Increased Incidence of Accessory Spleens in Hematologic Disease

Olsen, William R.

doi:10.1001/archsurg.1969.01340120110019

Cited by 62 publications

(32 citation statements)

References 15 publications

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“…Another patient showed a single, but enlarged accessory spleen, measuring 5 cm with inhomogeneous attenuation and most representative anatomical study, including 3000 patients (2), showed accessory spleens only in 311 cases -i.e. in around 10% of patients (2)(3)(4)(5).…”

Section: Discussionmentioning

confidence: 99%

“…This is especially evident after splenectomy -when the accessory spleen takes over the physiologic function of the main spleen, leading to an incredible enlargement of the accessory spleen, which may grow under these circumstances to a size of up to 7 cm although still keeping its original round shape (5,20). Accessory spleens may show also the same focal lesions as the main spleeen -ranging from cyst or even tumour and abscess formation to rupture, haemorrhage and infarction (21)(22)(23).…”

Section: Lesions and Complicationsmentioning

confidence: 99%

“…Certain authors have published an increased "incidence of accessory spleens" of up to 30% in patients with such haematologic disorders (5) and, although the term "incidence" is not appropriate in this setting (since accessory spleens are present or absent and since they never develop de novo! ), these studies support the hypothesis, that even in the time of modern MDCT-scanning, probably more than 50% of all accessory spleens remain just undetectable during life due to their very small size as long as they are not forced to grow.…”

Section: Hypothesismentioning

confidence: 99%

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The accessory spleen: prevalence and imaging findings in 1735 consecutuve patients examined by multidetector CT

Römer

Wiesner

2012

Journal of the Belgian Society of Radiology

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Accessory spleens represent congenital variants of small isles of normally encapsulated splenic tissue with its own arterial and venous vascularisation and their prevalence seems to range between 10 and 20% (1-5). Accessory spleens do undergo the same pathophysiological mechanisms as the main spleen and, therefore, they may show all the potential lesions that may be observed in the main spleen, ranging from shrinking to swelling, from calcification to cyst or tumor formation and from haemorrhage to infarction. Most accessory spleens are located near the pancreatic tail and the splenic hilum and accurate identification of an accessory spleen may be important to avoid misinterpretation and differentiation from pathologic findings in the upper abdomen (6-8).The only study on accessory spleens -detected by CT -reported even a prevalence of 16% around ten years ago (9). However, this study was performed at the beginning of the era of multidetector computed tomography -using dual phase CT with a collimation of 8 mm for both, the unenhanced and the enhanced portal venous phase scans. Therefore, the present study was initiated with the intention to analyze if an increased spatial resolution by using triple phase MDCT with a slice contrast material (Visipaque 320, GE Medical, Milwaukee, USA) was injected with a flow rate of 2-3 ml/sec. Arterial phase CT data acquisition started 35-40 seconds and portal-venous phase CT started 70-75 seconds after the intravenous administration of 100 ml of contrast material. CT parameters were as follows: Rotation time 0.8, helical thickness: 1.25 mm, pitch: 1.375:1, speed 27.5 mm, interval: 0.6 mm, KV 120, mAs (auto-mA): 400. Reconstructed slice thickness (and interval) was 5 mm for the unenhanced and the portal-venous phase images and 3.75 mm for the arterial phase images. Image analysis was performed on an integrated RIS/PACS work station (Centricity, GE Milwaukee, USA).All CT examinations were retrospectively analyzed by a radiologist, specialized in abdominal imaging on a double monitor work station of an integrated RIS/PACS System (Centricity, GE, Milwaukee) using both, slice after slice and cineviewing -technique in the axial plane, whereas multiplanar reconstructions were used only in selected and unclear cases. The reader was unaware of the reasons for the CT examination and of the clinical histories of the patients. Special emphasis was given on the presence, size, number and location, and if present, on visible pathologies of accessory spleens.The presence of an accessory spleen was confirmed only if it could be clearly depicted as a well circumscribed mass with similar attenuation and contrast enhancement as thickness of 3.75-5 mm would be able to detect more accessory spleens in the normal human population than reported in the literature until present. The present study addresses the CT-prevalence of accessory spleens in the normal population followed by a discussion of normal imaging findings, differential diagnoses and potential pitfalls that all may be helpful for their co...

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Section: Discussionmentioning

confidence: 99%

Section: Lesions and Complicationsmentioning

confidence: 99%

Section: Hypothesismentioning

confidence: 99%

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The accessory spleen: prevalence and imaging findings in 1735 consecutuve patients examined by multidetector CT

Römer

Wiesner

2012

Journal of the Belgian Society of Radiology

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“…Bei Patienten mit Immunthromobozytopenie und Lymphogranulomatose kommen Nebenmilzen in zirka 20-22% der Fälle vor [2]. Dieses höhere Aufkommen von Nebenmilzen bei hämatologischen Grunderkrankungen ist möglicherweise Folge einer intensiveren Diagnostik bei Patienten mit diesen Krankheitsbildern [19]. Curtis und Movitz [12] sehen die Ursache in pathologischen Prozessen, die von der Milz ausgehen und das Auftreten von Nebenmilzen beeinflussen, gehen aber auf diese nicht näher ein.…”

Section: Diskussionunclassified

“…Nebenmilzen können völlig unbemerkt bleiben oder klinische Bedeutung erlangen, wenn sie z.B. Lymphome oder Metastasen [19] oder einen Tumor des Magens [20][21][22], des Kolons, des Zwerchfells, der Niere, der Nebenniere [23,24] oder des Pankreas vortäuschen. Außerdem können sie durch Stieldrehung [25], Spontanrupturen [26,27], Infarkt oder Blutung [28] eine akute Bauchsymptomatik hervorrufen.…”

Section: Diskussionunclassified

Klinische Relevanz von Nebenmilzen nach elektiven und notfallmäßigen Splenektomien

Jakschik¹,

Joist²,

Braun³

2004

Visc Med

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Clinical Relevance of Accessory Spleens Following Elective and Emergency Splenectomies Background: With respect to the various functions of the spleen, a careful risk-benefit analysis must be done before splenectomy. Methods: During 10 years, 211 splenectomies were carried out in our hospital. In 185 of these clinical cases the documents were complete for an analysis. Results: The most frequent indications for surgical treatment were immunothrombocytopenia (22.2%) and lymphogranulomatosis (18.9%) followed by spleen bleedings (24.3%) of traumatically, iatrogenic or spontaneous origin. Postoperative complications such as pulmonary and cardiological disorders, disorders in wound healing, and abscesses could be found in 31.3% of the elective and in 80.4% of the emergency cases. 5.2 and 21.9% of the patients died after elective treatment and emergency surgery, respectively, resulting in an overall mortality of 10.8%. In the latter group death was mostly related to the severe concomitant injuries. The main problem during the postoperative period is the high rate of infections which could be attributed to the loss of an immunologically active organ. Postoperative thrombocytosis was temporary in most cases. A sepsis developed in 4.9% of the patients with a lethal outcome in 2.7% of the cases. 13.5% of the patients showed accessory spleens. In those patients suffering from immunothrombocytopenia and lymphogranulomatosis, they were even found in 22 and 20% of the cases, respectively. 12.1% of the 58 reinspected patients showed accessory spleens; some of them even had multiple accessory spleens. Mostly, solitary accessory spleens were found. They were located in the neighborhood of the spleen or – after splenectomy – in the former spleenic area. The size of accessory spleens ranged between some millimeters and 5 cm with an average length of about 1–2 cm. Accessory spleens were either completely unobtrusive with no function at all, or they can take over some spleenic functions, regardless of their size and location. Especially in combination with immunothrombocytopenia, they may be responsible for the failure of an otherwise successful splenectomy. However, relapses after splenectomy could not generally be attributed to accessory spleens since relapses also occurred after additional exstirpation of accessory spleens. Conclusion: As some accessory spleens take over specialized functions of the spleen while others remain unobtrusive, the benefit of splenectomy for the treatment of blood-related malignancies is hardly foreseeable.

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Twenty Years of Splenectomy for Hereditary Spherocytosis

Rutkow¹

1981

Arch Surg

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Increased Incidence of Accessory Spleens in Hematologic Disease

Cited by 62 publications

References 15 publications

The accessory spleen: prevalence and imaging findings in 1735 consecutuve patients examined by multidetector CT

The accessory spleen: prevalence and imaging findings in 1735 consecutuve patients examined by multidetector CT

Klinische Relevanz von Nebenmilzen nach elektiven und notfallmäßigen Splenektomien

Twenty Years of Splenectomy for Hereditary Spherocytosis

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