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Splenic Abscess Workup

  • Author: Julian E Losanoff, MD, MHA, MSS; Chief Editor: John Geibel, MD, DSc, MSc, MA  more...
 
Updated: Apr 15, 2016
 

Laboratory Studies

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.

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Imaging Studies

Radiography

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.

Nuclear studies

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.[27]  However, the evaluation is nonspecific and operator-dependent.

Computed tomography

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.

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Diagnostic Procedures

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.

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Contributor Information and Disclosures
Author

Julian E Losanoff, MD, MHA, MSS Associate Professor of Surgery, University of Nevada School of Medicine; Adjunct Professor of Surgery, Touro University Nevada; Chief of Surgery, VA Southern Nevada Healthcare System

Julian E Losanoff, MD, MHA, MSS is a member of the following medical societies: American College of Surgeons, American Society of Transplant Surgeons, Southern Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Marc D Basson, MD, PhD, MBA, FACS Associate Dean for Medicine, Professor of Surgery and Basic Science, University of North Dakota School of Medicine and Health Sciences

Marc D Basson, MD, PhD, MBA, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Gastroenterological Association, Phi Beta Kappa, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

David L Morris, MD, PhD, FRACS Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology

Disclosure: Received none from RFA Medical for director; Received none from MRC Biotec for director.

Chief Editor

John Geibel, MD, DSc, MSc, MA Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow

John Geibel, MD, DSc, MSc, 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, Society for Surgery of the Alimentary Tract

Disclosure: Received royalty from AMGEN for consulting; Received ownership interest from Ardelyx for consulting.

Additional Contributors

Lewis J Kaplan, MD, FACS, FCCM, FCCP Associate Professor of Surgery, Division of Trauma, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania; Section Chief, Surgical Critical Care, Philadelphia Veterans Affairs Medical Center

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, Surgical Infection Society

Disclosure: Nothing to disclose.

Acknowledgements

This material is the result of work supported with resources and facility use at the John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan, and VA Southern Nevada Healthcare System, North Las Vegas, Nevada.

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This patient has a splenic abscess due to pneumococcal bacteremia. Note that the massively enlarged spleen is readily visible, with minimal retraction in the left upper quadrant.
Resected spleen (same as in the above image) with abscesses caused by pneumococcal bacteremia. Note the discrete abscesses adjacent to normal parenchyma.
Splenic infarct. Selective splenic arteriogram showing extravasation of contrast from the splenic artery at the splenic hilum prior to angioembolization.
 
 
 
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