SPLENIC ABSCESS - COMPARISON OF 4 IMAGING METHODS

The most recent review of splenic abscess emphasized the difficulty of clinical diagnosis. In that report, Chulay and Lankerani suggested that the most useful radiographic information was contributed by the 99mTc Tc liver-spleen scan. In our patient, the nuclear scan was misleading, since it suggested a mass originating in the liver. Other authors have also reported the nonspecificity of nuclear scans. In our case arteriography was performed the next day, when the clinical impression favored a malignant mass in the liver and its resection was contemplated. This study did demonstrate an intrasplenic mass with stretched vessels and a hypervascular rim, findings previously described for splenic abscess by Reuter and Redman. Its extent, encapsulation, and internal structure seemed optimally defined by subsequent ultrasound and CT studies, undertaken to substantiate the arteriographic impression. CT further showed fluid levels of differing densities within the mass. While an abscess was anticipated preoperatively on the basis of the combined imaging studies, in retrospect, the least invasive and least expensive ultrasound study alone might have sufficed.