Nontraumatic splenic emergencies: cross-sectional imaging findings and triage

Abstract

The spleen is commonly involved in a wide spectrum of hematologic, immunologic, neoplastic, infectious, and vascular systemic disorders. Sometimes overlooked on imaging studies outside the trauma setting, the spleen may harbor severe infections, and occasionally undergoes spontaneous bleeding or rupture. This pictorial essay reviews common and unusual causes of nontraumatic acute abnormalities primarily involving the spleen, and their cross-sectional imaging appearances. Emphasis is placed on multidetector computed tomography (MDCT) imaging, which represents the modality of choice to comprehensively assess acute splenic disorders including partial or complete infarctions, vascular diseases such as venous thrombosis, abscess collections, bleeding, and rupture. State-of-the-art magnetic resonance imaging represents a problem-solving technique. Borrowing from experience with grading abdominal trauma according to the traditional American Association for the Surgery of Trauma scale, spontaneous splenic injuries are confidently detected and characterized at MDCT. Furthermore, MDCT allows to identify or exclude coexistent perisplenic and intraperitoneal hemorrhage, presence and source of active bleeding, and contained vascular injury. Occasionally idiopathic, spontaneous splenic injuries should be suspected when acute abdominal manifestations and signs of hemodynamic compromise occur in a background of acute viral infections, endocarditis or sepsis, malaria, immune suppression, hematological disorders, malignancies, coagulopathy, or therapeutic anticoagulation. These uncommon yet life-threatening conditions require prompt diagnostic evaluation that allows correct triage between conservative, medical, interventional, and surgical treatment, and may obviate splenectomy. Finally, MDCT imaging allows differentiation of splenic rupture from other rare causes of spontaneous hemoperitoneum, and reliable follow-up of nonsurgically treated patients.

Atraumatic splenic rupture, an underrated cause of acute abdomen

“…On the basis of our personal experience, we strongly agree with the Authors when they state that the spleen is an underrated cause of acute abdomen, and that severe morbidity and mortality result from delayed or missed diagnosis of splenic lesions. However, upon finishing reading the article we thought that general radiologists should be well aware of the condition known as life-threatening atraumatic splenic rupture (ASR), which has not yet been presented [ 1 – 3 ].…”

“…ASR should be strongly suspected when acute abdominal manifestations occur in young patients with acute infections, or in the setting of haemopoietic and lympho-reticular disorders. When anticoagulation and known systemic diseases are excluded, ASR is likely to be the manifesting complaint of an underlying infectious, immunologic, or neoplastic disorder: therefore, a quick but thorough history-taking and laboratory search for infections are required [ 2 , 3 , 7 ].…”

Non-traumatic ruptured splenic abscess presenting with pneumoperitoneum in an immunocompetent patient: a diagnostic dilemma

“…Splenic abscess is an uncommon and life-threatening condition with an incidence of 0.14%–0.7% in some series 1–3. However, recent literature demonstrate that splenic abscesses are increasingly being identified, possibly due to widespread use of imaging modalities, and increasing prevalence of immunodeficiency state like AIDS.…”

Systematic review of spontaneous splenic rupture in dengue‐infected patients

“…Splenic lesions are unspecific and overlapping in patterns . Although ultrasound (U/S) is considered a rapid tool to identify free fluid in peritoneum, it was found with (72%‐78%) specificity to detect splenic lesion, and with limited abilities in cases with large body built, bowel gases, echogenicity of abscess and hematoma, and panoramic view to the entire abdomen and pelvis . According to Tonolini et al, splenic rupture can be with or without hemoperitoneum and acute abdominal manifestations in young age patient with acute infection suggest an atraumatic splenic rupture .…”