eMedicine Specialties > General Surgery > Abdomen

Splenic Abscess: Workup

Author: Julian E Losanoff, MD, Associate Professor of Surgery, Wayne State University School of Medicine; Clinical Surgeon, Surgery Service, John D Dingell Veterans Affairs Medical Center
Coauthor(s): Marc D Basson, MD, PhD, MBA, Professor, Chair, Department of Surgery, Michigan State University
Contributor Information and Disclosures

Updated: Apr 14, 2009

Workup

Laboratory Studies

  • A complete blood count (CBC) demonstrates leukocytosis (white blood cell [WBC] count, >20,000/mm3) with a left shift in most patients. Patients who are immunologically compromised may deviate from this rule.
  • Recurrent positive blood cultures can further suggest the diagnosis.

Imaging Studies

  • A chest radiograph is typically the first step in the preoperative evaluation, although it will reveal nonspecific changes typical for a septic process in the region rather than diagnostic findings for a splenic abscess in particular.
    • Abnormal chest radiograph findings in most patients
    • Elevated left hemidiaphragm (>30%)
    • Pleural effusion (>20%)
  • Plain radiographic films of the abdomen are notoriously nonspecific in patients with a splenic abscess. Findings on abdominal radiographic films can include abnormal soft-tissue density or a gas collection in the left upper quadrant.
  • Radioisotope scanning is of little value, because most tests require more than 24 hours to perform and interpret.
  • Ultrasonography
    • Ultrasonography is cost-effective, noninvasive, and readily available at the bedside around the clock.
    • However, the evaluation is nonspecific and operator dependent.
  • CT scanning
    • CT scanning is presently the criterion standard in helping to establish the diagnosis of splenic abscess.
    • Reported sensitivity of the CT scan for this purpose typically approaches 100%.
    • The characteristic image of splenic abscess reveals low-density lesions that fail to enhance after intravenous contrast.
    • CT scanning best delineates the size, topography, and access routes to the spleen and surrounding structures.
    • CT scan – guided drainage can be performed during the examination.

Diagnostic Procedures

  • Diagnostic percutaneous aspiration guided by ultrasonography or CT scanning is useful in helping to confirm the diagnosis of splenic abscess and in providing a specimen for bacteriology.

Staging

No universally accepted staging system for splenic abscess exists.

More on Splenic Abscess

Overview: Splenic Abscess
Workup: Splenic Abscess
Treatment: Splenic Abscess
Follow-up: Splenic Abscess
Multimedia: Splenic Abscess
References
Further Reading
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References

  1. Reid SE, Lang SJ. Abscess of the spleen. American Journal of Surgery. 1954;88:912-917.

  2. Chang KC, Chuah SK, Changchien CS, Tsai TL, Lu SN, Chiu YC, et al. Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. World J Gastroenterol. Jan 21 2006;12(3):460-4. [Medline].

  3. Westh H, Reines E, Skibsted L. Splenic abscesses: a review of 20 cases. Scand J Infect Dis. 1990;22(5):569-73. [Medline].

  4. Al-Salem AH, Qaisaruddin S, Al Jam'a A, Al-Kalaf J, El-Bashier AM. Splenic abscess and sickle cell disease. Am J Hematol. Jun 1998;58(2):100-4. [Medline].

  5. Smyrniotis V, Kehagias D, Voros D, et al. Splenic abscess. An old disease with new interest. Dig Surg. 2000;17(4):354-7. [Medline].

  6. Schaberle W, Eisele R. [Percutaneous ultrasound controlled drainage of large splenic abscesses]. Chirurg. Jul 1997;68(7):744-8. [Medline].

  7. Fotiadis C, Lavranos G, Patapis P, et al. Abscesses of the spleen: report of three cases. World J Gastroenterol. May 21 2008;14(19):3088-91. [Medline].

  8. Bayer AS, Bolger AF, Taubert KA, et al. Diagnosis and management of infective endocarditis and its complications. Circulation. Dec 22-29 1998;98(25):2936-48. [Medline]. [Full Text].

  9. Albanopoulos K, Archontovassilis F, Alexakis N, Pantelidaki A, Bramis C, Leandros E. Splenic abscess in a patient with Wegener's granulomatosis treated with laparoscopic splenectomy. Mt Sinai J Med. Nov 2006;73(7):1045-8. [Medline].

  10. Lee CH, Leu HS, Hu TH, Liu JW. Splenic abscess in southern Taiwan. J Microbiol Immunol Infect. Feb 2004;37(1):39-44. [Medline]. [Full Text].

  11. Tung CC, Chen FC, Lo CJ. Splenic abscess: an easily overlooked disease?. Am Surg. Apr 2006;72(4):322-5. [Medline].

  12. Ulhaci N, Meteoglu I, Kacar F, Ozbas S. Abscess of the spleen. Pathol Oncol Res. 2004;10(4):234-6. [Medline].

  13. Villamil-Cajoto I, Lado FL, Van den Eynde-Collado A, Díaz-Peromingo JA. [Splenic abscess: presentation of nine cases.]. Rev Chilena Infectol. Jun 2006;23(2):150-4. [Medline].

  14. Iniguez A, Butte JM, Zuniga JM, et al. [Splenic abscesses. Report of seven cases]. Rev Med Chil. Jan 2008;136(1):38-43. [Medline].

  15. Liang JT, Lee PH, Wang SM, Chang KJ. Splenic abscess: a diagnostic pitfall in the ED. Am J Emerg Med. May/1995;13:337-43. [Medline].

  16. Alvi AR, Kulsoom S, Shamsi G. Splenic abscess: outcome and prognostic factors. J Coll Physicians Surg Pak. Dec 2008;18(12):740-3. [Medline].

  17. Klimpel V. [Does Kehr's sign derive from Hans Kehr? A critical commentary on its documentation?]. Chirurg. Jan 2004;75(1):80-3. [Medline].

  18. Moll R, Sailer M, Reith HB, Schindler G. CT-gesteuerte Drainagenbehandlung der Milz bei Abscessen und Hamatomen. Klinikarzt. June/2004;33:183-188.

  19. Volk M, Strotzer M. [Diagnostic imaging of splenic disease]. Radiologe. Mar 2006;46(3):229-43; quiz 244. [Medline].

  20. Legrand F, Lecuit M, Dupont B, et al. Adjuvant corticosteroid therapy for chronic disseminated candidiasis. Clin Infect Dis. Mar 1 2008;46(5):696-702. [Medline].

  21. Zerem E, Bergsland J. Ultrasound guided percutaneous treatment for splenic abscesses: The significance in treatment of critically ill patients. World J Gastroenterol. Dec 7 2006;12(45):7341-5. [Medline].

  22. Ferraioli G, Brunetti E, Gulizia R, et al. Management of splenic abscess: report on 16 cases from a single center. Int J Infect Dis. Dec 11 2008;[Medline].

  23. Choudhury SR, Rajiv C, Pitamber S, et al. Management of splenic abscess in children by percutaneous drainage. J Pediatr Surg. Jan 2006;41(1):e53-6. [Medline].

  24. Ooi LL, Leong SS. Splenic abscesses from 1987 to 1995. Am J Surg. Jul 1997;174(1):87-93. [Medline].

  25. Carbonell AM, Kercher KW, Matthews BD, Joels CS, Sing RF, Heniford BT. Laparoscopic splenectomy for splenic abscess. Surg Laparosc Endosc Percutan Tech. Oct 2004;14(5):289-91. [Medline].

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Further Reading

Related eMedicine topics:
Candidiasis
Infective Endocarditis
Spleen, Trauma
Splenic Infarct
Splenic Rupture
Splenomegaly [Hematology]
Splenomegaly [Pediatrics: General Medicine]

Clinical guidelines:
Surgical treatment of disease and injuries of the spleen. Society for Surgery of the Alimentary Tract, Inc - Medical Specialty Society.  2004 Feb 21.  3 pages.  NGC:003836

Clinical trials:
Anticoagulation Post Laparoscopic Splenectomy
A Randomized Double Blinded Comparison of Ceftazidime and Meropenem in Severe Melioidosis (ATOM)

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Keywords

splenic abscess, spleen, abscess, splenectomy, spleen symptoms, spleen problems, spleen removal, endocarditis, spleen anatomy, spleens, spleen infection, splenic infarct, splenomegaly, abscess surgery, post splenectomy, removal of spleen, bacteremia, splenotomy

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Contributor Information and Disclosures

Author

Julian E Losanoff, MD, Associate Professor of Surgery, Wayne State University School of Medicine; Clinical Surgeon, Surgery Service, John D Dingell Veterans Affairs Medical Center
Julian E Losanoff, MD is a member of the following medical societies: American Society of Transplant Surgeons and Southern Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Marc D Basson, MD, PhD, MBA, Professor, Chair, Department of Surgery, Michigan State University
Marc D Basson, MD, PhD, MBA is a member of the following medical societies: American College of Surgeons and American Gastroenterological Association
Disclosure: Nothing to disclose.

Medical Editor

Lewis J Kaplan, MD, FACS, FCCM, FCCP, Director, SICU and Surgical Critical Care Fellowship, Associate Professor, Department of Surgery, Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Yale University School of Medicine
Lewis J Kaplan, MD, FACS, FCCM, FCCP is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Association for Academic Surgery, Association for Surgical Education, Connecticut State Medical Society, Eastern Association for the Surgery of Trauma, International Trauma Anesthesia and Critical Care Society, Society for the Advancement of Blood Management, Society of Critical Care Medicine, and Surgical Infection Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David L Morris, MD, PhD, Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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