Splenic Abscess Workup
- Author: Julian E Losanoff, MD, MHA, MSS; Chief Editor: John Geibel, MD, DSc, MSc, MA more...
A complete blood count (CBC) demonstrates leukocytosis (white blood cell [WBC] count, >20,000/μL) 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.
A chest radiograph is typically the first step in the preoperative evaluation, though it will reveal nonspecific changes typical of a septic process in the region rather than changes diagnostic of a splenic abscess in particular. The following may be noted:
Abnormal chest radiograph findings (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 is cost-effective, noninvasive, and readily available at the bedside around the clock. However, the evaluation is nonspecific and operator-dependent.
Computed tomography (CT) is presently the criterion standard in helping to establish the diagnosis of splenic abscess. The reported sensitivity of CT for this purpose typically approaches 100%. The characteristic image of splenic abscess reveals low-density lesions that fail to enhance after intravenous contrast. CT best delineates the size, topography, and access routes to the spleen and surrounding structures. CT-guided drainage can be performed during the examination.
Diagnostic percutaneous aspiration guided by ultrasonography or CT is useful in helping to confirm the diagnosis of splenic abscess and in providing a specimen for bacteriology.
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. 2006 Jan 21. 12(3):460-4. [Medline].
Westh H, Reines E, Skibsted L. Splenic abscesses: a review of 20 cases. Scand J Infect Dis. 1990. 22(5):569-73. [Medline].
Al-Salem AH, Qaisaruddin S, Al Jam'a A, Al-Kalaf J, El-Bashier AM. Splenic abscess and sickle cell disease. Am J Hematol. 1998 Jun. 58(2):100-4. [Medline].
Smyrniotis V, Kehagias D, Voros D, et al. Splenic abscess. An old disease with new interest. Dig Surg. 2000. 17(4):354-7. [Medline].
Schaberle W, Eisele R. [Percutaneous ultrasound controlled drainage of large splenic abscesses]. Chirurg. 1997 Jul. 68(7):744-8. [Medline].
Volk M, Strotzer M. [Diagnostic imaging of splenic disease]. Radiologe. 2006 Mar. 46(3):229-43; quiz 244. [Medline].
Iniguez A, Butte JM, Zuniga JM, et al. [Splenic abscesses. Report of seven cases]. Rev Med Chil. 2008 Jan. 136(1):38-43. [Medline].
Fotiadis C, Lavranos G, Patapis P, et al. Abscesses of the spleen: report of three cases. World J Gastroenterol. 2008 May 21. 14(19):3088-91. [Medline].
Pangonis S, Patamasucon P, Fitzpatrick E. Pneumococcal Sepsis Complicated by Splenic Abscesses and Purpura Fulminans in a 15-Month-Old Child: Case Report and Review of the Literature. J Investig Med High Impact Case Rep. 2016 Jan-Mar. 4 (1):2324709616636398. [Medline].
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. 2006 Nov. 73(7):1045-8. [Medline].
Lee CH, Leu HS, Hu TH, Liu JW. Splenic abscess in southern Taiwan. J Microbiol Immunol Infect. 2004 Feb. 37(1):39-44. [Medline].
Tung CC, Chen FC, Lo CJ. Splenic abscess: an easily overlooked disease?. Am Surg. 2006 Apr. 72(4):322-5. [Medline].
Ulhaci N, Meteoglu I, Kacar F, Ozbas S. Abscess of the spleen. Pathol Oncol Res. 2004. 10(4):234-6. [Medline].
Villamil-Cajoto I, Lado FL, Van den Eynde-Collado A, Díaz-Peromingo JA. [Splenic abscess: presentation of nine cases.]. Rev Chilena Infectol. 2006 Jun. 23(2):150-4. [Medline].
Yilmaz M, Arslan F, Baskan O, Mert A. Splenic abscess due to brucellosis: a case report and a review of the literature. Int J Infect Dis. 2014 Mar. 20:68-70. [Medline].
Chong VH, Abdullah MS, Sangkarakumar S, Mathew VV, Telisinghe PU. Chronic Splenic Abscess as the First Manifestation of Pancreatic Tail Tumor. Indian J Surg. 2015 Dec. 77 (Suppl 3):1504-5. [Medline].
Schiavo L, Scalera G, De Sena G, Ciorra FR, Pagliano P, Barbarisi A. Nonsurgical management of multiple splenic abscesses in an obese patient that underwent laparoscopic sleeve gastrectomy: case report and review of literature. Clin Case Rep. 2015 Oct. 3 (10):870-4. [Medline].
Moll R, Sailer M, Reith HB, Schindler G. CT-gesteuerte Drainagenbehandlung der Milz bei Abscessen und Hamatomen. Klinikarzt. June/2004. 33:183-188.
Carbonell AM, Kercher KW, Matthews BD, Joels CS, Sing RF, Heniford BT. Laparoscopic splenectomy for splenic abscess. Surg Laparosc Endosc Percutan Tech. 2004 Oct. 14(5):289-91. [Medline].
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].
Alvi AR, Kulsoom S, Shamsi G. Splenic abscess: outcome and prognostic factors. J Coll Physicians Surg Pak. 2008 Dec. 18(12):740-3. [Medline].
Klimpel V. [Does Kehr's sign derive from Hans Kehr? A critical commentary on its documentation?]. Chirurg. 2004 Jan. 75(1):80-3. [Medline].
Handa U, Tiwari A, Singhal N, Mohan H, Kaur R. Utility of ultrasound-guided fine-needle aspiration in splenic lesions. Diagn Cytopathol. 2011 Sep 26. [Medline].
Legrand F, Lecuit M, Dupont B, et al. Adjuvant corticosteroid therapy for chronic disseminated candidiasis. Clin Infect Dis. 2008 Mar 1. 46(5):696-702. [Medline].
Zerem E, Bergsland J. Ultrasound guided percutaneous treatment for splenic abscesses: The significance in treatment of critically ill patients. World J Gastroenterol. 2006 Dec 7. 12(45):7341-5. [Medline].
Ferraioli G, Brunetti E, Gulizia R, et al. Management of splenic abscess: report on 16 cases from a single center. Int J Infect Dis. 2008 Dec 11. [Medline].
Choudhury SR, Rajiv C, Pitamber S, et al. Management of splenic abscess in children by percutaneous drainage. J Pediatr Surg. 2006 Jan. 41(1):e53-6. [Medline].
Ooi LL, Leong SS. Splenic abscesses from 1987 to 1995. Am J Surg. 1997 Jul. 174(1):87-93. [Medline].