Autosplenectomy denotes spontaneous infarction of the spleen with resulting hyposplenism.
Autosplenectomy is most frequently encountered in patients with homozygous sickle cell disease, although it has also been reported in pneumococcal septicaemia 1, and SLE 2. The demographics thus match those of sickle cell disease, usually occurring gradually in childhood with complete autosplenectomy achieved by the age of 8 4.
Clinically, patients may be asymptomatic accruing gradual damage, or more commonly present with repeated episodes of acute left upper quadrant pain due to splenic infarction. Pain may be referred via the diaphragm to the shoulder.
The spleen is susceptible to repeated episodes of focal veno-occlusive disease with infarction resulting in gradual perivascular fibrosis and shrinkage of the organ.
As the spleen infarcts it shrinks and calcifies, becoming as little as 1 cm in diameter 6.
If heavily calcified, the splenic remnant may be visible in the left upper quadrant.
Ultrasound will either not be able to demonstrate a spleen at all, or identify a small irregular and shadowing nodule in the splenic bed.
CT easily identifies the abnormally small and irregular splenic remnant, which is usually calcified.
Technetium-99m liver-spleen scans fail to demonstrate any splenic uptake.
Treatment and prognosis
The absence of a spleen leads to a number of haematological changes, the most important being that of a predisposion to overwhelming sepsis from encapsulated organisms including Pneumococcus and Haemophilus influenzae.
Prophylactic administration of penicillin has significantly reduced the incidence of infant and early childhood mortality from such infection 3.
- surgical splenectomy
- Thorotrast (thorium dioxide) accumulation: usually both the liver and lymph nodes are also affected
- wandering spleen
- normal appearance of the spleen
- pseudolesion of the spleen: inhomogeneous splenic enhancement
splenic lesions and anomalies
- congenital anomalies
- mass lesions
- infiltrative processes
- incidental splenic lesion (approach)
- 1. Eshel Y, Sarova-pinhas I, Lampl Y et-al. Autosplenectomy complicating pneumococcal meningitis in an adult. Arch. Intern. Med. 1991;151 (5): 998-9. Arch. Intern. Med. (link) - Pubmed citation
- 2. Leipe J, Hueber AJ, Kallert S et-al. Autosplenectomy: rare syndrome in autoimmunopathy. Ann. Rheum. Dis. 2007;66 (4): 566-7. doi:10.1136/ard.2006.063313 - Free text at pubmed - Pubmed citation
- 3. Claster S, Vichinsky EP. Managing sickle cell disease. BMJ. 2003;327 (7424): 1151-5. doi:10.1136/bmj.327.7424.1151 - Free text at pubmed - Pubmed citation
- 4. Gruchy GC, Firkin F. De Gruchy's clinical haematology in medical practice. Wiley-Blackwell. (1989) ISBN:0632017155. Read it at Google Books - Find it at Amazon
- 5. Harisinghani MG, Mueller PR. Teaching Atlas of Abdominal Imaging. Thieme. (2009) ISBN:1588906566. Read it at Google Books - Find it at Amazon
- 6. Johnson CD, Schmit GD. Mayo Clinic gastrointestinal imaging review. Informa HealthCare. (2005) ISBN:0849397952. Read it at Google Books - Find it at Amazon