Imaging Pearls ❯ Spleen ❯ Hemorrhage
|
-- OR -- |
|
- Causes of Spontaneous Bleeds: Spleen
- Angiosarcoma
- Prior pseudocyst from pancreatitis - "The most common primary tumor of the spleen asso- ciated with hemorrhage is, although rare, angiosarcoma. Tumor rupture is not rare in these patients, with a reported prevalence of 25%. Metastatic foci within liver parenchyma are commonly detected at the initial diagnosis. On cross-sectional imaging, these tumors are typically heterogeneously hyperenhancing masses with internal necrosis and hemorrhage. These imaging features characteristically reflect the biologically aggressive nature of these tumors.”
Imaging findings of spontaneous intraabdominal hemorrhage: neoplastic and non‐neoplastic causes
Sevtap Arslan et al.
Abdominal Radiology (2022) 47:1473–1502
- “Active haemorrhage can be demonstrated by contrast-enhanced CT as an extravasation of intravenously introduced contrast material to the abdominal cavity. However, active extravasation should be evaluated by dual (arterial and venous) phase CT with appropriate contrast injection, since arterial phase images may not demonstrate venous extravasation, and similarly, arterial extravasation may not be differentiated from venous bleeding on venous phase imaging.”
Imaging findings of splenic emergencies: a pictorial review Unal E et al. Insights Imaging. 2016 Apr; 7(2): 215–222. - “Active extravasation can be seen as a focus of linear or nodular hyperdensity within a hematoma or into the abdominal cavity, on arterial phase images. On delayed phase images, accumulation of contrast is seen within or in the dependent portion of hematoma with regard to degree of clot formation. In the presence of acute massive haemorrhage, hemorrhagic fluid may act in a pattern similar to the free fluid due to decreased percentage of clot formation. In subtle extravasation, haemorrhage is commonly restricted to the site of solid organ injury, with the appearance of what is called the “sentinel clot sign”.”
Imaging findings of splenic emergencies: a pictorial review Unal E et al. Insights Imaging. 2016 Apr; 7(2): 215–222. - “The spleen is one of the most commonly injured organs in blunt abdominal trauma. Nevertheless, inflammatory and infectious disorders of the spleen are not uncommon. In addition, less common vascular incidents and splenic torsion can also be seen. Ultrasound (US) is usually used for the follow-up of patients with splenic emergencies, since accurate initial diagnosis based solely on US findings is limited. Differentiation of splenic hematoma from abscess or infarct and detection of an active bleeding may not be reliably made by US. Moreover, presence of subcutaneous air bubbles or air bubbles in an abscess cavity may prevent sonographic evaluation.”
Imaging findings of splenic emergencies: a pictorial review Unal E et al. Insights Imaging. 2016 Apr; 7(2): 215–222.
- Spontaneous Abdominal Hemorrhage: Spleen
- Marked splenomegaly in malignancies like acute leukemia and lymphoma
- Marked splenomegaly in infectious causes like mononucleosis or CMV infection
- Prior trauma or history of repeated episodes of pancreatitis - Spontaneous Splenic Hemorrhage:
- Prior trauma
- Mononucleosis
- Underlying tumor
- Prior infarction
- Pancreatitis