Splenic Abscess Workup

Updated: Apr 21, 2020
  • Author: Julian E Losanoff, MD, MHA, MSS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Workup

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 (US) is cost-effective, noninvasive, and readily available at the bedside around the clock. [35]  However, US evaluation has the drawbacks of being 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 (IV) administration of 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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Procedures

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

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