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Best Cases from the AFIP

Splenic Torsion¹

¹ From the Department of Radiology, Penn State University, Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA 17033-0850. Received June 13, 2002; revision requested August 20 and received September 24; accepted September 25. Address correspondence to S.C. (e-mail: simmic@hotmail.com).

View larger version (109K): [in a new window]   Figure 1a.  Abdominal CT scans obtained with intravenously and orally administered contrast material demonstrate an enlarged, nonenhancing spleen (a); stranding and a whorl of concentric arcs in the region of the splenic hilum (arrow) (b); and posterior, medial, and inferior displacement of the pancreatic tail (*) (c).

View larger version (110K): [in a new window]   Figure 1b.  Abdominal CT scans obtained with intravenously and orally administered contrast material demonstrate an enlarged, nonenhancing spleen (a); stranding and a whorl of concentric arcs in the region of the splenic hilum (arrow) (b); and posterior, medial, and inferior displacement of the pancreatic tail (*) (c).

View larger version (111K): [in a new window]   Figure 1c.  Abdominal CT scans obtained with intravenously and orally administered contrast material demonstrate an enlarged, nonenhancing spleen (a); stranding and a whorl of concentric arcs in the region of the splenic hilum (arrow) (b); and posterior, medial, and inferior displacement of the pancreatic tail (*) (c).

View larger version (106K): [in a new window]   Figure 2.  US image of the left upper quadrant demonstrates an enlarged spleen with a patchy, heterogeneous echotexture. There are multiple areas of hypo- and hyperechogenicity that represent areas of hemorrhage (clot), infarction, and congestion. The spleen is superior to the stomach (ST) and left kidney (LK).

View larger version (138K): [in a new window]   Figure 3a.  Intraoperative photographs demonstrate an enlarged, engorged spleen with no tethering visceral attachments (a) and torsion of the vascular pedicle of at least 720° (b). The arc of pink tissue to the left (arrow) represents the colon, and the purple tissue superiorly (*) represents the stomach.

View larger version (141K): [in a new window]   Figure 3b.  Intraoperative photographs demonstrate an enlarged, engorged spleen with no tethering visceral attachments (a) and torsion of the vascular pedicle of at least 720° (b). The arc of pink tissue to the left (arrow) represents the colon, and the purple tissue superiorly (*) represents the stomach.

View larger version (113K): [in a new window]   Figure 4.  Photograph of the enlarged, engorged spleen (split longitudinally) demonstrates a large area of central hemorrhage and irregular texture that corresponds to the echotexture seen at US (cf Fig 2).

View larger version (130K): [in a new window]   Figure 5a.  (a) Photomicrograph of the spleen reveals nearly complete infarction of the parenchyma and marked splenic congestion with necrosis. (b) Photomicrograph of the spleen helps confirm thrombosis of the hilar vessels.

View larger version (167K): [in a new window]   Figure 5b.  (a) Photomicrograph of the spleen reveals nearly complete infarction of the parenchyma and marked splenic congestion with necrosis. (b) Photomicrograph of the spleen helps confirm thrombosis of the hilar vessels.