Solitary Splenic Tuberculosis in an Immunocompetent Child: A Case Report

Splenic Abscesses in the Pediatric Population: A Literature Review of an Uncommon Entity

Splenic abscess in the pediatric population is a rare but serious condition. Its incidence is reported to be between 0.05% and 0.7%. Splenic abscess is an infectious suppurative process with a discernible macroscopic filling defect in the subcapsular space or spleen parenchyma. Causes include bacterial infection through the hematogenous route or from locoregional spread such as the gastrointestinal tract, septic emboli, trauma, sickle cell anemia, and malarial infestation. Diagnosis is often delayed due to non-specific signs and symptoms. Symptoms include fever, abdominal pain, and palpable left upper abdominal swelling. Ultrasound and cross-sectional imaging such as CT scans are useful for the diagnosis of splenic abscess but contrast-enhanced CT scans are considered the gold standard because of their high sensitivity and specificity. Treatment options range from antimicrobial therapy, percutaneous drainage, and aspiration to surgical interventions such as splenectomy. As it has a high mortality rate, prompt diagnosis and appropriate treatment are essential for optimal outcomes.

Contrast-Enhanced Ultrasound Imaging Features of Focal Splenic Tuberculosis

Background

The aim of this study was to characterize the contrast-enhanced ultrasound imaging features of focal splenic tuberculosis.

Material/Methods

We retrospectively analyzed the conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) imaging features of 22 patients with splenic TB confirmed by surgical histopathology or biopsy.

Results

Conventional US demonstrated that 15 of the 22 patients had a single lesion, while 7 had multiple lesions. The maximum diameter of the lesions ranged from 1.0 to 3.7 cm. Of the 22, 17 were detected with hypoecho and 5 were detected with complex echo by conventional US. Seven (7/22) were detected with blood flow signals by color Doppler flow image (CDFI). CUES demonstrated that 18 cases (81.8%, 18/22) began to enhance in the arterial phase, mostly followed by slow wash-out in the intermediate or late parenchymal phase, and 4 (18.2%, 4/22) presented with non-enhancement during all phases. The enhancement patterns were categorized into 4 types: Type I, homogeneous enhancement (2/22); Type II, rim-like enhancement (12/22); Type III, septation-like enhancement (4/22); and Type IV, non-enhancement (4/22).

Conclusions

CEUS showed that splenic TB lesions were enhanced in the arterial phase, followed by slow washed out or persistent enhancement in the intermediate and late parenchymal phases. The rim- or septation-like enhancement may be helpful for diagnosing splenic TB. The splenic lesions presenting round hypoecho by conventional US and complete non-enhancement by CEUS are highly suspicious of splenic TB.