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.

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.^[37] 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.

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.

Treatment & Management

Lotfollahzadeh S, Mathew G, Zemaitis MR. Splenic Abscess. Treasure Island, FL: StatPearls; 2021. [Full Text].
REID SE, LANG SJ. Abscess of the spleen. Am J Surg. 1954 Dec. 88 (6):912-7. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
Westh H, Reines E, Skibsted L. Splenic abscesses: a review of 20 cases. Scand J Infect Dis. 1990. 22 (5):569-73. [QxMD MEDLINE Link].
Lee MC, Lee CM. Splenic Abscess: An Uncommon Entity with Potentially Life-Threatening Evolution. Can J Infect Dis Med Microbiol. 2018. 2018:8610657. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
Smyrniotis V, Kehagias D, Voros D, Fotopoulos A, Lambrou A, Kostopanagiotou G, et al. Splenic abscess. An old disease with new interest. Dig Surg. 2000. 17 (4):354-7. [QxMD MEDLINE Link].
Nieciecki M, Kozuch M, Czarniecki M, Mlosek RK, Michno A, Olszewski W, et al. How to diagnose splenic abscesses?. Acta Gastroenterol Belg. 2019 Jul-Sep. 82 (3):421-426. [QxMD MEDLINE Link]. [Full Text].
Schäberle W, Eisele R. [Percutaneous ultrasound controlled drainage of large splenic abscesses]. Chirurg. 1997 Jul. 68 (7):744-8. [QxMD MEDLINE Link].
Völk M, Strotzer M. [Diagnostic imaging of splenic disease]. Radiologe. 2006 Mar. 46 (3):229-43; quiz 244. [QxMD MEDLINE Link].
Iñiguez A, Butte JM, Zuñiga JM, Torres J, Llanos O. [Splenic abscesses. Report of seven cases]. Rev Med Chil. 2008 Jan. 136 (1):38-43. [QxMD MEDLINE Link].
Fotiadis C, Lavranos G, Patapis P, Karatzas G. Abscesses of the spleen: report of three cases. World J Gastroenterol. 2008 May 21. 14 (19):3088-91. [QxMD MEDLINE Link].
Bayer AS, Bolger AF, Taubert KA, Wilson W, Steckelberg J, Karchmer AW, et al. Diagnosis and management of infective endocarditis and its complications. Circulation. 1998 Dec 22-29. 98 (25):2936-48. [QxMD MEDLINE Link]. [Full Text].
Zubair CM, Haider MM, Musa MA, Khosa ZA. Challenges in the Management of Multiple Splenic Abscesses caused by Extensively Drug-resistant (XDR) Salmonella Typhi. J Coll Physicians Surg Pak. 2021 Jul. 30 (7):855-857. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Lee CH, Leu HS, Hu TH, Liu JW. Splenic abscess in southern Taiwan. J Microbiol Immunol Infect. 2004 Feb. 37 (1):39-44. [QxMD MEDLINE Link].
Tung CC, Chen FC, Lo CJ. Splenic abscess: an easily overlooked disease?. Am Surg. 2006 Apr. 72 (4):322-5. [QxMD MEDLINE Link].
Ulhaci N, Meteoğlu I, Kacar F, Ozbaş S. Abscess of the spleen. Pathol Oncol Res. 2004. 10 (4):234-6. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Al-Salem AH. Splenic complications of sickle cell anemia and the role of splenectomy. ISRN Hematol. 2011. 2011:864257. [QxMD MEDLINE Link]. [Full Text].
Yilmaz M, Arslan F, Başkan 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. [QxMD MEDLINE Link].
Aslam A, Ahmed Shatla ES, Imanullah S, Bedair EM. Splenic Abscess: A Rare Complication of the UVC in Newborn. Case Rep Pediatr. 2014. 2014:903421. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Nassour F, Schoucair NM, Tranchart H, Maitre S, Dagher I. Delayed Intra Splenic Abscess: a Specific Complication Following Laparoscopic Sleeve Gastrectomy. Obes Surg. 2018 Feb. 28 (2):589-593. [QxMD MEDLINE Link].
Li G, Gao L, Zhou J, Ye B, Zhang J, Qu C, et al. Management of Splenic Abscess after Splenic Arterial Embolization in Severe Acute Pancreatitis: A 5-Year Single-Center Experience. Gastroenterol Res Pract. 2019. 2019:6069179. [QxMD MEDLINE Link]. [Full Text].
Bundy JJ, Hage AN, Srinivasa RN, Gemmete JJ, Srinivasa RN, Jairath N, et al. Intra-arterial ampicillin and gentamicin and the incidence of splenic abscesses following splenic artery embolization: A 20-year case control study. Clin Imaging. 2019 Mar - Apr. 54:6-11. [QxMD MEDLINE Link].
AlZarooni N, AlBaroudi A, AlOzaibi L, AlZoabi O. Splenic abscess as a possible sequela of COVID-19: a case series. Ann Saudi Med. 2021 Sep-Oct. 41 (5):307-311. [QxMD MEDLINE Link]. [Full Text].
Davido B, Dinh A, Rouveix E, Crenn P, Hanslik T, Salomon J. [Splenic abscesses: From diagnosis to therapy]. Rev Med Interne. 2017 Sep. 38 (9):614-618. [QxMD MEDLINE Link].
Moll R, Sailer M, Reith HB, Schindler G. CT-gesteuerte Drainagenbehandlung der Milz bei Abscessen und Hamatomen. Klinikarzt. 2004 Jun. 33:183-8.
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. [QxMD MEDLINE Link].
Hung SK, Ng CJ, Kuo CF, Goh ZNL, Huang LH, Li CH, et al. Comparison of the Mortality in Emergency Department Sepsis Score, Modified Early Warning Score, Rapid Emergency Medicine Score and Rapid Acute Physiology Score for predicting the outcomes of adult splenic abscess patients in the emergency department. PLoS One. 2017. 12 (11):e0187495. [QxMD MEDLINE Link]. [Full Text].
Liang JT, Lee PH, Wang SM, Chang KJ. Splenic abscess: a diagnostic pitfall in the ED. Am J Emerg Med. 1995 May. 13 (3):337-43. [QxMD MEDLINE Link].
Alvi AR, Kulsoom S, Shamsi G. Splenic abscess: outcome and prognostic factors. J Coll Physicians Surg Pak. 2008 Dec. 18 (12):740-3. [QxMD MEDLINE Link].
Klimpel V. [Does Kehr's sign derive from Hans Kehr? A critical commentary on its documentation?]. Chirurg. 2004 Jan. 75 (1):80-3. [QxMD MEDLINE Link].
Handa U, Tiwari A, Singhal N, Mohan H, Kaur R. Utility of ultrasound-guided fine-needle aspiration in splenic lesions. Diagn Cytopathol. 2013 Dec. 41 (12):1038-42. [QxMD MEDLINE Link].
Divyashree S, Gupta N. Splenic Abscess in Immunocompetent Patients Managed Primarily without Splenectomy: A Series of 7 Cases. Perm J. 2017. 21:16-139. [QxMD MEDLINE Link]. [Full Text].
Faruque AV, Qazi SH, Arshad M, Anwar N. Isolated splenic abscess in children, role of splenic preservation. Pediatr Surg Int. 2013 Aug. 29 (8):787-90. [QxMD MEDLINE Link]. [Full Text].
Okamoto T, Nakamura K, Fukuda K. Endoscopic ultrasound-guided transluminal drainage for aseptic splenic abscess. Endosc Int Open. 2021 Oct. 9 (10):E1581-E1582. [QxMD MEDLINE Link]. [Full Text].
Legrand F, Lecuit M, Dupont B, Bellaton E, Huerre M, Rohrlich PS, et al. Adjuvant corticosteroid therapy for chronic disseminated candidiasis. Clin Infect Dis. 2008 Mar 1. 46 (5):696-702. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Ferraioli G, Brunetti E, Gulizia R, Mariani G, Marone P, Filice C. Management of splenic abscess: report on 16 cases from a single center. Int J Infect Dis. 2009 Jul. 13 (4):524-30. [QxMD MEDLINE Link].
Choudhury S R, Rajiv C, Pitamber S, Akshay S, Dharmendra S. Management of splenic abscess in children by percutaneous drainage. J Pediatr Surg. 2006 Jan. 41 (1):e53-6. [QxMD MEDLINE Link].
Ooi LL, Leong SS. Splenic abscesses from 1987 to 1995. Am J Surg. 1997 Jul. 174 (1):87-93. [QxMD MEDLINE Link].

Media Gallery

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

of 3

Author

Julian E Losanoff, MD, MHA, MSS Professor of Surgery, University of Nevada-Las Vegas School of Medicine; Adjunct Professor of Surgery, Touro University College of Osteopathic Medicine; 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, Southern Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Marc D Basson, MD, PhD, MBA, FACS Senior Associate Dean for Medicine and Research, Professor of Surgery, Pathology, and Biomedical Sciences, 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, The Scientific Research Honor Society

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, MSc, DSc, AGAF Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, Professor, Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow; Fellow of the Royal Society of Medicine

John Geibel, MD, MSc, DSc, AGAF 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: Nothing to disclose.

Additional Contributors

Lewis J Kaplan, MD, FACS, FCCM, FCCP Professor of Surgery, Division of Trauma, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the 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.