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Everything you need to know about Computed Tomography (CT) & CT Scanning

MDCT of the Spleen: Pathology: Cyst


A wide variety of entities can produce cysts or cyst like lesions in the spleen including true epidermoid cysts, false cysts, and cysts due to infection/inflammation or tumors. True cysts, also known as epidermoid cysts, are congenital, lined with epithelium, and account for less than 20% of all splenic cysts. These lesions are well-defined, oval, hypodense on CT and do not enhance with contrast. Occasionally wall trabeculation, peripheral septation or wall calcification may be present. Cysts are usually single, and rarely multiple. Splenic cysts are asymptomatic unless large enough to produce left upper quadrant fullness. Potential complications include superimposed infection or rupture.

Non-epithelial, or false cysts develop from prior trauma, infection or infarction. These psudeocysts comprise 80% of all splenic cysts. The appearance is similar to true cysts on CT, however 25-30% have calcified walls. Differentiation between true and false cysts may be impossible radiographically, however the distinction is typically of no or little clinical significance. However, differentiation from other cystic entities is important and can often be accomplished with CT. Lesions that may masquerade as cysts include splenic abscess, extension of adjacent pancreatic psuedocysts abutting the spleen, infectious entities as Echinococcus, and cystic tumors including lymphangioma, hemangiomas, cystic hamartomas, lymphoma, or cystic degeneration of metastatic disease. Differentiation depends on careful inspection of the cystic lesions to look for any signs of complexity including thick septations, wall thickening, or enhancement. Clinical history and patient presentation will usually help narrow the differential diagnosis.



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