Acute Presentations of Splenic Diseases

Abstract

A wide range of acute pathologic conditions can affect the spleen. Some of these processes cause isolated splenic disease, whereas other involve the spleen as part of a systemic illness. Imaging is playing an important role in diagnosis and characterization of these diseases especially in their acute settings.

US plays a central role for the evaluation of the spleen. The spleen is easily visualized and measured with curved probes. It will appear relatively and diffusely hypoechoic with a central vascular pedicle demonstrable on color Doppler. A more reticular pattern, potentially corresponding to white and red pulp, will be visualized using linear probes.

CE-CT and MR imaging may contribute in some specific diseases; still the normal patterns of the spleen in children should be taken into account. For instance, on early phase of CE-CT, the spleen may appear heterogeneous as the contrast progresses distally. In newborns, there is a larger proportion of red pulp and therefore on MR imaging, the spleen tends to be hyposignal compared to the liver in T1 and T2-Weighted sequences. After one year, the white pulp becomes larger. The spleen will then appear hyperintense compared to the muscles and hypointense to the liver on T1-Weighted images. It will appear hypersignal to the liver on T2-Weighted sequences.