Wandering spleen with torsion: Appearance on CT and ultrasound

Abstract

Wandering spleen is a rare entity which may present with symptoms suggestive of other, more common abdominal processes. Torsion of the long pedicle may occur causing abdominal pain. This article describes a case of wandering spleen diagnosed by computed tomography (CT). Liver spleen scintigraphy and sonography supported this diagnosis and suggested torsion. To our knowledge this is only the second case of this entity in which color flow and duplex Doppler findings have been reported.

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.…”

“…Probably the most specific sign of torsion is a whirl appearance of splenic vessels and surrounding fat, usually noted at the splenic hilum [1,9], which should not be interpreted as bowel intussusception [8]. It is invaluable for the diagnosis [1,7], in cases of a torsioned spleen retaining its position at the left upper abdomen, whereas it is of no importance in cases of a torsioned accessory spleen [12] which normally is not equipped with a pedicle.…”

Torsion of a wandering accessory spleen: CT findings

“…This rare condition may result from congenital maldevelopment or laxity of the splenic suspensory ligaments [3][4][5] or from acquired problems such as splenomegaly, abdominal trauma, and pregnancy [3]. Multiple imaging techniques such as ultrasound, CT, and scintigraphy have been reported in the diagnosis of wandering spleen with acute torsion [4][5][6][7]. The diagnosis is usually straightforward when a spleenlike nonenhancing mass is detected in the abdomen in the absence of spleen in the left upper quadrant [4].…”

The value of MR angiography in predicting the risk of torsion of a pelvic spleen during pregnancy

“…b An MR contrast-enhanced venography after maximum intensity projection reconstruction, shows a corkscrewlike appearance of an elongated splenic vein (arrowheads) draining into the portal vein (arrow). c An MR urogram in the late phase of the MR angiogram shows external impression on both ureters by the enlarged pelvic spleen, without any significant hydronephrosis a b c dering spleen [8,9], the complete evaluation of the vessels of an ectopic spleen needs more sophisticated techniques. Angiography is an invasive technique and MRI and MRA are attractive tools for the evaluation of an ectopic spleen.…”