Recognition of malposition of the liver and spleen: CT, MRI, nuclear scan and fluoroscopic imaging

Abstract

Thirteen children initially suspected to have an intrathoracic or intraabdominal mass had malposition of the liver and/or spleen discovered by ultrasound. This group consisted of five children with diaphragmatic eventration or hernia and eight with wandering spleen or liver. Careful ultrasonographic examinations were diagnostic in all patients; seven had surgical confirmation. CT, MRI, nuclear scan and fluoroscopic imaging were useful in select instances. The liver and spleen have a characteristic anatomic configuration and sonographic appearance that should enable them to be recognized, and pathological alterations appreciated, even when these organs are ectopic in location or malformed.

Acute abdomen due to torsion of wandering spleen: CT diagnosis

“…In cases of torsion associated with infarction, the spleen's attenuation has been reported to be considerably lower than that of the liver [1,2,8,10] and the differential diagnosis includes mesenteric or omental cysts and abscesses [2]. Low attenuation of splenic parenchyma was not observed on the pre-contrast CT scans in our patients, except for case 1.…”

“…Mild enhancement may be attributed to collateral circulation through the short gastric and left gastric veins [1] and/or the short gastric and pancreatic arteries [9]. It has been reported that splenic perfusion and viability of the spleen can also be assessed by Doppler ultrasonography [7,9] and scintigraphy [10,11]. Information concerning splenic perfusion is important for the surgeon, especially in younger children where splenopexy instead of splenectomy is the treatment of choice [2,5,11].…”

“…Moreover, hypertrophy and lateral extension of the liver's left lobe, as noted in cases 1 and 2, might be confused with a normal spleen on ultrasonographic evaluation, whereas altered anatomic relationships in the left upper abdomen with the spleen retaining its subdiaphragmatic location, as in case 3, might mislead the ultrasonographic diagnosis. These problems are overcome using CT which typically depicts a mass representing the wandering spleen at the mid-abdomen [1,13] or the pelvis [1,9,10,13] and rarely at the right iliac fossa [14]. The spleen's comma-shaped configuration is usually preserved unless torsion is complicated by other conditions: trauma and subsequent hematoma or contusion in an ectopic spleen may result in altered shape and size or abnormal contrast enhancement, as noted in case 1 of the study.…”

Mass at the Splenic Hilum

“…Plain radiographs are usually nonspecific, but with marked splenic displacement, the splenic silhouette disappears, and gas-filled bowel loops may be noted in the splenic fossa. Barium enemas, scintigraphy, and angiography have been helpful in some cases in the past 3…”

Power Doppler sonographic diagnosis of torsion in a wandering spleen

“…Diffuse increased echogenicity of the spleen may correspond to areas of hemorrhagic congestion at the time of surgery. 5 Use of color and duplex Doppler sonography allows evaluation of blood flow in the splenic parenchyma and in the major splenic vessels. 2,6 It has been reported that the absence of sonographically detectable flow in the splenic parenchyma may be due to insufficient sensitivity of color and duplex Doppler sonography to slow or low-amplitude blood flow.…”