2005) Assessment of nonoperative management of blunt spleen and liver trauma. Am Surg 71:379–386

    PubMed  Google Scholar 

  • Soleimani M, Mehrabi A, Kashfi A et al (2007) Surgical treatment of patients with wandering spleen: report of six cases with a review of the literature. Surg Today 37:261–269

    Article  PubMed  Google Scholar 

  • Testerman GM, Easparam S, Jacome F (2011) Western trauma association blunt splenic injury algorithm is useful in spontaneous rupture of a normal spleen. Am Surg 77(5):E85–E86

    PubMed  Google Scholar 

  • Thompson BE, Munera F, Cohen SM et al (2006) Computed tomography scan scoring system predicts the need for intervention after splenic injury. J Trauma 60:1083–1086

    Article  PubMed  Google Scholar 

  • van der Vlies CH, van Delden OM, Punt BJ et al (2010) Literature review of the role of ultrasound, computed tomography, and transcatheter arterial embolization for the treatment of traumatic splenic injuries. Cardiovasc Intervent Radiol 33:1079–1087

    Article  PubMed  Google Scholar 

  • Velmahos GC, Toutouzas KG, Radin R et al (2003) Nonoperative treatment of blunt injury to solid abdominal organs: a prospective study. Arch Surg 138:844–851

    Article  PubMed  Google Scholar 

  • Wei B, Hemmila MR, Arbabi S et al (2008) Angioembolization reduces operative intervention for blunt splenic injury. J Trauma 64:1472–1477

    Article  PubMed  Google Scholar 

  • Wu SC, Fu CY, Chen RJ et al (2011) Higher incidence of major complications after splenic embolization for blunt splenic injuries in elderly patients. Am J Emerg Med 29:135–140

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Digna R. Kool .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Kool, D.R., Berger, F.H., Vos, P.M. (2011). Spleen . In: Scaglione, M., Linsenmaier, U., Schueller, G. (eds) Emergency Radiology of the Abdomen. Medical Radiology(). Springer, Milano. https://doi.org/10.1007/174_2011_468

Download citation

  • DOI: https://doi.org/10.1007/174_2011_468

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2512-7

  • Online ISBN: 978-88-470-2513-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics