Splenic Abscess Clinical Presentation

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

History

The history and physical examination are not sufficiently reliable to make the diagnosis of splenic abscess. However, information derived from the history and physical examination can suggest this diagnosis. Therefore, the clinician must maintain a high index of suspicion, particularly in higher-risk clinical scenarios and patient groups. [24]

Although the signs and symptoms of splenic abscess have been well described, they are not very specific. Therefore, splenic abscess remains a substantial diagnostic challenge. The classical triad of fever, left-upper-quadrant pain, and splenomegaly is seen in only about one third of patients.

The symptoms of splenic abscess can be variable and depend on the location, size, and progression of the process. They can also be acute, subacute, or chronic. Deep-seated, small abscesses can be painless and accompanied by septic symptoms. [25]  The following may be noted:

  • Fever (>90%) can be moderate, continuous, intermittent, or even absent
  • Abdominal pain (>60%) typically occurs suddenly, with a punctum maximum in the left hypochondrium (>39%); pain usually signifies perisplenitis [26]
  • Involvement of the diaphragmatic pleura can cause shoulder pain; the associated eponym is the Kehr sign, though there is no clear demonstration that Kehr either described it or suffered from it
  • Pleuritic chest pain around the left lung base (>15%) is aggravated by coughing or forced expiration
  • General malaise and other constitutional and dyspeptic symptoms can be included, all of which can also be seen in a variety of other septic conditions
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Physical Examination

Abdominal tenderness (>50% of cases) may or may not be accompanied by muscle guarding in the left upper quadrant. There may be edema of the soft tissues overlying the spleen. Costovertebral tenderness may also be noted.

Splenomegaly (<50%) is less frequently observed, probably because of early diagnosis resulting from the widespread use of imaging methods.

Chest findings are nonspecific and reportedly include dullness at the left lung base (>30%), left basilar rales (>21%), or elevation of the left hemidiaphragm (>15%).

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