Differential diagnosis between splenic nodules and peritoneal metastases with contrast-enhanced ultrasound based on signal-intensity characteristics during the late phase

„Hyposplenie“, eine weitgehend unerkannte Immunschwäche: Ist die Sonografie hilfreich?

Das Immundefizienzsyndrom der funktionellen Hyposplenie/Asplenie ist weitgehend unerkannt. Die Goldstandardprozedur stellt die Technetium-99m-Szintigrafie von hitzedenaturierten Erythrozyten (TSZ) sowie der Nachweis von pitted Erythrozyten oder Howell-Jolly-Körperchen (HJB) dar. Erste Arbeiten weisen darauf hin, dass dieses Krankheitsbild mit einer kleinen Milz assoziiert ist. Ziel der vorliegenden Übersicht ist es, den Stellenwert der B-Bild-Sonografie und der kontrastunterstützten Sonografie bei der Immunschwäche der Hyposplenie darzustellen.

Pancreatic splenosis demonstrated by contrast-enhanced sonography

Pancreatic splenosis is a very rare condition whose features on contrast-enhanced ultrasound (CEUS) have not, to our knowledge, been previously reported. We present the imaging findings in a case of pancreatic splenosis, in which a confident diagnosis was achieved with the use of CEUS and confirmed by a labeled heat denatured red cell scan. Accumulation of ultrasound contrast microbubbles in splenic tissue can be readily visualized on late-phase CEUS and this technique has already been used to confirm the nature of intrapancreatic accessory spleens. This case shows that it can also confirm the diagnosis of splenosis.

Intraperitoneal splenosis: a simple diagnosis if you remember to think of it

A 72-year old man presented with clinical signs of small bowel obstruction. The medical history revealed an asymptomatic retrogastric tumor 5 cm in diameter with impression of the gastric fundus that was found 10 years ago and showed no progression. This diagnosis was made endoscopically, by endosonography and abdominal computed tomography. Finally, as the small bowel obstruction occurred, an explorative laparotomy was performed to clarify the ambiguous abdominal scenario. The intraoperative situs showed multiple red nodules with diameters of up to 1 cm based on the serosa of the small bowel. The histopathological assessments of the peritoneal nodules as well as of the resected retrogastric tumor revealed the diagnosis of splenosis. Retrospectively, the patient reported a road accident with splenic rupture and splenectomy more than 30 years ago. He had simply forgotten this fact and thus had not mentioned it to the examining doctors. The decisive hint for the diagnosis of splenosis results from the thorough inquiry of the medical history, revealing experienced splenectomy. Splenosis should be considered as a crucial differential diagnosis of unexplained masses or occult bleeding in individuals who underwent splenectomy to avoid unnecessary diagnostic or therapeutic procedures.