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Herrera-Ortiz AF, Del Castillo V, Aguirre D, Duarte JN, Gutierrez MJ, Olarte LM, Noguera V, Quiroz-Alfaro AJ. Spleen anomalies and lesions in CT and MRI: essentials for radiologists and clinicians-a pictorial review. Abdom Radiol (NY) 2024:10.1007/s00261-024-04405-6. [PMID: 39192089 DOI: 10.1007/s00261-024-04405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 08/29/2024]
Abstract
The precise evaluation of splenic lesions using cross-sectional imaging presents a complex challenge due to the overlapping imaging characteristics of most splenic diseases and the absence of specific symptoms, complicating the diagnosis process. This pictorial review highlights the essential elements that should be included in a radiology report to interpret cross-sectional imaging studies of splenic lesions. To augment the diagnostic accuracy, we propose the implementation of a stepwise algorithmic approach. This approach offers a comprehensive analysis of splenic anomalies and lesions, providing an invaluable tool for radiologists and clinicians.
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Affiliation(s)
- Andrés Felipe Herrera-Ortiz
- Radiology, Fundación Santa Fe de Bogotá, 116 Street # 9-02, 110111, Bogotá, Colombia
- Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Valeria Del Castillo
- Radiology, Fundación Santa Fe de Bogotá, 116 Street # 9-02, 110111, Bogotá, Colombia.
- Medicine, Universidad El Bosque, Bogotá, Colombia.
| | - Diego Aguirre
- Radiology, Fundación Santa Fe de Bogotá, 116 Street # 9-02, 110111, Bogotá, Colombia
- Medicine, Universidad El Bosque, Bogotá, Colombia
| | - José Nicolás Duarte
- Radiology, Fundación Santa Fe de Bogotá, 116 Street # 9-02, 110111, Bogotá, Colombia
- Medicine, Universidad El Bosque, Bogotá, Colombia
| | | | | | - Valeria Noguera
- Radiology, Fundación Santa Fe de Bogotá, 116 Street # 9-02, 110111, Bogotá, Colombia
- Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Alejandro José Quiroz-Alfaro
- Medicine, Universidad del Rosario, Bogotá, Colombia
- Internal Medicine, North Mississippi Medical Center, Tupelo, USA
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Valizadeh P, Jannatdoust P, Tahamtan M, Soleimani Dorcheh S, Khalaj F, Ghorani H, Ayoobi Yazdi N, Salahshour F. Differentiating malignant from benign splenic lesions: a meta-analysis and pictorial review of imaging features. Abdom Radiol (NY) 2024; 49:2833-2857. [PMID: 38900328 DOI: 10.1007/s00261-024-04447-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES Splenic lesions might exhibit overlapping imaging features, varying from benign entities like cysts and hemangiomas to malignancies such as lymphoma and angiosarcoma. This meta-analysis aims to delineate imaging characteristics that distinguish malignant from benign splenic lesions. METHODS Adhering to PRISMA guidelines, we searched PubMed, Scopus, and Web of Science for studies on imaging features differentiating malignant from benign splenic lesions. We extracted data on splenic pathology and imaging characteristics and assessed the methodological quality via QUADAS-2. Odds ratio meta-analyses were performed using STATA (Version 17.0, Stata Corp, College Station, TX). RESULTS Portal phase hypoenhancement, hypovascular enhancement pattern, diffusion restriction, and late phase hypoenhancement, with odds ratios above 10, highly indicate malignancy. Other features suggestive of malignancy include solid morphology, lymphadenopathy, presence of perisplenic fluid, arterial hypoenhancement, hypoechogenicity on ultrasound, splenomegaly, and presence of multiple lesions. In contrast, cystic morphology, hypervascular-washout and hypervascular-persistent pattern of enhancement, late phase hyperenhancement, anechogenicity on ultrasound, portal phase hyperenhancement, well-defined borders, and calcification are in favour of benign pathology. CONCLUSION The study underscores the critical role of contrast-enhanced and diffusion-weighted imaging in distinguishing malignant from benign splenic lesions, emphasizing the role of features like portal phase hypoenhancement and restricted diffusion in diagnosing malignancies. Additionally, the study emphasizes the value of contrast-enhanced ultrasound, which allows for the visualization of key contrast-enhancement patterns without the risk of ionizing radiation exposure.
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Affiliation(s)
- Parya Valizadeh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Jannatdoust
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Tahamtan
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Soroush Soleimani Dorcheh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Student's Scientific Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Fattaneh Khalaj
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Ghorani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloofar Ayoobi Yazdi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Faeze Salahshour
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran.
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Krähling H, Seidensticker M, Heindel WL, Gerwing M. Diagnostic approach to splenic lesions. ROFO-FORTSCHR RONTG 2024; 196:573-581. [PMID: 37967822 DOI: 10.1055/a-2193-2292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
BACKGROUND Splenic lesions are rare and mostly incidental findings on cross-sectional imaging. Most lesions are of benign nature and can be correctly identified based on imaging characteristics. Further, invasive evaluation is only necessary in cases of splenic lesions with uncertain or potentially malignant etiology. METHOD While in most cases a correct diagnosis can be made from computed tomography (CT), (additional) magnetic resonance imaging (MRI) can aid in the identification of lesions. As these lesions are rare, only a few of the differential diagnoses are regularly diagnosed in the clinical routine. RESULT AND CONCLUSION This review presents the differential diagnoses of splenic lesions, including imaging characteristics and a flowchart to determine the right diagnosis. In conjunction with laboratory results and clinical symptoms, histological workup is necessary only in a few cases, especially in incidental findings. In these cases, image-guided biopsies should be preferred over splenectomy, if possible. KEY POINTS · Splenic lesions are rare and are usually incidental findings on abdominal imaging. · CT imaging and MRI imaging are the diagnostic tools of choice for the further workup of splenic lesions. · Based on their image morphological characteristics, a large number of splenic lesions can be assigned to one entity and do not need histological analysis. CITATION FORMAT · Krähling H, Seidensticker M, Heindel WL et al. Diagnostic approach to splenic lesions. Fortschr Röntgenstr 2024; 196: 573 - 581.
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Affiliation(s)
| | - Max Seidensticker
- Department of Radiology, Ludwig-Maximilians-Universität München, Germany
| | | | - Mirjam Gerwing
- Clinic of Radiology, University of Münster, Münster, Germany
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Tivadar BM, Dumitrascu T, Vasilescu C. A Glimpse into the Role and Effectiveness of Splenectomy for Isolated Metachronous Spleen Metastasis of Colorectal Cancer Origin: Long-Term Survivals Can Be Achieved. J Clin Med 2024; 13:2362. [PMID: 38673636 PMCID: PMC11050850 DOI: 10.3390/jcm13082362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Many papers exploring the role of resectioning metastases in colorectal cancer (CRC) have focused mainly on liver and lung sites, showing improved survival compared with non-resectional therapies. However, data about exceptional metastatic sites such as splenic metastases (SMs) are scarce. This paper aims to assess the role and effectiveness of splenectomy in the case of isolated metachronous SM of CRC origin. Methods: The patients' data were extracted after a comprehensive literature search through public databases for articles reporting patients with splenectomies for isolated metachronous SM of CRC origin. Potential predictors of survival were explored, along with demographic, diagnostic, pathology, and treatment data for each patient. Results: A total of 83 patients with splenectomies for isolated metachronous SM of CRC origin were identified. The primary CRC was at an advanced stage (Duke's C-70.3%) and on the left colon (45.5%) for most patients, while the median interval between CRC resection and SM was 24 months. The median overall survival after splenectomy was 84 months, and patients younger than 62 years presented statistically significantly worse overall survival rates than those ≥62 years old (p = 0.011). There was no significant impact on the long-term outcomes for factors including primary tumor location or adjuvant chemotherapy (p values ≥ 0.070, ns). Laparoscopic splenectomy was increasingly used in the last 20 years from 2002 (33.3% vs. 0%, p < 0.001). Conclusions: Splenectomy is the optimal treatment for patients with isolated metachronous SM of CRC, with the laparoscopic approach being increasingly used and having the potential to become a standard of care. Encouraging long-term survival rates were reported in the context of a multidisciplinary approach. Younger ages are associated with worse survival. Perioperative chemotherapy in the context of a patient diagnosed with SM of CRC origin appears to be a reasonable option, although the present study failed to show any significant impact on long-term survival.
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Affiliation(s)
| | - Traian Dumitrascu
- Department of General Surgery, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Fundeni Street No. 258, 022328 Bucharest, Romania; (B.M.T.); (C.V.)
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Moreira GS, Feijóo NDAP, Tinoco-da-Silva IB, Aguiar CM, da Conceição FO, de Castro GCM, de Carvalho MGB, de Almeida TVDPA, Garrido RQ, Lamas CDC. Splenic Embolism in Infective Endocarditis: A Systematic Review of the Literature with an Emphasis on Radiological and Histopathological Diagnoses. Trop Med Infect Dis 2024; 9:83. [PMID: 38668544 PMCID: PMC11053958 DOI: 10.3390/tropicalmed9040083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/29/2024] Open
Abstract
Infective endocarditis (IE) is characterised by fever, heart murmurs, and emboli. Splenic emboli are frequent in left-sided IE. A systematic review of the literature published on splenic embolism (SE) between 2000 and 2023 was conducted. Search strategies in electronic databases identified 2751 studies published between 1 January 2000 and 4 October 2023, of which 29 were finally included. The results showed that the imaging tests predominantly used to detect embolisms were computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)/CT, single-photon emission computed tomography/CT, ultrasound, and contrast-enhanced ultrasound. More recent studies typically used 18F-FDG PET-CT. The proportion of SE ranged from 1.4% to 71.7%. Only seven studies performed systematic conventional CT screening for intra-abdominal emboli, and the weighted mean frequency of SE was 22% (range: 8-34.8%). 18F-FDG PET-CT was performed systematically in seven studies, and splenic uptake was found in a weighted mean of 4.5%. There was a lack of uniformity in the published literature regarding the frequency and management of splenic embolisation. CT scans were the most frequently used method, until recently, when 18F-FDG PET-CT scans began to predominate. More data are necessary regarding the frequency of SE, especially focusing on their impact on IE management and prognosis.
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Affiliation(s)
- Gabriel Santiago Moreira
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
| | - Nícolas de Albuquerque Pereira Feijóo
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
| | - Isabella Braga Tinoco-da-Silva
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
| | - Cyntia Mendes Aguiar
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
| | | | - Gustavo Campos Monteiro de Castro
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
| | - Mariana Giorgi Barroso de Carvalho
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
| | - Thatyane Veloso de Paula Amaral de Almeida
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
| | - Rafael Quaresma Garrido
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro 21040-360, Rio de Janeiro, Brazil
| | - Cristiane da Cruz Lamas
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro 21040-360, Rio de Janeiro, Brazil
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Belard S, Taccari F, Kumwenda T, Huson MA, Wallrauch C, Heller T. Point-of-care ultrasound for tuberculosis and HIV-revisiting the focused assessment with sonography for HIV-associated tuberculosis (FASH) protocol and its differential diagnoses. Clin Microbiol Infect 2024; 30:320-327. [PMID: 37923216 DOI: 10.1016/j.cmi.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/10/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The 'Focused assessment with sonography for HIV-associated tuberculosis' (FASH) protocol has been applied and researched for over a decade in HIV-infected patients with suspected extra-pulmonary tuberculosis. Interpretation of target FASH features may be challenging as they can also indicate alternative opportunistic diseases. OBJECTIVES The primary aim of the review was summarizing the accumulated evidence on the diagnostic accuracy of the FASH protocol including description of diagnoses of target FASH features. SOURCES Literature was searched using PubMed, Google Scholar, and publications referencing the original FASH publications; data from identified studies were compiled with data from studies identified by a preceding Cochrane review. A meta-analysis was performed based on a generalized linearized mixed model. Data on differential diagnoses were compiled by literature review and retrospective evaluation of clinical data. CONTENT We identified ten studies; abdominal target FASH features were most studied. Sensitivity and specificity estimates were 39% (95% CI 25-54) and 89% (95% CI 83-96) for enlarged lymph nodes (ten studies), and 30% (95% CI 16-45%) and 93% (95% CI 89-98%) for hypoechoic spleen lesions (eight studies). In people living with HIV differential diagnoses of target FASH features are multiple and primarily include other opportunistic infections and malignancies such as non-tuberculous mycobacterial infection, bacillary angiomatosis, hepato-splenic brucellosis, meliodiosis, visceral leishmaniasis, invasive fungal infections, and lymphoma as well as Kaposi sarcoma. Ultrasound-guided diagnostic sampling may assist obtention of a definitive diagnosis. IMPLICATIONS On the basis of current evidence, although limited by methodology, and personal experience, we recommend basic ultrasound training, including the FASH protocol and ultrasound-guided diagnostic interventions, for all healthcare providers working with people living with HIV in resource-limited settings.
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Affiliation(s)
- Sabine Belard
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; Partner Site Tübingen, German Center for Infection Research (DZIF), Tübingen, Germany.
| | - Francesco Taccari
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Michaëla Am Huson
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Tom Heller
- Lighthouse Clinic Trust, Lilongwe, Malawi; International Training and Education Center for Health, University of Washington, Seattle, WA, USA
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Pu SH, Bao WYG, Jiang ZP, Yang R, Lu Q. Percutaneous ultrasound-guided coaxial core needle biopsy for the diagnosis of multiple splenic lesions: A case report. World J Gastrointest Surg 2024; 16:616-621. [PMID: 38463358 PMCID: PMC10921196 DOI: 10.4240/wjgs.v16.i2.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/18/2023] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The overlap of imaging manifestations among distinct splenic lesions gives rise to a diagnostic dilemma. Consequently, a definitive diagnosis primarily relies on histological results. The ultrasound (US)-guided coaxial core needle biopsy (CNB) not only procures sufficient tissue to help clarify the diagnosis, but reduces the incidence of puncture-related complications. CASE SUMMARY A 41-year-old female, with a history of pulmonary tuberculosis, was admitted to our hospital with multiple indeterminate splenic lesions. Gray-scale ultrasonography demonstrated splenomegaly with numerous well-defined hypoechoic masses. Abdominal contrast-enhanced computed tomography (CT) showed an enlarged spleen with multiple irregular-shaped, peripherally enhancing, hypodense lesions. Positron emission CT revealed numerous abnormal hyperglycemia foci. These imaging findings strongly indicated the possibility of infectious disease as the primary concern, with neoplastic lesions requiring exclusion. To obtain the precise pathological diagnosis, the US-guided coaxial CNB of the spleen was carried out. The patient did not express any discomfort during the procedure. CONCLUSION Percutaneous US-guided coaxial CNB is an excellent and safe option for obtaining precise splenic tissue samples, as it significantly enhances sample yield for exact pathological analysis with minimum trauma to the spleen parenchyma and surrounding tissue.
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Affiliation(s)
- Sha-Hong Pu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wu-Yong-Ga Bao
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zhen-Peng Jiang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Rui Yang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qiang Lu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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Sritharan S, Lau PST, Manan K, Mohan A. Case report: Aseptic splenic abscesses in childhood-onset systemic lupus erythematosus. Front Pediatr 2023; 11:1214551. [PMID: 37520056 PMCID: PMC10374253 DOI: 10.3389/fped.2023.1214551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023] Open
Abstract
Background Systemic lupus erythematosus (SLE) can involve any organ system and cause a wide range of manifestations. Noninfectious inflammatory lesions termed aseptic abscesses have been reported in some autoimmune and autoinflammatory conditions but not in childhood-onset SLE. In this report, we highlight the unusual finding of occult splenic abscesses in two children diagnosed with SLE who had no evidence of concomitant infection. Case presentation An 8-year-old and an 11-year-old were admitted separately to the hospital with fever for 7 and 14 days, respectively. In the younger child, a generalized rash preceded the fever. Both had been well, with no significant past medical history prior to the onset of the illness. In both girls, abdominal ultrasonography showed multiple small hypoechoic lesions suggestive of abscesses scattered throughout the spleen. Their C-reactive protein and blood cultures were negative, and symptoms persisted despite intravenous antibiotics. Fulfilling the clinical and immunologic criteria for diagnosis, both were ultimately diagnosed with childhood-onset SLE. Rapid recovery of symptoms and complete resolution of the abscesses ensued with corticosteroids and immunosuppressive therapy. Conclusions These two cases suggest that aseptic splenic abscesses may occur in childhood-onset SLE. Autoimmune conditions such as SLE should be included in the differential diagnosis of children with occult splenic abscesses.
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Affiliation(s)
- Shobashenee Sritharan
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Malaysia
| | - Peter Sie-Teck Lau
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Malaysia
| | - Kamilah Manan
- Department of Radiology, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Malaysia
| | - Anand Mohan
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Malaysia
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
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Unusual Rapid Growth of Primary Splenic Diffuse Large B-Cell Lymphoma with Extensive Necrosis. Diagnostics (Basel) 2022; 13:diagnostics13010035. [PMID: 36611326 PMCID: PMC9818288 DOI: 10.3390/diagnostics13010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/10/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
The primary splenic lymphoma is extremely uncommon with an incidence rate of <1% of all the lymphomas under the strict criteria for diagnosis expounded by Das Gupta et al. Clinical presentations of nonspecific symptoms are weight loss, weakness, fever, and left upper quadrant pain or discomfort due to enlarged spleen. Abdominal ultrasound and CT are the most widely used imaging modality for the assessment of lymphoma. The imaged features of splenic lymphoma are nonspecific; typical lymphoma presents as a diffusely enlarged spleen. The abdominal CT scan in our case showed a large cystic splenic mass measuring 14 cm without enhancement after contrast medium. Lymphoma is often described as an aggressive tumor because its rapid doubling time can quickly increase the size of a tumor. In our case, the tumor grew to more than 100 times its original size in 4 months. So, we present this unusual rapid growth of primary splenic lymphoma.
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Tan M, Low HM, Shelat V, Tan CH. Imaging patterns in non-traumatic spleen lesions in adults-a review. Jpn J Radiol 2022; 40:664-677. [PMID: 35099683 DOI: 10.1007/s11604-022-01250-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/17/2022] [Indexed: 02/05/2023]
Abstract
The spleen is a complex organ involved in multiple physiological processes in the human body. Elective splenectomy is an uncommon operation, and the precise characterization of the lesion should be achieved to determine the risks and benefits of this operation accurately. Given the significant role of the spleen in homeostasis and the potential risks of the surgery itself and following sequelae such as infection susceptibility, accurate recognition, and classification of splenic lesions is required before surgery. This review provides an overview of malignant (e.g., lymphoma, angiosarcoma) and benign (e.g., cysts, hemangioma, hamartoma) splenic lesions that may warrant an elective splenectomy. Images from a cohort of adult patients undergoing isolated splenectomy for non-traumatic indications in a single center are provided. This review highlights the considerable overlap in imaging patterns between splenic lesions, splenic lesions masquerading as lesions in other organs, increased detection of asymptomatic splenic incidentalomas due to improvements in imaging modalities. This review also provides clinical correlations for each lesion, providing additional information to help clinicians differentiate between lesions and accurately identify diseases amenable to surgical management.
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Affiliation(s)
| | - Hsien Min Low
- Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vishalkumar Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Cher Heng Tan
- Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
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Hellinckx H, Mertes H, Vanreusel I, Demedts I, Dutré J. Clostridium perfringens splenic abscess treated with percutaneous drainage and antibiotic therapy: a case report. Acta Clin Belg 2022; 77:688-692. [PMID: 34151751 DOI: 10.1080/17843286.2021.1940606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Splenic abscesses are a rare medical entity with high mortality, with Clostridium perfringens being an exceptional pathogen. We present the first case describing an abscess of the spleen in a patient undergoing treatment with adalimumab, an anti-tumour necrosis factor commonly used in inflammatory bowel diseases. PATIENT We describe the case of a 73-year-old woman, treated with adalimumab therapy, who was found to have a splenic abscess, caused by C. perfringens. RESULT After antibiotic treatment and percutaneous drainage, the patient recovered both clinically and radiographically. DISCUSSION We reviewed literature about C. perfringens splenic abscesses. In all cases identified, a splenectomy was performed. This is the first case description of splenic abscess caused by C. perfringens where a percutaneous drainage was performed, leading to complete recovery in our patient. This seems to indicate that a splenectomy is not necessary in all C. perfringens splenic abscesses.
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Affiliation(s)
- Hanne Hellinckx
- Department of internal medicine, Catholic University of Leuven, Leuven, Belgium
| | - Helena Mertes
- Department of Infectiology, Jan Palfijn Merksem, Merksem, Belgium
| | - Inne Vanreusel
- Department of cardiology, University of Antwerp, Antwerp, Belgium
| | - Ingrid Demedts
- Department of Gastro-enterology, UZ Leuven, Leuven, Belgium
| | - Joris Dutré
- Department of Gastro-enterology, Jan Palfijn Merksem, Merksem, Belgium
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Kim N, Auerbach A, Manning MA. Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation. Radiographics 2022; 42:683-701. [PMID: 35302864 DOI: 10.1148/rg.210071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Splenic lesions are commonly discovered incidentally at imaging, without clinical signs or symptoms that may aid in diagnosis. As such, the differential diagnosis and subsequent management are based primarily on imaging characteristics. Much has been written about the myriad pathologic conditions that can occur in the spleen; however, there is little guidance on the approach to an incidental splenic mass. Applying an approach frequently used in imaging to the splenic mass-based on the number and consistency of lesions and refined by supplementary imaging features-allows formulation of a useful differential diagnosis. Solitary cystic masses include true cysts, pseudocysts, and parasitic cysts. When multiple cystic lesions are present, the differential diagnosis expands to include infectious lesions (abscess or microabscesses) and lymphangioma (a benign cystic neoplasm). Hemangioma is the most common solitary solid mass, although other vascular lesions (hamartoma, sclerosing angiomatoid nodular transformation) and nonvascular lesions (inflammatory pseudotumor, lymphoma) manifest as solitary and solid. When multiple solid masses are present, diffuse inflammatory disease (sarcoidosis), littoral cell angioma, and lymphoma should be considered. Malignancies, such as angiosarcoma or metastasis, can manifest as solitary or multiple and solid or cystic masses but are typically associated with symptoms or widespread primary malignancy. Careful assessment of the multimodality imaging characteristics of splenic lesions based on this approach aids the radiologist faced with the incidental splenic lesion. Online supplemental material is available for this article. Work of the U.S. Government published under an exclusive license with the RSNA.
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Affiliation(s)
- Nancy Kim
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, CCC Building Ground Floor, CG 201, Washington, DC 20007 (N.K., M.A.M.); the Joint Pathology Center, Silver Spring, Md (A.A.); and the American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
| | - Aaron Auerbach
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, CCC Building Ground Floor, CG 201, Washington, DC 20007 (N.K., M.A.M.); the Joint Pathology Center, Silver Spring, Md (A.A.); and the American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
| | - Maria A Manning
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, CCC Building Ground Floor, CG 201, Washington, DC 20007 (N.K., M.A.M.); the Joint Pathology Center, Silver Spring, Md (A.A.); and the American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
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13
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Choi G, Kim KA, Lee J, Park YS, Lee J, Choi JW, Lee CH. Ultrasonographic atlas of splenic lesions. Ultrasonography 2022; 41:416-429. [PMID: 35045593 PMCID: PMC8942726 DOI: 10.14366/usg.21189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/02/2021] [Indexed: 11/03/2022] Open
Abstract
Ultrasonography (US) is widely used for abdominal imaging. Its noninvasiveness, extensive range of application, and low cost make US a useful and valuable tool for the detection, diagnosis, and follow-up of splenic abnormalities. Concomitantly with the increasing frequency of imaging, more splenic lesions are being discovered and the requirements for the differential diagnosis are rising. In this pictorial essay, we introduce the representative US findings of many different splenic lesions, including normal sonographic findings, normal variants and congenital anomalies, infectious conditions, benign and malignant neoplasms, and non-neoplastic lesions. Knowledge of the US features of various splenic lesions will help narrow the differential diagnosis and guide clinical decision-making.
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Affiliation(s)
- Gayoung Choi
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.,Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Kyeong Ah Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jinhwan Lee
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yang Shin Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jongmee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jae Woong Choi
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chang-Hee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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14
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Malgras B, Najah H, Dohan A, Barat M, Soyer P. Diagnosis and treatment of focal splenic lesions. J Visc Surg 2022; 159:121-135. [DOI: 10.1016/j.jviscsurg.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Imam M, Hammond GW. Splenic infarction secondary to COVID-19 complicated by Clostridium Paraputrificum infection. IDCases 2021; 27:e01357. [PMID: 34900587 PMCID: PMC8647475 DOI: 10.1016/j.idcr.2021.e01357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/24/2022] Open
Abstract
A 58-year-old woman with COVID-19 presented with an acute abdomen. Her spleen was found to be infarcted with a large fluid and gas collection. Treatment included broad-spectrum antibiotics and CT-guided drainage. Definitive treatment was splenectomy. We postulate that COVID-19 related splenic infarction created ideal conditions for Clostridium paraputrificum to cause a splenic abscess.
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Affiliation(s)
- Malaz Imam
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gregory William Hammond
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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16
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Abstract
Introduction: Spleen angiosarcoma (SA) is a rare malignant neoplasm that arises from the splenic vascular endothelium, with only around 300 cases reported to date. Due to a limited number of reported cases, there is a paucity of data and a lack of understanding of its presentation, diagnosis, and management. In this study, we aim to provide a comprehensive review of SA.Areas covered: On 27 February 2021, a literature search was done in PubMed and Embase database. The search yielded 122 articles involving 205 patients. The focus was on patient demographics, risk factors, clinical presentations, investigation results, preliminary diagnoses, therapies provided, and patient outcomes. These factors were analyzed to identify possible risk factors, diagnostic modalities, and therapeutic principles that were not mentioned before.Expert opinion: The clinical presentation or investigation results of patients with SA are often nonspecific. Hence, they may not be sufficient to clinch the diagnosis of SA if used alone. The authors recommend a triple assessment of clinical examination, imaging findings, and pathology to diagnose SA with high accuracy. Splenectomy should be the mainstay of management, with chemotherapy and radiotherapy considered as adjuncts, especially in the presence of metastases.
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17
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Nakamura F, Kato H, Ozeki M, Matsuo M. CT and MRI Findings of Focal Splenic Lesions and Ascites in Generalized Lymphatic Anomaly, Kaposiform Lymphangiomatosis, and Gorham-Stout Disease. J Clin Imaging Sci 2021; 11:44. [PMID: 34513208 PMCID: PMC8422418 DOI: 10.25259/jcis_101_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022] Open
Abstract
Objectives: This study aimed to evaluate the CT and MRI findings of focal splenic lesions and ascites in generalized lymphatic anomaly (GLA), kaposiform lymphangiomatosis (KLA), and Gorham-Stout disease (GSD). Material and Methods: Twenty-three patients (10 with GLA, 5 with KLA, and 8 with GSD) who underwent abdominal CT and/or MRI before treatment were included in this study, and their imaging findings were retrospectively evaluated. Results: Focal splenic lesions were observed in nine patients; these lesions were observed frequently in GLA (n = 5; 50%) or KLA (n = 3; 60%) compared with GSD (n = 1; 13%); however, no significant differences were found between the three groups (P = 0.190). On CT images among eight patients (4 with GLA, 3 with KLA, and 1 with GSD) with focal splenic lesions who underwent CT, the number of focal splenic lesions per patient ranged from 2 to 189 (mean, 42) and the maximum diameter of focal splenic lesions ranged from 2 to 39 mm (mean, 8 mm), while more than 30 focal splenic lesions per patient were observed in 2 (50%) GLA and focal splenic lesions with maximum diameters of ≥10 mm were observed in 4 (100%) GLA but not in KLA or GSD. Ascites was observed in five patients; significant differences were observed among KLA (n = 4; 80%), GLA (n = 1; 10%), and GSD (n = 0; 0%) (P < 0.01). Ascites was significantly more frequent in KLA than in GSD (P < 0.05). Conclusion: More than 30 focal splenic lesions per patient and/or focal splenic lesions with maximum diameters of ≥10 mm were observed only in GLA. Focal splenic lesions tended to be less frequent in GSD, whereas ascites tended to be frequent in KLA.
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Affiliation(s)
| | - Hiroki Kato
- Department of Radiology, Gifu University, Gifu, Japan
| | - Michio Ozeki
- Department of Radiology, Gifu University, Gifu, Japan
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18
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Ozkale Yavuz O, Ozcan HN, Oguz B, Ayaz E, Ekinci S, Ciftci TT, Haliloglu M. Imaging findings of benign and malignant pediatric splenic lesions. Abdom Radiol (NY) 2021; 46:3245-3252. [PMID: 33661318 DOI: 10.1007/s00261-021-03004-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 02/06/2023]
Abstract
Splenic lesions in children have a wide histological spectrum. The majority of pediatric splenic lesions are benign and detected incidentally, and the most common benign lesions are cysts, followed by hemangiomas and lymphatic malformations. Most of the splenic malignancies in children are secondary to leukemia or lymphoma. The purpose of this article is to describe the ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) features of benign and malignant splenic lesions in the pediatric age group.
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Affiliation(s)
- Ozlem Ozkale Yavuz
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06230, Ankara, Turkey.
- Division of Pediatric Radiology, Department of Radiology, Ankara Bilkent City Hospital, Ankara, Turkey.
| | - Hatice Nursun Ozcan
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06230, Ankara, Turkey
| | - Berna Oguz
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06230, Ankara, Turkey
| | - Ercan Ayaz
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06230, Ankara, Turkey
- Department of Radiology, Diyarbakır Children Hospital, Diyarbakır, Turkey
| | - Saniye Ekinci
- Department of Pediatric Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Turkmen Turan Ciftci
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mithat Haliloglu
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06230, Ankara, Turkey
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19
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Sahli J, DeLeon S. Splenic Micro-Abscesses as a Complication of Epstein-Barr Virus. Clin Pediatr (Phila) 2021; 60:325-327. [PMID: 33899534 DOI: 10.1177/00099228211010561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jenna Sahli
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Stephanie DeLeon
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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20
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Barat M, Hoeffel C, Aissaoui M, Dohan A, Oudjit A, Dautry R, Paisant A, Malgras B, Cottereau AS, Soyer P. Focal splenic lesions: Imaging spectrum of diseases on CT, MRI and PET/CT. Diagn Interv Imaging 2021; 102:501-513. [PMID: 33965354 DOI: 10.1016/j.diii.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/12/2022]
Abstract
The spleen can be affected by a variety of diseases. Some of them are readily identified as variations of normal or benign diseases on imaging. However, for a substantial number of focal splenic abnormalities, the diagnosis can be difficult so that histopathologic analysis may be required for a definite diagnosis. In this review, the typical splenic abnormalities that can be diagnosed with imaging with a high degree of confidence are illustrated. The complementary role of computed tomography (CT), magnetic resonance imaging and positron emission tomography/CT that helps make a diagnostic approach is discussed. Finally, current applications and future trends of radiomics and artificial intelligence for the diagnosis of splenic diseases are addressed.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France.
| | - Christine Hoeffel
- Department of Radiology, Reims University Hospital, 51092 Reims, France; CRESTIC, University of Reims Champagne-Ardenne, 51100 Reims, France
| | | | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Amar Oudjit
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Raphael Dautry
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Anita Paisant
- Department of Radiology, University Hospital of Angers, 49100 Angers, France; Faculté de Médecine, Université d'Angers, 49045 Angers, France
| | - Brice Malgras
- Department of Digestive and Endocrine Surgery, Bégin Army Training hospital, 94160 Saint-Mandé, France; École du Val-de-Grâce, 75005 Paris, France
| | - Anne-Ségolène Cottereau
- Université de Paris, 75006 Paris, France; Department of Nuclear Medicine, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France
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21
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Yang R, Lu Q, Xu J, Huang J, Gao B, Zhang H, Zhou J, Du L, Yan F. Value of Contrast-Enhanced Ultrasound in the Differential Diagnosis of Focal Splenic Lesions. Cancer Manag Res 2021; 13:2947-2958. [PMID: 33833578 PMCID: PMC8021137 DOI: 10.2147/cmar.s300601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/08/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose To identify and validate contrast-enhanced ultrasound (CEUS) features for differentiating malignant from benign splenic lesions. Patients and Methods Splenic lesions in 123 patients who underwent conventional ultrasound (B-mode US) and CEUS were included in this study. Two radiologists evaluated the sonograms of B-mode and CEUS. Statistical analysis was performed to identify significant imaging predictors for splenic malignant lesions. Two other radiologists independently reviewed B-mode and CEUS sonograms and diagnosed the lesions based on proposed criteria as 1) benign, 2) probably benign, 3) probably malignant or 4) malignant. The diagnostic efficiency between B-mode US and CEUS was compared. Results Common imaging findings of malignant lesions included hypoechoic, ill-defined margin, absence of cystic/necrotic portion, presence of splenomegaly on B-mode US, and hypoenhancement, rapid washout and presence of intralesional vessels on CEUS (P < 0.05). Among them, three independent features were identified using multivariate logistic regression analysis: hypoechoic pattern, hypoenhancement pattern and intralesional vessels. When three of these findings were combined as a predictor for splenic malignant lesions, 22 (55.0%) of 40 malignant splenic lesions were identified with a specificity of 100%. The diagnostic performance of two readers using receiver operating characteristic curve analysis was 0.622 and 0.533, respectively, for B-mode US, which was significantly improved to 0.908 and 0.906 for CEUS (P < 0.001). The degree of other diagnostic efficiency and inter-reader agreement also increased with CEUS compared to B-mode US. Conclusion CEUS may provide more useful information than B-mode US and improve the diagnosis efficiency for distinguishing malignant from benign splenic lesions.
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Affiliation(s)
- Rui Yang
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Ultrasound Imaging, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Qiang Lu
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jinshun Xu
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Ultrasound Imaging, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jiayan Huang
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Binyang Gao
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Ultrasound Imaging, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Huan Zhang
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Ultrasound Imaging, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jie Zhou
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Ultrasound Imaging, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Lanxin Du
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Feng Yan
- Laboratory of Ultrasound Imaging, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
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22
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Nadeem M, Tiwari HA, Jambhekar K, Shah H, Ram R. Revisiting the Spleen—An Imaging Review of the Common and Uncommon Splenic Pathology. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0040-1721626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractThe spleen is the largest lymphatic organ and is responsible for both hematological and immunological functions. Several common etiologies such as trauma, developmental variants, infectious/inflammatory conditions, and benign and malignant lesions can occur in the spleen. The role of imaging modalities such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) in diagnosing these conditions continues to evolve. The main objective of this review article is to illustrate the role of imaging in identifying the common and uncommon pathology of the spleen.
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Affiliation(s)
- Meshaal Nadeem
- Department of Diagnostic Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Hina Arif Tiwari
- Division of Radiology, Department of Medical Imaging, University of Arizona Health sciences, Tuscon, Arizona, United States
| | - Kedar Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Hemendra Shah
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
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23
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Consul N, Javed-Tayyab S, Morani AC, Menias CO, Lubner MG, Elsayes KM. Iron-containing pathologies of the spleen: magnetic resonance imaging features with pathologic correlation. Abdom Radiol (NY) 2021; 46:1016-1026. [PMID: 32915270 DOI: 10.1007/s00261-020-02709-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/17/2020] [Accepted: 07/25/2020] [Indexed: 12/13/2022]
Abstract
Systemic and non-systemic pathologies that involve iron deposition within the spleen have characteristic features on MRI due to the susceptibility properties of deposited iron, or hemosiderin. These lesions will have signal loss on longer echo sequences due to the T2* effect when evaluated with dual-echo gradient-echo sequences. The pathophysiology of systemic and localized iron sequestration disease processes can elucidate an underlying diagnosis based on these imaging features in conjunction with clinical information.
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Affiliation(s)
- Nikita Consul
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Sidra Javed-Tayyab
- Department of Radiology, Memorial-Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Ajaykumar C Morani
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, 53726, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, AZ, USA.
- Department of Radiology, Unit 1473, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
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24
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Yamaguchi Y, Nakagawa M, Nakagawa S, Nagao K, Inoue S, Sugiyama T, Izawa S, Hijikata Y, Ebi M, Funaki Y, Ogasawara N, Sasaki M, Kasugai K. Rapidly Progressing Aseptic Abscesses in a Patient with Ulcerative Colitis. Intern Med 2021; 60:725-730. [PMID: 32999240 PMCID: PMC7990631 DOI: 10.2169/internalmedicine.5733-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Aseptic abscesses (AAs) are extraintestinal manifestations of inflammatory bowel disease (IBD). IBD-associated AAs are rare in Japan. We treated a 45-year-old man with ulcerative colitis (UC)-associated AAs. During remission, multiple progressive abscesses were detected in the spleen; he underwent splenectomy because an infectious disease was suspected. Although his condition improved temporarily after splenectomy, a large liver abscess was noted, and a diagnosis of UC-associated AAs was made. Granulocytapheresis (GCAP) and infliximab (IFX) administration resolved the abscess. This is the first reported case of UC-associated AAs in a Japanese patient treated by splenectomy, GCAP, and IFX.
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Affiliation(s)
- Yoshiharu Yamaguchi
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Marie Nakagawa
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Shoko Nakagawa
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Kazuhiro Nagao
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Satoshi Inoue
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Tomoya Sugiyama
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Shinya Izawa
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Yasutaka Hijikata
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Masahide Ebi
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Yasushi Funaki
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Naotaka Ogasawara
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Makoto Sasaki
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Kunio Kasugai
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
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25
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Elo P, Li XG, Liljenbäck H, Gardberg M, Moisio O, Miner M, Virta J, Saraste A, Srinivasarao M, Pugh M, Low PS, Knuuti J, Jalkanen S, Airas L, Lu YJ, Roivainen A. Efficacy and tolerability of folate-aminopterin therapy in a rat focal model of multiple sclerosis. J Neuroinflammation 2021; 18:30. [PMID: 33472663 PMCID: PMC7819223 DOI: 10.1186/s12974-021-02073-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Activated macrophages in the experimental model of multiple sclerosis (MS) express folate receptor-β (FR-β), representing a promising target for the treatment of MS. Here, we both evaluated the efficacy of a novel folate-aminopterin construct (EC2319) in a rat focal model of multiple sclerosis (MS) and investigated the utility of 68Ga-labeled 1,4,7-triazacyclononane-1,4,7-triacetic acid-conjugated folate (68Ga-FOL) for assessing inflammatory lesions. In addition, we investigated whether FR-β is expressed in the brain of patients with MS. METHODS Focal delayed-type hypersensitivity experimental autoimmune encephalomyelitis (fDTH-EAE) was induced in 40 Lewis rats; 20 healthy Lewis rats were used as controls. Rats were divided into six groups according to the duration of disease (control, acute, or chronic) and intervention (vehicle versus EC2319). 68Ga-FOL analyses, histology, and immunofluorescence of the brain were performed to evaluate the efficacy of subcutaneously administered EC2319 on lesion development. Immunofluorescence was used to assess FR-β expression in postmortem brain samples from 5 patients with MS and 5 healthy controls. RESULTS Immunofluorescence and histological analyses revealed significant reductions in FR-β expression (P < 0.05) and lesion size (P < 0.01), as well as improved inducible nitric oxide synthase/mannose receptor C type 1 ratios (P < 0.01) in macrophages and microglia during the chronic but not acute phase of fDTH-EAE in EC2319-treated rats. The uptake of IV-injected 68Ga-FOL in the brain was low and did not differ between the groups, but the in vitro binding of 68Ga-FOL was significantly lower in EC2319-treated rats (P < 0.01). FR-β positivity was observed in chronically active lesions and in normal-appearing white matter in MS brain samples. CONCLUSIONS EC2319 was well tolerated and attenuated inflammation and lesion development in a rat model of a chronic progressive form of MS. Human MS patients have FR-β-positive cells in chronically active plaques, which suggests that these results may have translational relevance.
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Affiliation(s)
- Petri Elo
- Turku PET Centre, University of Turku, Turku, Finland
| | - Xiang-Guo Li
- Turku PET Centre, University of Turku, Turku, Finland.,Turku PET Centre, Åbo Akademi University, Turku, Finland
| | - Heidi Liljenbäck
- Turku PET Centre, University of Turku, Turku, Finland.,Turku Center for Disease Modeling, University of Turku, Turku, Finland
| | - Maria Gardberg
- Department of Pathology, Turku University Hospital and Institute of Biomedicine, University of Turku, Turku, Finland
| | - Olli Moisio
- Turku PET Centre, University of Turku, Turku, Finland
| | - Maxwell Miner
- Turku PET Centre, University of Turku, Turku, Finland
| | - Jenni Virta
- Turku PET Centre, University of Turku, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, University of Turku, Turku, Finland.,Turku PET Centre, Turku University Hospital, Turku, Finland
| | | | - Michael Pugh
- Endocyte, Inc., now part of Novartis Institutes for Biomedical Research, West Lafayette, IN, USA
| | - Philip S Low
- Department of Chemistry, Purdue University, West Lafayette, IN, USA
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, Turku, Finland.,Turku PET Centre, Åbo Akademi University, Turku, Finland.,Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Sirpa Jalkanen
- MediCity Research Laboratory, University of Turku, Turku, Finland
| | - Laura Airas
- Department of Neurology, Turku University Hospital, Turku, Finland
| | - Yingjuan June Lu
- Endocyte, Inc., now part of Novartis Institutes for Biomedical Research, West Lafayette, IN, USA
| | - Anne Roivainen
- Turku PET Centre, University of Turku, Turku, Finland. .,Turku Center for Disease Modeling, University of Turku, Turku, Finland. .,Turku PET Centre, Turku University Hospital, Turku, Finland.
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Abrishami A, Khalili N, Kooraki S, Abrishami Y, Grenacher L, Kauczor HU. Evaluation of cross-sectional imaging features that aid in the differentiation of benign and malignant splenic lesions. Eur J Radiol 2021; 136:109549. [PMID: 33465552 DOI: 10.1016/j.ejrad.2021.109549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE This study aimed to investigate the role of cross-sectional imaging in differentiating between benign and malignant splenic lesions based on various imaging features. METHODS Database of imaging reports from January 2015 to December 2017 were searched dedicatedly for "spleen" or "splenic" terms to identify patients with splenic lesions found either on CT or MRI. The study cohort consisted of patients who had available histological reports or had follow-up imaging for a minimum of one year. Patients were categorized into the benign subcohort if they did not have a history of extra-splenic malignancy, and had a splenic lesion(s) falling into one of these categories: benign histopathology on biopsy, stable size and enhancement, or decreased size on follow-up imaging. Those who had malignant histopathology on biopsy were included in the malignant subcohort. Various morphologic features and enhancement patterns of these lesions were carefully reviewed by two radiologists who were blinded to the final histopathologic diagnosis. RESULTS We identified 161 patients (54 % males, mean age ± SD = 59.7 ± 15.4) including 124 (77 %) in the benign and 37 (23 %) in the malignant subcohort. Benign lesions were more likely to be cystic (21.7 % vs 2.7 %, p < 0.001), homogenous (59.7 % vs. 29.7 %, p = 0.001) and to demonstrate well-defined borders (69.3 % vs. 29.7 % p= <0.001). Malignant lesions had significantly larger diameter (median size: 15 vs 11 mm, p = 0.03). Restricted diffusion was not seen in any of the benign lesions; however, 50 % of malignant lesions demonstrated restricted diffusion (p = 0.003). Features such as lesion distribution, presence of calcification, splenomegaly and number of lesions were not significantly different between benign and malignant lesions. CONCLUSION Smaller lesion diameter, well-defined border and homogeneity favor benign nature of splenic lesions while restricted diffusion should raise suspicion for malignancy.
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Affiliation(s)
- Alireza Abrishami
- Department of Radiology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Nastaran Khalili
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Cancer Immunology Project, Universal Scientific Education and Research Network, Tehran, Iran
| | - Soheil Kooraki
- Department of Nuclear Medicine, University of California, Los Angeles, CA, USA
| | - Yalda Abrishami
- Department of Radiation Oncology, University Hospital of Augsburg, Augsburg, Germany
| | - Lars Grenacher
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Conradia Radiologie München, Department of Radiology, Munich, Germany.
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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Gonzalez L, Shapiro AF, Tafur A, Plaza-Meneses C, Sabando B. Splenic Infarct Secondary to High Altitude Exposure in Sickle Cell Trait Patients: A Case Series. Cureus 2020; 12:e9815. [PMID: 32821639 PMCID: PMC7431312 DOI: 10.7759/cureus.9815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The sickle cell trait is considered a benign entity that generally does not show clinical manifestations. However, some complications have been described under certain conditions, such as a decrease in oxygen level, dehydration, and strenuous physical efforts. Among them, splenic infarct is a rare complication that presents as left upper abdominal pain in a situation of stress such as high altitude exposure. We present two cases of splenic infarcts in patients with undiagnosed sickle cell trait who showed to our institution with severe abdominal pain after coming from high altitude cities.
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Affiliation(s)
- Luis Gonzalez
- Medicine, Nassau University Medical Center, East Meadow, USA
| | | | | | | | - Brenner Sabando
- Hematology, Hospital Luis Vernaza/Universidad Espíritu Santo (UEES), Guayaquil, ECU
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28
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Matsuzawa H, Goto T, Ohshima S, Shibuya T, Sato W, Chiba M, Takahashi K, Minami S, Iijima K. Sarcoidosis with Splenic Involvement Diagnosed with Endoscopic Ultrasound-guided Fine-needle Aspiration. Intern Med 2020; 59:2077-2081. [PMID: 32389948 PMCID: PMC7492119 DOI: 10.2169/internalmedicine.4512-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Splenic sarcoidosis is often diagnosed by splenectomy or an ultrasound-guided splenic biopsy. However, splenectomy is invasive and costly, and a percutaneous biopsy is sometimes difficult. We herein report a case of splenic sarcoidosis diagnosed with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). A 71-year-old man was referred to our hospital for abnormal shadows on a chest roentgenogram. Computed tomography showed multiple lesions in the spleen and pulmonary consolidations. Bronchoscopy revealed no definitive diagnosis. We therefore performed EUS-FNA for a splenic lesion that led to the diagnosis. This case suggests that EUS-FNA is useful in confirming the diagnosis of sarcoidosis with suspected splenic lesions.
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Affiliation(s)
- Hisanori Matsuzawa
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Takashi Goto
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Shigetoshi Ohshima
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Tomomi Shibuya
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Wataru Sato
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Mitsuru Chiba
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Kenichi Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Shinichiro Minami
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
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Detection of spleen abscesses facilitates diagnosis of melioidosis in Malaysian children. Int J Infect Dis 2020; 98:59-66. [PMID: 32535300 DOI: 10.1016/j.ijid.2020.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Melioidosis is associated with extremely high case fatality ratios. The aim of this study was to determine whether detection of abdominal visceral abscesses can facilitate diagnosis of melioidosis in children. METHODS We conducted a retrospective analysis of all children who had liver and/or spleen abscesses on abdominal ultrasonography admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2014 until December 2018. RESULTS Fifty-three children had liver and/or spleen abscesses. Spleen abscesses were present in 48 (91%) cases; liver abscesses in 15 (28%). Melioidosis was confirmed by culture in 9 (17%) children; small occult splenic abscesses were present in all cases. In 78% of these cases, the lesions were detected before any positive culture (or serology) results were available. Four (8%) children had bacteriologically-confirmed tuberculosis. Two (4%) had Staphylococcus aureus infection. Of the remaining 38 (72%) culture-negative cases, 36 (95%) had clinical and imaging characteristics similar to that of children with culture-confirmed melioidosis and improved with empirical melioidosis antibiotic therapy. CONCLUSIONS A large number of children in Bintulu Hospital in Sarawak, Malaysia, were found to have spleen abscesses. Melioidosis was the most common etiology identified in these children. Abdominal ultrasonography is extremely useful in facilitating the diagnosis of pediatric melioidosis.
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Jang S, Kim JH, Hur BY, Ahn SJ, Joo I, Kim MJ, Han JK. Role of CT in Differentiating Malignant Focal Splenic Lesions. Korean J Radiol 2018; 19:930-937. [PMID: 30174483 PMCID: PMC6082758 DOI: 10.3348/kjr.2018.19.5.930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 03/02/2018] [Indexed: 12/17/2022] Open
Abstract
Objective The purpose of this study was to asses the CT findings and clinical features differentiating malignant from benign focal splenic lesions. Materials and Methods Among 673 patients with splenectomy, we included 114 patients with pathologically confirmed focal splenic lesions (malignant = 66, benign = 48). Two radiologists retrospectively assessed CT findings including: size, number, solid component, margin, wall, calcification, contrast-enhancement, lymph node (LN) enlargement and possible malignancy. We assessed clinical features including age, sex, underlying malignancy, fever, and leukocytosis. Multivariate logistic regression analysis was performed to identify significant predictors of malignant lesion. We used receiver operating curve analysis for determination of diagnostic performance. Results Common findings of malignant lesions include enhanced, mainly solid, ill-defined margin, absence of splenomegaly, absence of the wall, absence of calcification, LN enlargement, and presence of underlying malignancy (p < 0.05). Among them, mainly solid features (odds ratio [OR], 39.098, p = 0.007), LN enlargement (OR, 6.326, p = 0.005), and presence of underlying malignancy (OR, 8.615, p = 0.001) were significant predictors of malignancy. The mean size of benign splenic lesions (5.8 ± 3.3 cm) was larger than that of malignant splenic lesions (4.0 ± 3.4 cm). Diagnostic performance of CT findings by two reviewers using receiver operating characteristic curve analysis for differentiation of malignant lesions was 0.856 and 0.893, respectively. Conclusion Solid nature of the splenic mass on CT images, LN enlargement, and presence of underlying malignancy are significant predictors of malignant splenic lesion.
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Affiliation(s)
- Siwon Jang
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.,Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Bo Yun Hur
- Department of Radiology, National Cancer Center, Goyang 10408, Korea
| | - Su Joa Ahn
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Min Ju Kim
- Department of Radiology, National Cancer Center, Goyang 10408, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.,Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
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31
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Yuksel UM, Turanli S, Berberoglu AU, Gulben K. Management of Incidentally Diagnosed Splenic Masses. Indian J Surg 2018. [DOI: 10.1007/s12262-016-1582-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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32
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Huynh F, McLean C, Smith M. Localized lymphoid hyperplasia of the spleen mimicking metastatic colorectal adenocarcinoma. ANZ J Surg 2018; 89:1330-1332. [PMID: 29952067 DOI: 10.1111/ans.14705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 04/25/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Frederick Huynh
- Department of Surgery (Upper Gastrointestinal - Hepatopancreaticobiliary Service), Alfred Hospital, Melbourne, Victoria, Australia
| | - Catriona McLean
- Department of Anatomical Pathology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Marty Smith
- Department of Surgery (Upper Gastrointestinal - Hepatopancreaticobiliary Service), Alfred Hospital, Melbourne, Victoria, Australia.,Victorian HepatoPancreato Biliary Surgery Group, Cabrini Hospital, Melbourne, Victoria, Australia.,Department of Upper GI/HPB Surgery, Western Hospital, Melbourne, Victoria, Australia
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33
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Extranodal lymphomas of abdomen and pelvis: imaging findings and differential diagnosis. Abdom Radiol (NY) 2017; 42:1096-1112. [PMID: 27866240 DOI: 10.1007/s00261-016-0964-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A wide spectrum of extranodal lymphomas in the abdomen and pelvis is commonly encountered by imaging. Diagnosing these lesions generally requires a multimodality approach. This review highlights imaging appearances of extranodal lymphomas in the abdomen and pelvis with emphasis on computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography along with the relevant differential diagnosis.
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34
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Regenboog M, Bohte AE, Somers I, van Delden OM, Maas M, Hollak CE. Imaging characteristics of focal splenic and hepatic lesions in type 1 Gaucher disease. Blood Cells Mol Dis 2016; 60:49-57. [DOI: 10.1016/j.bcmd.2016.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 02/07/2023]
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35
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Awotar GK, Luo F, Zhao Z, Guan G, Ning S, Ren J, Liu Y, Wang G, Liu P. Splenic abscess owing to cancer at the splenic flexure: A case report and comprehensive review. Medicine (Baltimore) 2016; 95:e4941. [PMID: 27661050 PMCID: PMC5044920 DOI: 10.1097/md.0000000000004941] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/23/2016] [Accepted: 08/18/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The cancer of the splenic flexure of the colon is a rare medical entity with severe morbidity because of its insidious onset. METHODS We present the case of a 59-year-old male patient with dull left upper quadrant pain, leukocytosis, and anemia. A splenic abscess described as an air-fluid level with splenocolic fistula was found on CT scan imaging. Surgery was done for splenic pus drainage. He was again admitted 2 months later for intestinal obstruction. RESULTS An exploratory laparotomy showed multiple hard, gray liver nodules as well as a hard mass in the small bowel. Owing to extensive adhesions and a late stage of cancer involvement, the splenic flexure tumor was not resected. A loop transverse colostomy was done and a Coloplast Colostomy bag placed. We also reviewed the literature-linking colon cancer and splenic abscess with specific attention to the carcinoma of the splenic flexure. As the latter invades through the spleen matter, there is the creation of a splenocolic fistula, which allows the migration of normal gut flora into the spleen. This leads to the formation of the splenic abscess. CONCLUSION This is the 13 case report pertaining to invading colonic cancer causing a splenic abscess. Although the treatment for splenic abscesses is shifting from splenectomy to image-guided percutaneous pus drainage, the few reported cases make the proper management of such complication still unclear.
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Affiliation(s)
- Gavish K. Awotar
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Fuwen Luo
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Zhengdong Zhao
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Guoxin Guan
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Shili Ning
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Jinshuai Ren
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Yaqing Liu
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Guangzhi Wang
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Pixu Liu
- The First Affiliated Hospital Collaborative Innovation Center of Oncology-Institute of Cancer Stem Cell, Dalian Medical University, Dalian City, Liaoning Province, P.R. China
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36
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Safety and Accuracy of Percutaneous Image-Guided Core Biopsy of the Spleen. AJR Am J Roentgenol 2016; 206:655-9. [DOI: 10.2214/ajr.15.15125] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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37
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Vancauwenberghe T, Snoeckx A, Vanbeckevoort D, Dymarkowski S, Vanhoenacker FM. Imaging of the spleen: what the clinician needs to know. Singapore Med J 2016; 56:133-44. [PMID: 25820845 DOI: 10.11622/smedj.2015040] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The spleen is considered 'the forgotten organ' among radiologists and clinicians, although it is well visualised on abdominal computed tomography and magnetic resonance imaging. Moreover, the spleen is commonly involved in a wide range of pathologic disorders. These include congenital anomalies, infectious and inflammatory diseases, vascular disorders, benign and malignant tumours, and systemic disorders. In this review, we focus on the key imaging findings of the normal spleen, its variants, as well as relevant congenital and acquired abnormalities. It is of utmost importance to recognise and correctly interpret the variable spectrum of abnormalities that may involve the spleen, in order to avoid unnecessary invasive procedures and to guide adequate treatment.
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Affiliation(s)
- T Vancauwenberghe
- Department of Radiology, Leuven University Hospital, Herestraat 49, 3000 Leuven, Belgium.
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38
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Matsui T, Matsubayashi H, Sugiura T, Sasaki K, Ito H, Hotta K, Imai K, Tanaka M, Kakushima N, Ono H. A Splenic Epithelial Cyst: Increased Size, Exacerbation of Symptoms, and Elevated Levels of Serum Carcinogenic Antigen 19-9 after 6-year Follow-up. Intern Med 2016; 55:2629-34. [PMID: 27629958 DOI: 10.2169/internalmedicine.55.6970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 58-year-old man, who had presented with a large cyst between the pancreatic tail and splenic hilum 6 years previously, was referred to our hospital with exacerbation of abdominal distention. Computed tomography revealed a well-demarcated, unilocular cyst, with a beak sign for the pancreas, without wall thickening or nodules suggestive of a non-neoplastic cyst. Compared with 6 years previously, the cyst had increased in size from 14.7 cm to 19.5 cm, and the serum carcinogenic antigen 19-9 level had increased from 635 U/mL to 1,918 U/mL. To prevent spontaneous rupture, laparotomy was performed, and the cyst was pathologically diagnosed as a splenic epithelial cyst.
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Affiliation(s)
- Toru Matsui
- Division of Endoscopy, Shizuoka Cancer Center, Japan
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39
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Localized lymphoid hyperplasia of the spleen: a rare benign condition grossly mimicking malignancy. J Hematop 2015. [DOI: 10.1007/s12308-015-0263-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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40
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Bassuner KJ, Kirkpatrick DL, Northrup M, Connors JP. Multiple Targetoid Lesions in the Spleen. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2015. [DOI: 10.1177/8756479315572228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is the most prevalent hematologic malignancy of adults in the western hemisphere. Involvement of the spleen is not uncommon, often presenting as diffuse enlargement due to infiltration of neoplastic cells. A case is presented of an 81-year-old woman with a past medical history of CLL who was incidentally found to have multiple, focal splenic infiltrates on sonography. The patient had a normal sized spleen, which is a less common occurrence with splenic invasion by CLL. As current CLL guidelines discourage imaging but rely on evidence of organ involvement, this finding was critical in staging the patient properly. The sonographic appearance of this rare condition is described, and the advantages of sonography in its evaluation are discussed.
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41
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Chen YG, Peng CK, Dai MS, Lin TY, Chen YC. Reconcilable differences: idiopathic antiphospholipid syndrome. Am J Med 2015; 128:471-4. [PMID: 25656111 DOI: 10.1016/j.amjmed.2015.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 01/08/2015] [Accepted: 01/26/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Yu-Guang Chen
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Ming-Shen Dai
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Te-Yu Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Yeu-Chin Chen
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.
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42
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Vlachou P, Fagkrezos D, Tzivelopoulou A, Kyriakopoulou G, Maniatis P, Triantopoulou C, Papailiou J. A rare case of a splenic hamartoma in a patient with a huge palpable abdominal mass: a case report. J Med Case Rep 2015; 9:4. [PMID: 25626774 PMCID: PMC4405829 DOI: 10.1186/1752-1947-9-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 11/18/2014] [Indexed: 12/31/2022] Open
Abstract
Introduction Splenic hamartoma is a primary benign tumor of the spleen, which is often found incidentally. Splenic hamartomas are very rare, with approximately 150 cases documented in the literature to date. They represent benign vascular proliferation. Histological findings consist of disorganized stroma and vascular channels of varying width, with or without lymphoid follicles. Case presentation We present the case of a 39-year-old Greek woman, with no significant medical history, who was diagnosed incidentally with an enormous splenic hamartoma on computed tomography, finally confirmed by surgery and histopathology. Hamartomas are benign lesions, and it is important to differentiate them from malignancy. Conclusion Hamartoma represents a rare vascular entity characterized by a cluster of differentiation 8-positive immunophenotype. It is usually asymptomatic but large hamartomas may present with symptoms such as hemopoetic disorders, which resolve after splenectomy. It is important for radiologists to be able to differentiate splenic hamartoma from malignant entities.
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Affiliation(s)
| | - Dimitris Fagkrezos
- Computed Tomography Department, Konstantopouleio General Hospital, Agias Olgas 3-5, 14233 Nea Ionia, Greece.
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Gaetke-Udager K, Wasnik AP, Kaza RK, Al-Hawary MM, Maturen KE, Udager AM, Azar SF, Francis IR. Multimodality imaging of splenic lesions and the role of non-vascular, image-guided intervention. ACTA ACUST UNITED AC 2014; 39:570-87. [DOI: 10.1007/s00261-014-0080-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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44
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Sammon J, Twomey M, Crush L, Maher MM, O'Connor OJ. Image-guided percutaneous splenic biopsy and drainage. Semin Intervent Radiol 2013; 29:301-10. [PMID: 24293803 DOI: 10.1055/s-0032-1330064] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Percutaneous splenic biopsy and drainage are relatively safe and accurate procedures. The risk of major complication (1.3%) following percutaneous splenic biopsy does not exceed that of other solid intra-abdominal organ biopsies, and it has less morbidity and mortality than splenectomy. Both computed tomography and ultrasound can be used to provide image guidance for biopsy and drainage. The safety profile of fine-needle aspiration cytology is better than core needle biopsy, but core biopsy has superior diagnostic accuracy.
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Affiliation(s)
- Jennifer Sammon
- Department of Radiology, Cork University Hospital and University College Cork, Wilton, Cork, Ireland
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The spleen revisited: an overview on magnetic resonance imaging. Radiol Res Pract 2013; 2013:219297. [PMID: 24377046 PMCID: PMC3859258 DOI: 10.1155/2013/219297] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 10/08/2013] [Accepted: 10/10/2013] [Indexed: 12/26/2022] Open
Abstract
Despite being well visualized by different cross-sectional imaging techniques, the spleen is many times overlooked during the abdominal examination. The major reason is the low frequency of splenic abnormalities, the majority consisting of incidental findings. There has been a steady increase in the number of performed abdominal magnetic resonance imaging (MRI) studies; therefore, it is important to be familiar to the major MRI characteristics of disease processes involving the spleen, in order to interpret the findings correctly, reaching whenever possible the appropriate diagnosis. The spleen may be involved in several pathologic conditions like congenital diseases, trauma, inflammation, vascular disorders and hematologic disorders, benign and malignant tumors, and other disease processes that focally or diffusely affect the spleen. This paper presents a description and representative MRI images for many of these disorders.
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Laparoscopic splenic biopsy--porcine to human studies--using a fibrin sealant technique. Surg Laparosc Endosc Percutan Tech 2013; 23:e54-6. [PMID: 23579529 DOI: 10.1097/sle.0b013e318272fd01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Splenic biopsies are not routinely performed because of the risk of severe hemorrhage. The aim of this study was to explore the feasibility of performing laparoscopic splenic biopsies using a fibrin sealant in pigs and then to translate this technique into the clinical setting. METHOD Four German Landrace pigs underwent a laparoscopic splenic biopsy using a fibrin sealant to occlude the needle tract. Time to achieve hemostasis and postoperative hemorrhage were assessed. RESULT The average time to achieve haemostasis was 15 s (range, 8 to 25 s) with no hemorrhage from the needle tract observed. Subsequently this was translated into the clinical setting where a patient also underwent a laparoscopic splenic biopsy without any adverse effect. CONCLUSIONS Laparoscopic splenic biopsy with the application of a fibrin sealant is a safe and efficient technique.
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Extrapulmonary Tuberculosis (TB) Diagnosed With the Aid of Endoscopic Ultrasound–Guided Lymph Node Biopsy. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2013. [DOI: 10.1097/ipc.0b013e3182611408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yamaoka R, Nishihira T, Shimada T, Nishimura M, Inoue H, Yasuda K, Ishikawa Y, Hirose T, Ogino T, Shibatoge M. Adenocarcinoma in an intrapancreatic accessory spleen: report of a case. Surg Today 2011; 41:1552-5. [PMID: 21969161 DOI: 10.1007/s00595-010-4534-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 10/26/2010] [Indexed: 12/15/2022]
Abstract
We report a case of adenocarcinoma in an intrapancreatic accessory spleen (IPAS). A 78-year-old woman presented with abdominal discomfort, and investigations revealed an elevated serum carbohydrate antigen 19-9 level, to 161.8 U/ml (normal, <37 U/ml). Ultrasonography showed a heterogeneous echogenic tumor with a vascular hilum. Computed tomography showed a heterogeneously enhanced tumor, 8 cm in diameter, adjacent to the pancreatic body, accompanying a feeding artery arising from the splenic artery, and a drainage vein flowing into the splenic vein. We performed a distal pancreaticosplenectomy. The tumor was surrounded by a fibrous capsule and was in contact with the pancreatic body. Histological examinations revealed invasive growth of adenocarcinoma in a structure identical to the spleen. The results of both radiological and histological examinations suggested that the tumor originated from an intrapancreatic accessory spleen. Extensive examinations revealed no other malignancy, based on which we concluded that the adenocarcinoma was primary. Surgical intervention is strongly recommended when a malignancy in an IPAS cannot be ruled out.
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Affiliation(s)
- Ryoya Yamaoka
- Department of Surgery, Takamatsu Red-Cross Hospital, 4-1-3 Bancho, Takamatsu, Kagawa, 760-0017, Japan
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McInnes MDF, Kielar AZ, Macdonald DB. Percutaneous Image-guided Biopsy of the Spleen: Systematic Review and Meta-Analysis of the Complication Rate and Diagnostic Accuracy. Radiology 2011; 260:699-708. [DOI: 10.1148/radiol.11110333] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Maliyil J, Caire W, Nair R, Bridges D. Splenic abscess and multiple brain abscesses caused by Streptococcus intermedius in a young healthy man. Proc AMIA Symp 2011; 24:195-9. [PMID: 21738290 DOI: 10.1080/08998280.2011.11928714] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We report a case of splenic abscess with multiple brain abscesses caused by Streptococcus intermedius in a healthy young man without any identifiable risk factors, which resolved with percutaneous drainage and antibiotics. Streptococcus intermedius, a member of the Streptococcus anginosus group, is a common commensal organism of the oral cavity and gastrointestinal tract, and it is a known cause of deep-seated infections. Suppurative infections caused by Streptococcus anginosus group are sometimes associated with bacteremia, but hematogenous spread of infection from an occult source leading to concurrent splenic abscess and multiple brain abscesses has never been previously reported in a healthy young individual.
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Affiliation(s)
- Jepsin Maliyil
- Department of Family Medicine (Maliyil, Caire, Nair) and the Division of Infectious Diseases, Department of Internal Medicine (Bridges), Baylor Medical Center at Garland, Garland, Texas
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