Splenic pseudomasses

Ben Taragin

Montefiore Children's Hospital

Abstract

16 yo with sickle cell disease

Keywords

SPR unknown case 2 splenic pseudomass

Publication Date: 2009-02-27

History

16 year old with sickle cell disease

Findings

Selected ultrasound images of the abdomen demonstrate rounded, hypoechoic nodules within the spleen.

Diagnosis

Splenic pseudomasses: preserved, functioning splenic tissue within an otherwise completely infarcted spleen.

DDx

splenic abscesses/infection

Discussion

Splenic involvement in sickle cell disease with vaso-occlusive crisis is common. Often, the spleen becomes infarcted and radiographically will become small and of high density, due to calcification and iron deposition. However, occasionally round “masses” within the infracted spleen have been observed, and have been confused with infection or focal infarction. However, upon surgery and pathological analysis, it was determined that these round “masses” actually represent islands of functional splenic tissue, surrounded by an otherwise diffusely infarcted spleen. These round “masses” have also been proven to represent normal functional splenic tissue on sulfur colloid scanning.

The recognition of these rounded lesions as normal splenic tissue is important, as it can obviate the need for biopsy or splenectomy. The diagnosis can be suggested on ultrasound, CT or MRI. Confirmation of functional splenic tissue can be made with sulfur colloid scanning, if clinically necessary.

References

Levin, T.L. “Intrasplenic masses of “preserved” functioning splenic tissue in sickle cell disease: correlation of imaging findings (CT, ultrasound, MRI and nuclear scintigraphy)”, Pediatr Radiol (1996) 26: 646-649.