Imaging Pearls ❯ Spleen ❯ Splenic Infarction
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- "The spleen is universally affected in SCD. Repeated episodes of VOC lead to splenic autoinfarction and functional hypo- or asplenia, usually occurring within the first 2 years of life. An autoinfarcted spleen is easily recognized on CT and frequently on plain radiography as a contracted, calcified left upper quadrant mass. Functional asplenia from autoinfarction is associated with a susceptibility to infection, particularly by encapsulated bacteria; therefore, prophylactic administration of penicillin and pneumococcal vaccine is rec- ommended in childhood.”
Imaging review of sickle cell disease for the emergency radiologist
Shenise N. Gilyard et al.
Emergency Radiology (2021) 28:153–164
- Splenic Calcifications
- calcified phleboliths
- healed granulomatous disease
- autosplenectomy
- infarct
- splenic cysts
- hemangioma
- lymphangioma
- “Pyogenic abscesses are most commonly caused by hematogenous spread of infection. Other causes include penetrating trauma and prior splenic infarction. On ultrasound, ab- scesses appear as poorly defined hypoecho- ic or cystic lesions. On CT, microabscesses are multiple ill-defined low-attenuation lesions. Lesions are usually small, 5–10 mm. A central focus of higher attenuation and ring enhancement can also be seen. Fungal microabscesses usually occur in immunocom- promised patients.”
Nonneoplastic, Benign, and Malignant Splenic Diseases: Cross-Sectional Imaging Findings and Rare Disease Entities Thipphavong S et al. AJR 2014; 203:315–322
- Differential Diagnosis of Acute LUQ Pain
Spleen
• Infarct and sickle cell crisis
• Splenomegaly
• Rupture
• Abscess and infection
• Ruptured splenic artery aneurysm
• Splenic torsion
• Splenic vein thrombosis - Splenic Infarction: Causes
• Trauma
• Iatrogenic
• Splenic artery interventions and therapeutic embolization
• Intra-aortic balloon pump
• Postoperative
• Pharmacologic: vasopressin, erythropoietin, clofazimine
• Hypercoagulable states - Splenic Infarction: Causes
• Embolic
• Bacterial endocarditis
• Thromboembolic
• Atrial fibrillation
• Patent foramen ovale
• Atheroembolic
• Aortic dissection
• Pancreatitis and pancreatic cancer - Splenic Infarction: Causes
• Splenic disorders
• Torsion
• Splenomegaly
• Drugs: cocaine
• Collagen vascular disease
- Splenic Infaction
Segmental
- Focal zones of the spleen involved
- More common
- 1 or more infarcts seen
Global
- Entire spleen involved
- Often due to trauma - Splenic Infarction:
Etiology
- bacterial endocarditis, atrial fibrillation, sickle cell anemia, lymphoma, splenomegaly, etc
CT appearance
- wedge shaped areas of decreased attenuation which extend to the surface of the spleen
- usually involve a portion of the spleen
- CT appearance can vary over time - "Segmental splenic infarction is a rare manifestation of blunt splenic trauma. The diagnosis is readily made using contrast-enhanced CT. The majority will decrease in size on follow-up CT and resolve without clinical sequelae. Resolution of infarction is also seen and these cases are best described as temporary perfusion defects."
CT diagnosis of splenic infarction in blunt trauma: imaging features, clinical significance and complications.
Miller LA, Mirvis SE, Shanmuganathan K, Ohson AS.
Clin Radiol. 2004 Apr;59(4):342-8. - Splenic Calcification: Differential Dx:
- Granulomatous diseases
- Prior infaction
- Old hematoma
- Sickle cell disease
- Metastases
- Thorotrast (just looks like calcification)
- Hydatid disease