Unusual Infarction of the Accessory Spleen or Polysplenia in Two Children: Case Report

The usual imaging findings of common splenic infarction are well known, while the findings for splenic infarctions in the accessory spleen or polysplenia are rare; these unusual imaging findings may make the diagnosis difficult. We report here on two patients who have complained of abdominal pain, and they were diagnosed as splenic infarction that developed in either the accessory spleen or as has having polysplenia. We can diagnose splenic infarction that unusually develops in the accessory spleen or polysplenia when we identify a round, hyperechoic, avascular solid mass on US, or when we identify a round, rim-enhancing, hypodense solid mass with adjacent inflammatory changes and a small amount of ascites on CT that is adjacent to the normal spleen or in one of splenules of polysplenia in the clinical settings of acute abdominal pain.

Inflammatory Pseudotumor of the Spleen: A Case Report

Inflammatory pseudotumor is a rare benign lesion consisting of inflammatory cells and fibroblastic stroma, and is reported to have occurred. in various organs. Splenic involvement, however, is extremely rare. We report the spiral CT findings of pathologically proven inflammatory pseudotumor of the spleen. The CT scan shows delayed enhancement with central, stellate, low attenuation.

To rsion of the Accessory Spleen with Infarction: CT Features in a Case Report

Torsion of the accessory spleen is a rare entity that can have variable clinical presentations. We report case involving an 11-year-old boy with severe abdominal pain and a mass that was found to be due to infarction of the accessory spleen, which was twisted on its pedicle. CT revealed a low-attenuating mass with peripheral inflammatory changes in the left upper abdomen. The mass was pathologically confirmed as torsion of the ac-cessory spleen with infarction.

Imaging of Nontraumatic Benign Splenic Lesions

The spleen is one of the largest organ in the reticuloendothelial system and plays an important role in theac-tivation of immune response. It is the organ most commonly injured after blunt abdominal trauma, and malig-nantlesions such as lymphoma, or these due to metastasis, occur not infrequently. Even so, it is ignored even inabdominal ultrasonography. Some benign splenic lesions, however can cause severe symptoms and result in high mortality, and their accurate diagnosis is therefore essential. This study describes the imaging findings andhistopathologic features of various nontraumatic benign splenic lesions.

Splenic Space Occupying Losion Observed in The Dual-Phase Bolus CT File

PURPOSE: To evaluate the dual-phase bolus CT findings and clinical significance of splenic S. O. L.(SpaceOccupying Lesion) basically included in abdominal CT but previously not considered important. MATERIALS AND METHODS: We retrospectively reviewed 64 splenic S.O.L.'s(0.94%) detected among 6842 patients who underwentdual-phase rapid sequence abdominal CT. Diffuse splenomegaly and heterogeneous enhancement during the arterialphase were excluded. Fifty-eight of 64 splenic S. O. L. cases were confirmed by surgery, biopsy, radiologic studyand follow up. RESULTS: In only eight patients(12.5%) were symptoms localized to the left upper quadrant. Therewere 21 cases of inflammatory and ischemic diseases(36.2%), 19 malignant tumors(32.8%), 12 benign cysts(20.7%),four benign tumors(6.9%), one metabolic disease and one hematoma(each 1.7%) ; six cases were not confirmed and inthese, S.O.L. was also found at other sites. Escept in the case of benign cysts and tumors, the early phase wasbetter than the late for the detection of S.O.L., though both were good for diagnosis. Among 21 inflammatory andischemic lesions there were eight cases of portal hypertensions, seven of pancreatitis, and one of tuberculosis ;five were due to other cauese. Among 19 patients with malignant tumors, metastases were most common(11 cases).Cases involving malignancy involved four lymphomas, two cases of leukemias and two angiosarcomas, which togetherrepresented only primary splenic malignancy. Two epidermoid and ten simple cysts were benign, while benign tumorsincluded three hemangiomas and one lymphangiomatosis ; these were difficult to differentiate from angiosarcoma.Gaucher's disease showed multiple low density lesions in the enlarged spleen and one hematoma was also present. CONCLUSION: Splenic S.O.L.'s are very rare and clinical symptoms directly related to splenic mass are uncommon.Benign and secondary lesions are more common than malignant and primary lesions, and cysts are also much rarerthan any other solid organs. Dual-phase CT especially during the early phase, is currently the modality of choicefor the evaluation of splenic S.O.L.

Transient Inhomogeneous Contrast Enhancement of the Spleen on Arterial Phase of Spiral CT

PURPOSE: To assess the relationship between splenic transient inhomogeneous contrast enhancement(CE) on the arterial phase of spiral CT, and splenic volume, and to classify the CE pattern in liver cirrhosis. MATERIALS AND METHODS: We measured the splenic volume of 120 patients, 60 showed inhomogeneous splenic CE on arterial phase,and 60 showed homogeneous splenic CE. CT scans with intrinsic splenic pathology were excluded. Sixteen patients with clinically confirmed liver cirrhosis were included. Splenic volumes of the inhomogeneous and homogeneous CE group were compared. The inhomogeneous group was divided into three grades according to areas of non-enhanced portion (grade I, focal geographic ; grade II, multifocal patchy, grade III, extensive serpentine inhomogeneous CE) , and these were correlated with splenic volume. RESULTS: Among the 60 inhomogeneous CE scans, 23 cases(38.3%) showed splenomegaly (spleen volume>220cm3); in contrast, this applied to only 8 cases (13.3%) of the 60 homogeneous CE scans. Mean splenic volume in the inhomogeneous CE group (226.74+/-129.78cm3) was greater than in the homogeneous CE group (184.56+/-77.44cm3) (p<0.033). A larger splenic volume and extensive inhomogeneous CE(grade III) were noted, and most liver cirrhosis patients(14/16) were grade III. Three such patients who had shown inhomogeneous splenic CE on arterial phase showed inhomogeneous CE even on portal phase. CONCLUSION: Inhomogeneous splenic CE on arterial phase was more common in cases of an enlarged spleen, and more extensive in liver cirrhosis. These findings suggest hemodynamic change of the spleen may be a contributory factor.

Evaluation of Lateral Margin of Left Lobe of the Liver on CT Scan: Focus on Perisplenic Extension

PURPOSE: The perisplenic extension of the left lobe of the liver can be misinterpreted as a splenic or perisplenic lesion on ultrasonography(US) and computed tomography(CT). The purpose of our study is to classify thelateral margin of the left lobe of the liver into three types and to evaluate the incidence and the relationship between each type and abnormal liver on CT scan. MATERIAL & METHODS: A total of 515 abdominal CT scans frompatients over 15 years old were retrospectively evaluated. Liver contours were divided into three types on the basis of degree of the left lateral extension of left lobe of the liver. Type A was defined as the lateral extension of the left lobe of liver to the medial portion of the stomach, type C as the perisplenic portion, andtype B as between the two types. Each type was further divided into normal and abnormal liver groups based onclinical, CT, surgical & patholigic findings and evaluated on its ratio of normal and abnormal liver, intrahepatic diseases associated with an abnormal liver and statistical significance between a normal and abnormal liver. RESULTS: The incidence of the three types of liver among the 515 patients was 360(69.9%), 121(23.5%) and 34(6.6%) patients in type A, B and C, respectively. Type C showed normal liver in six patients, which was 2.7% of allnormal livers(221/515) and abnormal liver in 28 patients, which was 9.5% of all abnormal livers(294/515). Type Ashowed normal liver in 49.7%, abnormal liver in 50.3% and there was not statistically significant difference between normal and abnormal liver(P>0.05). Type B showed normal liver in 29.8% and abnormal liver in 70.2% ; type C showed normal liver in 17.6%, abnormal liver in 82.4% and there was a statistically significant difference between normal & abnormal liver(P<0.001). The space occupying lesion(SOL) was most common(52.6%) in all theabnormal livers and hepatoma was the most common disease in the SOL(47.2%). In the abnormal type C liver, SOL(58%)and diffuse hepatopathy(32.8%) were most common and hepatoma and liver cirrhosis were the most common diseases,respectively. CONCLUSION: The perisplenic extension of the left lobe of the liver(type C) was seen in 6.6% of abdominal CT scans, and was frequently associated with abnormal liver conditions including SOL. Careful interpretation is needed to differentiate from splenic or perisplenic disease.

Correlation Between Contrast Enhancement of Portal Vein and Spleen Size in Dual-phase Spiral CT

URPOSE: To evaluate using spiral CT the effect of spleen size on blood flow in the portal venous system andto know the usefulness of this evaluation. MATERIALS AND METHODS: Fifty-one patients without evidence on spiralCT scan of abnormality thought to affect portal venous flow presented between December 1994 and June 1995. We measured spleen size and Hounsfield units of portal vein in dual-phase, and calculated the ratio of the unit inthe portal phase to that in the arterial phase. Spleen size was measured, using the length of X-axis by that of Z-axis on spiral CT scan. We then measured the correlation between the two values. CT was performed with a Somatom Plus-S scanner(Siemens, Erlangen, Germany). A total dose of 120ml of non-ionic contrast material(Ultravist) was administered at a rate of 3ml/sec. Arterial and portal phase were obtained after 30 seconds and 60 seconds fromthe beginning of the contrast agent injection. RESULTS: The correlation between spleen size and contrast enhancement of the portal vein was relatively significant(Pearson's correlation coefficient(r)=0.41801). CONCLUSIONS: Spleen size significantly affects portal venous flow on spiral CT scan. The evaluation of spleensize and contrast enhancement of the portal vein could be useful in the differential diagnosis of diseases which affect portal venous flow.