Splenule Frequency on Computed Tomography Scans in Children, Presenting to the Emergency Department

Abstract

Objectives: Accessory spleen, also known as “splenule”, is the presence of splenic tissue in ectopic localisations. The presence of splenule is important, especially in patients planned for splenectomy, as it may cause refractory symptoms. The aim of the present study is to define the frequency of splenule(s) in children (0-17 years) who received non-contrast and contrast enhanced computed tomography (NECT and CECT) protocols in the emergency department.
 Material and methods: 748 children (aged 0 to 17 years) who were admitted to the emergency department between May 2015 – September 2022 and had NECT and CECT abdominal scans were included in the study. Patients whose CT protocols were incomplete and cases with traumatic splenic injury and / or cases with poor image quality and patients with a history of splenectomy or hematologic pathology were excluded from the study (n: 100). A total of 648 patients were included in the cohort. NECT and CECT scans of all patients were assessed; the localisation of splenules as well as the antero-posterior (AP), medio-lateral (ML) and cranio-caudal (CC) dimensions of each splenule were measured.
 Results: A total of 648 cases with 467 males (72.1%) and 181 females (27.9%) were included in the study. Splenules were observed in 131 (20.2%) cases. More than one splenule was observed in 21 of these 131 cases. A total number of 159 splenules were observed in total, with a mean volume of 0,72 ±0,95 ml. The most common location was found to be the splenic hilus (n=55, 41.9%). 
 Conclusion: Our study have stated that splenules are common anatomical variants, seen at a rate of 20,2% in this age cohort. A cross-sectional imaging should be performed to determine the presence, location, and number of the splenules before a planned splenectomy.