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Everything you need to know about Computed Tomography (CT) & CT Scanning

Imaging Pearls ❯ Spleen ❯ Splenic Infarction

  
  • "The spleen is universally affected in SCD. Repeated episodes of VOC lead to splenic autoinfarction and functional hypo- or asplenia, usually occurring within the first 2 years of life. An autoinfarcted spleen is easily recognized on CT and frequently on plain radiography as a contracted, calcified left upper quadrant mass. Functional asplenia from autoinfarction is associated with a susceptibility to infection, particularly by encapsulated bacteria; therefore, prophylactic administration of penicillin and pneumococcal vaccine is rec- ommended in childhood.”
    Imaging review of sickle cell disease for the emergency radiologist  
    Shenise N. Gilyard et al.
    Emergency Radiology (2021) 28:153–164 
  • Splenic Calcifications
    - calcified phleboliths
    - healed granulomatous disease
    - autosplenectomy
    - infarct
    - splenic cysts
    - hemangioma
    - lymphangioma
  • “Pyogenic abscesses are most commonly caused by hematogenous spread of infection. Other causes include penetrating trauma and prior splenic infarction. On ultrasound, ab- scesses appear as poorly defined hypoecho- ic or cystic lesions. On CT, microabscesses are multiple ill-defined low-attenuation lesions. Lesions are usually small, 5–10 mm. A central focus of higher attenuation and ring enhancement can also be seen. Fungal microabscesses usually occur in immunocom- promised patients.” 


    Nonneoplastic, Benign, and Malignant Splenic Diseases: Cross-Sectional Imaging Findings and Rare Disease Entities 
Thipphavong S et al.
AJR 2014; 203:315–322
  • Differential Diagnosis of Acute LUQ Pain
    Spleen
    • Infarct and sickle cell crisis
    • Splenomegaly
    • Rupture
    • Abscess and infection
    • Ruptured splenic artery aneurysm
    • Splenic torsion
    • Splenic vein thrombosis
  • Splenic Infarction: Causes
    • Trauma
    • Iatrogenic
       • Splenic artery interventions and therapeutic embolization
       • Intra-aortic balloon pump
       • Postoperative
       • Pharmacologic: vasopressin, erythropoietin, clofazimine
    • Hypercoagulable states
  • Splenic Infarction: Causes
    • Embolic
       • Bacterial endocarditis
       • Thromboembolic
          • Atrial fibrillation
          • Patent foramen ovale
    • Atheroembolic
    • Aortic dissection
    • Pancreatitis and pancreatic cancer
  • Splenic Infarction: Causes
    • Splenic disorders
       • Torsion
       • Splenomegaly
    • Drugs: cocaine
    • Collagen vascular disease
  • Splenic Infaction

    Segmental

    - Focal zones of the spleen involved
    - More common
    - 1 or more infarcts seen

    Global

    - Entire spleen involved
    - Often due to trauma
  • Splenic Infarction:

    Etiology

    - bacterial endocarditis, atrial fibrillation, sickle cell anemia, lymphoma, splenomegaly, etc

    CT appearance

    - wedge shaped areas of decreased attenuation which extend to the surface of the spleen
    - usually involve a portion of the spleen
    - CT appearance can vary over time
  • "Segmental splenic infarction is a rare manifestation of blunt splenic trauma. The diagnosis is readily made using contrast-enhanced CT. The majority will decrease in size on follow-up CT and resolve without clinical sequelae. Resolution of infarction is also seen and these cases are best described as temporary perfusion defects."

    CT diagnosis of splenic infarction in blunt trauma: imaging features, clinical significance and complications.
    Miller LA, Mirvis SE, Shanmuganathan K, Ohson AS.
    Clin Radiol. 2004 Apr;59(4):342-8.
  • Splenic Calcification: Differential Dx:

    - Granulomatous diseases
    - Prior infaction
    - Old hematoma
    - Sickle cell disease
    - Metastases
    - Thorotrast (just looks like calcification)
    - Hydatid disease

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