Asymptomatic Splenic Cysts in an Immunocompromised Patient: Should They Be Investigated

Giant splenic cyst: A case series of rare and challenging cases from the last 22 years

INTRODUCTION AND IMPORTANCE

Splenic cyst is a rare disease, with reported incidences ranging from 0.07 to 0.3 %. A splenic cyst is typically discovered inadvertently and may not cause any symptoms until it grows to a significant size. In some cases, complications such as acute abdomen may be brought on by an intracystic hemorrhage, rupture, or infection. As a rare disease, diagnosing a splenic cyst is still precarious because only a few cases have been reported.

CASE PRESENTATION

The first case is a 23-year-old Asian man without a significant history of illness who complains of a left upper quadrant mass that he discovered 10 years prior. Since then, the mass had been gradually growing and had been accompanied by severe pain. Walking made the pain worse; lying down made it lessen. A computed tomography (CT) scan of the abdomen showed a 20.05 × 15.95 × 26.71 cm splenic cyst. Surgery for a peri-cystic splenectomy was done. A primary splenic cyst was identified in the specimen after microscopic and macroscopic examination. After 10 days, the patient was released from the hospital without complications. The second case is that of a 28-year-old Asian man who complained of a mass in their abdomen that was getting bigger in size. Four years prior to the complaint, the patient had fallen while driving a motorcycle, and the left side of his abdomen collided with the sidewalk. In this patient, a splenectomy-the complete removal of all spleen parts-was done. The specimen's macroscopic and microscopic examination revealed a splenic pseudocyst. The patient was discharged after three days without complications.

CLINICAL DISCUSSION

Splenic cysts are considered rare and challenging to diagnose, as there have been only a limited number of reports. Nevertheless, proper management is still needed, as it carries the risk of rupturing and causing complications such as peritonitis and anaphylactic reactions. Considering the risk of overwhelming post-splenectomy infection (OPSI), conservative treatment can be the gold standard for splenic cysts. However, considering the risk from the size of the cyst, splenectomy or peri-cystic splenectomy is an appropriate surgery option for a splenic cyst.

CONCLUSION

Splenectomy, or peri-cystic splenectomy, is a surgery option for a splenic cyst with significant size and rupture risk.

MDCT Findings of Splenic Pathology

The delineation and characterization of splenic lesions and other abnormalities can be challenging on computed tomography. Many splenic lesions are incidentally found, imaging features tend to overlap, and without the appropriate clinical context, differentials can range from benign to malignant. Radiologists should be familiar with the wide variety of pathologies seen on computed tomography as it is often the first imaging modality a splenic lesion is seen. The purpose of this MDCT-focused review is to understand normal splenic anatomy and its variants, to illustrate and describe typical and atypical imaging patters of inflammatory, infectious, vascular, traumatic, benign, and malignant tumors of the spleen and provide clues in reaching the appropriate differential diagnosis and management.