CT diagnosis of splenic vein occlusion: imaging features, etiology and clinical manifestations.

Abstract

Previous reports have described the computed tomographic (CT) appearance of collateral veins following splenic vein occlusion (SVO). This retrospective study was performed to determine the etiology, clinical manifestations, and accuracy of CT diagnosis in patients with this entity. A computer search of radiology reports for a 1-year period found 52 patients with SVO diagnosed by absence of visualization of the splenic vein accompanied by the formation of the expected perigastric collateral veins. Clinical data were reviewed for sequela of SVO and clinical impact of the diagnosis. In 12 cases, other studies confirmed the CT diagnosis of SVO. In no case was the CT diagnosis proved to be incorrect by other imaging studies. Angiographic records found five additional cases with SVO not diagnosed by CT, but two of five had convincing CT evidence of SVO noted upon reevaluation by the authors. Review of clinical data showed heme-positive stool in six, of which three had significant gastrointestinal hemorrhage. Splenic infarction occurred in two cases. Our data indicate that SVO is more common than previously suspected and usually remains clinically silent, but CT appears to be highly specific and fairly sensitive for its diagnosis.