Login Register Cart 0
Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Case Studies

Torsion of Wandering Spleen: Importance of Splenic Density and Liver-to- Spleen Attenuation Ratio on CT

Author(s): Yusuf Kenan Cetinoglu*, Sebnem Karasu, Turan Acar, Muhsin Engin Uluc, Mehmet Haciyanli and Ozgur Tosun

Volume 16, Issue 1, 2020

Page: [88 - 93] Pages: 6

DOI: 10.2174/1573405614666181009142322

Price: $65

Open Access Journals Promotions 2
conference banner
Abstract

Background: Wandering spleen (WS) is a rare clinical condition which may cause fatal complication like torsion with subsequent infarction. Determination of splenic parenchyma viability is very important in deciding whether splenopexy rather than splenectomy is an option. Contrast- enhanced computed tomography (CECT) is important for the diagnosis of WS and assessment of the viability of spleen.

Discussion: We reviewed the CT studies of four cases with WS. We measured the mean splenic and liver density and calculated liver-to-spleen attenuation ratio (LSAR). We also assessed the CT findings for each patient. Mean splenic density was measured as 40.77 Hounsfield Unit (HU) in cases with infarction, 127.1 HU in case without infarction. LSAR was calculated as 2.55 in cases with infarction, 0.99 in case without infarction. We detected whirlpool sign, intraperitoneal free fluid, splenic arterial enhancement in all patient, parenchymal and splenic vein enhancement in one patient without infarction, fat rim sign in three patients with infarction, capsular rim sign in one patient with infarction.

Conclusion: CECT should be obtained for the diagnosis of WS and assessment of the viability of spleen. CECT could suggest the diagnosis of infarction of the spleen with following findings; absence of parenchymal enhancement, very low density of spleen (<45 HU), and LSAR which is greater than 2.

Keywords: Wandering spleen, torsion, infarction, computed tomography, density, splenectomy, splenopexy.

Graphical Abstract

[1]
Ben Ely A, Zissin R, Copel L, et al. The wandering spleen: CT findings and possible pitfalls in diagnosis. Clin Radiol 2006; 61(11): 954-8.
[http://dx.doi.org/10.1016/j.crad.2006.06.007] [PMID: 17018308]
[2]
Allen KB, Andrews G. Pediatric wandering spleen--the case for splenopexy: review of 35 reported cases in the literature. J Pediatr Surg 1989; 24(5): 432-5.
[http://dx.doi.org/10.1016/S0022-3468(89)80395-1] [PMID: 2661792]
[3]
Dawson JH, Roberts NG. Management of the wandering spleen. Aust N Z J Surg 1994; 64(6): 441-4.
[http://dx.doi.org/10.1111/j.1445-2197.1994.tb02249.x] [PMID: 8010910]
[4]
Fiquet-Francois C, Belouadah M, Ludot H, et al. Wandering spleen in children: multicenter retrospective study. J Pediatr Surg 2010; 45(7): 1519-24.
[http://dx.doi.org/10.1016/j.jpedsurg.2010.03.003] [PMID: 20638536]
[5]
Sodhi KS, Saggar K, Sood BP, Sandhu P. Torsion of a wandering spleen: acute abdominal presentation. J Emerg Med 2003; 25(2): 133-7.
[http://dx.doi.org/10.1016/S0736-4679(03)00160-4] [PMID: 12901997]
[6]
Steinberg R, Karmazyn B, Dlugy E, et al. Clinical presentation of wandering spleen. J Pediatr Surg 2002; 37(10): 1-4.
[http://dx.doi.org/10.1053/jpsu.2002.35443] [PMID: 12378476]
[7]
Desai D, Hebra A, Davidoff AM, Schnaufe RL. Wandering spleen: a challenging diagnosis. Southern Med J 1997; 90(4): 439-43.
[http://dx.doi.org/10.1097/00007611-199704000-00017]
[8]
Raissaki M, Prassopoulos P, Daskalogiannaki M, Magkanas E, Gourtsoyiannis N. Acute abdomen due to torsion of wandering spleen: CT diagnosis. Eur Radiol 1998; 8(8): 1409-12.
[http://dx.doi.org/10.1007/s003300050562] [PMID: 9853224]
[9]
Priyadarshi RN, Anand U, Kumar B, Prakash V. Torsion in wandering spleen: CT demonstration of whirl sign. Abdom Imaging 2013; 38(4): 835-8.
[http://dx.doi.org/10.1007/s00261-012-9944-9] [PMID: 22829098]
[10]
Gayer G, Zissin R, Apter S, Atar E, Portnoy O, Itzchak Y. CT findings in congenital anomalies of the spleen. Br J Radiol 2001; 74(884): 767-72.
[http://dx.doi.org/10.1259/bjr.74.884.740767] [PMID: 11511506]
[11]
Fujiwara T, Takehara Y, Isoda H, et al. Torsion of the wandering spleen: CT and angiographic appearance. J Comput Assist Tomogr 1995; 19(1): 84-6.
[http://dx.doi.org/10.1097/00004728-199501000-00016] [PMID: 7822555]
[12]
Herman TE, Siegel MJ. CT of acute splenic torsion in children with wandering spleen. AJR Am J Roentgenol 1991; 156(1): 151-3.
[http://dx.doi.org/10.2214/ajr.156.1.1898552] [PMID: 1898552]
[13]
Berkenblit RG, Mohan S, Bhatt GM, Rosenzweig M, Blitz A. Wandering spleen with torsion: appearance on CT and ultrasound. Abdom Imaging 1994; 19(5): 459-60.
[http://dx.doi.org/10.1007/BF00206940] [PMID: 7950828]
[14]
Newman B, Bowen A, Eggli KD. Recognition of malposition of the liver and spleen: CT, MRI, nuclear scan and fluoroscopic imaging. Pediatr Radiol 1994; 24(4): 274-9.
[http://dx.doi.org/10.1007/BF02015456] [PMID: 7800451]
[15]
Bréguet R, Ronot M, Goossens N, et al. Liver volume is a prognostic indicator for clinical outcome of patients with alcoholic hepatitis. Abdom Radiol (NY) 2017; 42(2): 460-7.
[http://dx.doi.org/10.1007/s00261-016-0892-7] [PMID: 27604894]
[16]
Gilman RS, Thomas RL. Wandering spleen presenting as acute pancreatitis in pregnancy. Obstet Gynecol 2003; 101: 1100-2.
[PMID: 12738115]
[17]
Soleimani M, Mehrabi A, Kashfi A, Fonouni H, Büchler MW, Kraus TW. Surgical treatment of patients with wandering spleen: report of six cases with a review of the literature. Surg Today 2007; 37(3): 261-9.
[http://dx.doi.org/10.1007/s00595-006-3389-0] [PMID: 17342372]
[18]
Stedman JM, Franklin JM, Nicholl H, Anderson EM, Moore NR. Splenic parenchymal heterogeneity at dual-bolus single-acquisition CT in polytrauma patients-6-months experience from Oxford, UK. Emerg Radiol 2014; 21(3): 257-60.
[http://dx.doi.org/10.1007/s10140-013-1186-9] [PMID: 24402008]
[19]
Shao G, Zhou Y, Song Z, et al. The diffuse reduction in spleen density: an indicator of severe acute pancreatitis? Biosci Rep 2017; 37(1) BSR20160418
[http://dx.doi.org/10.1042/BSR20160418] [PMID: 27920277]
[20]
Sala M, van der Grond J, de Mutsert R, et al. Liver fat assessed with CT relates to MRI markers of incipient brain injury in middle-aged to elderly overweight persons. AJR Am J Roentgenol 2016; 206(5): 1087-92.
[http://dx.doi.org/10.2214/AJR.15.15251] [PMID: 26998564]
[21]
Ricci C, Longo R, Gioulis E, et al. Noninvasive in vivo quantitative assessment of fat content in human liver. J Hepatol 1997; 27(1): 108-13.
[http://dx.doi.org/10.1016/S0168-8278(97)80288-7] [PMID: 9252082]

Rights & Permissions Print Cite
Article Metrics
24
Wayfinder Image
Open Access Journals Promotions
© 2024 Bentham Science Publishers | Privacy Policy