Presentation
2-day-old healthy term newborn with abnormal prenatal ultrasound. Pediatrics team concerned for asplenism or heterotaxy syndrome.
Patient Data
A liver spleen scan was performed with 99mTc sulfur colloid to evaluate for evidence of splenic tissue.
Planar imaging shows homogeneous hepatic uptake which extends into the LUQ. The spleen is not visualized.
Additional SPECT was performed to confirm the absence of the spleen. Again, the elongated left liver extends into the LUQ which correlates with US findings. No splenic tissue is present.
Abdominal ultrasound demonstrates an elongated left liver extending into the LUQ. No splenic tissue was identified.
Radiograph of the chest and abdomen demonstrates normal position of the gastric bubble within the LUQ. Due to the apparent rotation of the heart and concern for possible heterotaxy, an echocardiaogram was performed which confirmed dextroposition rather than dextrocardia.
Case Discussion
Congenital asplenia is an uncommon disorder. Initial identification of asplenia warrants further workup to ensure that an underlying heterotaxy syndrome is not present. In this case, no other findings suggested right-sided isomerism as part of a heterotaxy syndrome.
The liver-spleen nuclear medicine scan is an uncommon exam, but can be very useful for identifying and localizing splenic tissue. Potential uses include splenosis, polysplenia, or asplenia. 99mTc labeled damaged RBCs can also be utilized, but this has been largely replaced with the 99mTc sulfur colloid technique for ease of use.
Asplenia is important to diagnose due to an increased risk of life-threatening infections.
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