Splenic epidermoid cyst

Case contributed by Dr Craig Hacking

Presentation

Fever and derranged LFTs post gastroenteritis and overseas travel.

Patient Data

Age: 32
Gender: Male
Modality: Ultrasound

The spleen is enlarged ( 16.5 cm ). There is a 4.8 cm lesion with mobile echogenic debris and no increased vascularity in the lower aspect of the spleen. Adjacent to this is a smaller 1.7 cm simple cyst.

The liver has normal echotexture and echogenicity with no focal lesion. The gallbladder is normal in appearance with no stones or sludge and no wall thickening. The main portal vein is non-dilated and flow is normal direction. There is no biliary dilatation. The pancreas is normal in appearance. The kidneys are normal in size and appearance.

Conclusion

The larger splenic lesion with uniform internal low level echoes has features of epidermoid cyst and would be atypical for an abscess.

Modality: CT

Multiple hypodense splenic lesions:

  • 19 mm lesion in the inferior anterior spleen corresponding to simple cyst demonstrated on ultrasound.
  • 49 mm lesion in the mid spleen (HU 26), as demonstrated on ultrasound
  • 12 mm lesion in the anterior superior spleen (HU45)
  • 34 mm lesion in the subcapsular superior spleen (HU23)
  • 16 mm lesion in the posterior superior spleen (HU 33)

The liver, adrenal glands, kidneys, pancreas and bowel including appendix are unremarkable. No free intra abdominal fluid or air identified.

Minor dependent lung changes in image bases. The appendix is normal in appearance.

Prominent right hilar fossa and para-aortic lymph nodes measuring at the upper limits normal.

Conclusion

Multiple hypodense splenic lesions are non-specific in appearance on CT criteria. Their density is not of simple cysts however there is no rim enhancement to suggest abscess. Review of the recent US suggests these lesions likely to reflect epidermoid cysts.

Retrospective correlation with an external CT from a year ago shows these lesions to be unchanged, confirming the diagnosis of epidermoid cysts.

Case Discussion

Epidermoid cysts are a relatively common cause of benign non-infective cystic lesions of the spleen. They are congenital, rarely become symptomatic or complicated and usually present incidentally.

In this case, the presentation of fever and recent overseas travel made splenic abscess more concerning but correlation with previous imaging (before the travel) showed the lesions were unchanged.

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Case Information

rID: 35770
Case created: 22nd Apr 2015
Last edited: 17th Sep 2016
Inclusion in quiz mode: Included

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