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The spleen

Pathological conditions

Splenomegaly

US is usually the first imaging modality to be employed in the investigation of splenomegaly as the organ size and the structure of the splenic parenchyma can be assessed. CT or MRI may be useful in certain individuals to characterize the cause of the splenic enlargement.

Infiltrates

Ultrasound and contrast enhanced CT and MRI are all used for the diagnosis of neoplastic lesions such as lymphoma, metastatic deposits, or, rarely, primary tumours (Fig. 50). Splenic infarction is seen as a typical, often wedge-shaped, peripheral lesion (Fig. 51). The different imaging modalities are complementary to one another, but US is usually the method of first choice.

	Figure 51. CT of the spleen, with contrast enhancement. Dorsally a peripheral area of decreased enhancement (arrows) is seen, representing an area of splenic infarction.
a	Figure 52. Splenic abscess. (a) On CT an irregular area of low attenuation is seen (arrows). (b) An abscess in the spleen has been drained. On this US the draining catheter (curved arrow) is seen within the abscess (large arrows).
b

Abscess, infection

With US and contrast-enhanced CT, abscesses are typically seen as localized lesions with thick and contrast-enhancing walls (Fig. 52). Foci of infection may sometimes be identified by sequential radionuclide imaging.

Trauma

Splenic rupture is not uncommon in abdominal injury, and is diagnosed by US and/or contrast-enhanced CT. Parenchymal lesions and intracapsular bleeding are seen with equal clarity using either method, but any changes in the surrounding region, such as may occur with rupture of the splenic capsule, are better shown on CT. Angiography can be performed in order to map the vascular anatomy in detail or to embolize if this seems feasible and appropriate but a decision whether or not to operate can usually be made solely on the basis of US and/or CT. It must be said, however, that most clinicians would base their decision on clinical findings rather than on CT and US.

Vascular anatomy

The arterial anatomy of the spleen is evaluated by splenic arteriography, e.g. prior to an embolization. The venous drainage may be demonstrated in certain problem cases, mainly those involving portal thrombosis and oesophageal varices, by an arterial contrast medium (indirect splenoportography, best performed using DSA), or by a direct injection into the splenic parenchyma through a percutaneously-introduced cannula, direct splenoportography.

David J. Allison and Carl-Gustaf Standertskjold-Nordenstam