Spleen imaging—Enlargement of the spleen

Abstract

A 19-year-old man was admitted for the acute onset of abdominal pain. He had experienced right abdominal pain for a month before admission but had no other symptoms. Physical examination revealed a hard, somewhat tender, midabdominal mass. Ultrasound and computed tomography (CT) showed a solid vascular mass in the midabdomen. No spleen was demonstrated. The nature of the mass was not clear and a neoplasm was suspected. On liver-spleen scintigram, uptake of colloid was seen in the large mass (Fig. 1). The spleen was not visualized in the left upper quadrant and the mass was considered to be a markedly enlarged and displaced spleen. At surgery a huge congestive spleen, weighing 1190 g, was found. No adhesions or indications of infarction were noted. The pedicle of the spleen was elongated and twisted. Pathologic examination only showed congestion of the spleen. Ectopic, aberrant, ptotic, floating, and wandering spleen are some of the names attached to a rare condition, in which the spleen is found in locations other than the left upper quadrant. Elongation of the splenic pedicle and malformation of the dorsal mesogastrium with laxity, poor development, or even absence of the lienogastric and lienorenal ligaments cause this condition) '2'3 It often occurs in females in childbearing age, and it must be differentiated from a tumor or an ovarian cyst. 34'5 A sudden torsion of the pedicle may cause acute venous occlusion which sometimes leads to infarctions. When the torsion is gradual the spleen may reach huge dimensions, as shown in the present case. The ability to take up colloid is apparently preserved. Diagnosis may be difficult. When the enlarged spleen is not located in the left upper quadrant it may not be recognized and mistaken for a neoplasm. Plain x-rays, excretory urography, barium enema, upper GI series, ultrasound, and angiography have been suggested, but preoperative diagnosis is rarely made. 3'6 Scintigraphy may help in establishing the nature of the mass. Causes of spleen enlargement follow. COM MON