Mycotic Intrasplenic Pseudoaneurysm:The "Yin-Yang" Sign.
Radiology. 2019 Mar;290(3):620. doi: 10.1148/radiol.2019182535. Epub 2019 Feb 5.
Chin LHQ1, Lee VKH1.
A 59-year-old man had a history of acute myeloid leukemia that was complicated by a postchemotherapy invasive fungal infection. Blood cultures grew Geotrichum species (including G capitatum) (1,2). Contrast material–enhanced CT angiography showed multiple hepatic and splenic microabscesses, likely related to disseminated fungemia. Follow-up CT angiography showed resolving microabscesses after antifungal therapy. However, de novo appearance of a nodular arterial enhancing lesion was detected at an area of a prior splenic abscess (Figure). This was confirmed with US to have Doppler flow with the “yin-yang” sign, which is suggestive of an intrasplenic pseudoaneurysm. Successful transarterial glue embolization of this pseudoaneurysm was achieved. This case illustrates a rare case of mycotic intrasplenic pseudoaneurysm likely related to invasive fungal infection, where serial follow-up CT angiography and color duplex Doppler US were crucial for the detection of delayed complications.