Splenic infarct

Case contributed by A.Prof Frank Gaillard

Presentation

Acute onset of left flank pain and pleuritic pain.

Patient Data

Age: 30 years
Gender: Male
CT

CT KUB

The spleen is enlarged. Involving the lateral aspect an ill-defined region of low density is seen, abutting the capsule. Incidental note is made of a small region of hepatic focal fatty change in segment 4 abutting the ligament teres.

Within the limits of a non contrast study, remaining solid abdominal viscera and hollow viscus structures, including bowel, are normal. The appendix is normal (not shown).

Conclusion

Low density region within an enlarged spleen suggests the presence of a splenic infarct may account for the patient's presentation. The underlying cause for the patient's splenomegaly is not evident on this scan.

Further assessment with contrast enhanced CT is recommended to confirm the diagnosis and evaluate for other regions of infarction.

CT

CT abdomen

The splenic enlargement and a wedge shaped infarct is confirmed. A rounded low density lesion in the adrenal gland on the right is noted, which in retrospect is visible on the noncontrast scans and has, on those scans, a density measurement of 5 HU, consistent with an incidental adrenal adenoma.

The liver is at the upper limit of normal in size and her main portal vein is enlarged measuring 17 mm in diameter. The splenic vein is also enlarged. Focal fatty change is again demonstrated. No focal lesions. The remainder of the upper abdominal solid viscera are unremarkable, with no other infarcts identified. No lymph node enlargement and no focal osseous lesion.

Conclusion

Splenic infarcts is confirmed and presumably accounts of the patient's presentation. The cause of the patient's splenomegaly is uncertain, although the main portal vein and splenic vein do appear enlarged as does the liver raising the possibility of portal hypertension. Incidental adrenal adenoma.

Case Discussion

This case highlights the need to remember the differential of regional pain when assessing CT KUB for nephrolithiasis. 

Related articles

  • splenic infarct
  • adrenal adenoma
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Case information

rID: 14504
Case created: 2nd Aug 2011
Last edited: 1st Sep 2016
Tag: spleen
Inclusion in quiz mode: Included

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