Splenic abscess: diagnosis and management.
OBJECTIVE
To evaluate the usefulness of a combination of computed tomography and sonography for splenic abscess diagnosis and management determination.


METHODS
From January 1986 to June 1999, 30 patients of pyogenic splenic abscess were collected in our hospital. Computed tomograms of the spleen were performed on all of the patients, and abdominal sonographies were performed on 26 of them. The imaging findings of all the patients were reviewed with respect to the clinical presentations, predisposing factors, infective organisms, method of treatment and clinical outcome.


RESULTS
The clinical triad of splenic abscess was the main presentation of the 30 patients; it included fever (92%), left upper abdominal pain (77%) and leukocytosis (66%). Infective bacteria were identified in 19 patients, and the most offending bacteria were aerobes (82.6%). The radiological findings included single abscess were found in 16 patients and multiple abscesses were noted in 14 patients. The computed tomography and sonography findings included abnormal gas content (6 cases), progressive enlargement of lesion (6 cases), subcapsular extension of lesion (6 cases), extracapsular fluid collection (8 cases) and cystic lesion (7 cases). 59% of the cases had at least one of the above imaging findings. With the combination of the clinical triad and the imaging findings, the diagnostic rate rose up to 86.7%.


CONCLUSIONS
Although splenic abscess is rare, it has a high mortality rate if there is delay in diagnosis and treatment. With the combination of computed tomography, sonography and clinical features, early diagnosis and treatment can be made. Percutaneous drainage for single abscess and splenectomy for multiple abscesses are the safe and effective treatment choice. The computed tomography and sonography appearance of splenic abscess is a valuable predictor of outcome of splenic abscess drainage. Medical treatment alone was definitely insufficient.
Ng
Koon-Kwan
KK
Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Linkou & Kaohsiang, Taiwan.
Lee
Tze-Yu
TY
Wan
Yung-Liang
YL
Tan
Chih-Feng
CF
Lui
Kar-Wai
KW
Cheung
Yun-Chung
YC
Cheng
Yu-Fan
YF
D000038:Abscess / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D013158:Splenic Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography