CT Finding on Spleen Abcess

1. Kristianto Budi Wibowo
Radiology Dept
Faculty of Medicine Gadjah Mada University

2. THIEME - Atlas of Anatomy

3. THIEME - Atlas of Anatomy

4.  Congenital
 Trauma
 Infection
 Malignancy
 Vascular
 Misc

5.  Epid : rare 0.05-0.7% , high mortality
 Etiology :
- Hematogenic Spread >>
- Infected Trauma
- Infected spleenic infarction
- Alcoholism,DM,Immunosupressan >>
 Pathophysiology
- Hematogenous embolization
- Spread from altered splenic architecture
- Contiguous spread
http://emedicine.medscape.com/article/194655-overview#a0104

6.  Fever
 Abdominal Pain (punctum maximum in the
left hypochondrium )
 Shoulder pain (Involvement of the
diaphragmatic pleura )
 Pleuritic chest pain
 General malaise
 Dyspeptic symtoms

7.  Plain photo
 US
 CT
 MRI

8.  NECT :
- Low attenuation, ill-defined lesion within splenic
parenchyma
- May rarely contain gas bubbles or air-fluid levels
 CECT:
- Low attenuation, nonenhancing complex fluid
collection
- May extend to subcapsular location
Diagnostic Imaging : Abdomen

9. CECT
Pyogenic splenic abscess on CECT. Pyogenic splenic abscess on axial CECT.
Note low attenuation abscess bulging Note thin septations within abscess (arrows)
splenic parenchyma (arrow).
Diagnostic Imaging : Abdomen

10. Nonenhanced CT scan shows a 6-cm
hypoattenuating mass within the spleen
(large arrow), with inflammatory soft tissue
stranding in the adjacent extraperitoneal fat
(small arrow)
RadioGraphics 1994; 14:307-332

11. Axial CECT of fungal microabscesses. Axial CECT demonstrates splenic microabscesses.
Note : numerous hypodense lesions. Note small < 1 cm lesions diffusely throughout the
spleen.

12.  Anatomy
 Abnormalities of Spleen
 Spleen Abcess
 Clinical Presentations
 Imaging modalities
 CT findings

13. An 62-year-old diabetic male with
multiple medical problems was referred
to the hospital because of 2 weeks of
fever unresponsive to empirical antibiotic
treatment. Because of an abnormal
chest x-ray, the patient underwent CT
scan. Herein the result of the
examination.
1. Please describe this picture
2. What is the most likely diagnosis