Learning objectives
To familiarise ourselves with the normal splenic anatomyand possible normal variants.To demonstrate various pathologies affecting the spleen with different imaging modalities. A review of the important differential diagnoses to consider.
Background
The spleen is the largest single mass of lymphoid tissue seen in the body. We familiarise with its normal image appearance using CT, USS and MRI. The pattern of contrast enhancement of the spleen during the arterial and venous phases in CT can mimic disease by forming pseudomasses. Normal variants such as splenunculus, splenic clefts/lobulations, liver wrap-around, wandering spleen as well as congenital heterotaxic syndromes will be discussed. A spectrum of splenic pathologies are demonstrated and the list of differential diagnoses that should be considered...
Imaging findings OR Procedure details
ANATOMY AND NORMAL VARIATIONSThe normal position of the spleen lies in the left upper quadrant along the shaft of the tenth rib. Spleen size varies with age, hydration and nutrition. CT and USS remain the major modalities used to visualise the spleen parenchyma. On all imaging modalities the spleen has a homogenous appearance. Radionuclide scanning with Technetium sulphur colloid is a useful tool demonstrating the presence of functioning splenic tissue. The normal spleen density is equal or less than the density of normal liver on...
Conclusion
There are several normal variants within the spleen which may mimic pathology. Congenital abnormalities such as asplenia and polysplenia are both rare conditions, however in the case of polysplenia care must be made not to misdiagnose it as post-traumatic splenosis. Trauma is a common cause for direct visualisation of the spleen. The different appearances of laceration, subcapsular and intraparenchymal haematoma should be recognised. It is important to be aware that delayed rupture up to 2 weeks after the initial trauma is possible.A wide spectrum of...
References
1.Brandt W.E; Helms C.A. Fundamentals of Diagnostic Radiology. Lippencott Williams and Wilkins.pp699-704.(1999).2.Dahnert W. Radiology Review Manual. Lippencott Williams &Wilkins. Pp556-558. (1996).3.Uriart C, Pomares N, Martin M, Conde A,Alonso N, Bueno MG,. Splenic Hydatidosis. Am J Trop Med Hyg 1991; 44(4):420-23.4.Grantham JR, Clore FC, Subcutaneous splenosis. AJR 1990;154:655.
Personal Information
Dr S Vessal; Dr A Anbarasu; Dr SB Rai; Dr W Shatwell; Dr R Ramachandra.Department of Clinical Radiology. University Hospitals Coventry and Warwickshire NHS Trust. Coventry. CV2 2DX, UK.
