The possibilities of diagnostic radiology for the primary identification of spleen abscesses

 The issue on the differential diagnosis of formations of purulent-inflammatory etiology and the choice of treatment method taking into account the visual picture does not lose its relevance. Ultrasound (US) is not less crucial than computed tomography (CT) for the primary diagnosis of spleen abscesses. This article presents clinical observations of patients with suspected spleen abscesses admitted to the emergency room of the Novosibirsk City Clinical Hospital No. 1 with emergency indications for 2017–2022. All patients underwent ultrasound with Philips Affiniti 70G, Mindray M9, and General Electric Logiq P6 devices. While performing ultrasound in In-mode, attention was paid to the main signs: localization (in the parenchyma, subcapsular), quantity, contours (wall thickness), the nature of the abscess contents, dimensions (volume calculated according to the formula for irregularly shaped formations, A × B × C × 0.52), the presence or absence of effusion in pockets the spleen. The formations were classified by volume into small (up to 50 ml), medium (50–100 ml) and large (more than 100 ml). The main ultrasound signs in the seroscale mode have been determined. The presented clinical observations illustrate the possibilities of ultrasound for deciding on the method of treatment: for primary diagnosis (including emergency), it was possible to determine the presence of formations of purulent- inflammatory etiology, to determine the localization, the main signs in which minimally invasive treatment was effective (formed abscess of "medium" volume). Surgical abdominal treatment was preferable in the presence of multiple abscesses (without a formed capsule) of small size.

1. Rumer VB, Arablinskiy AV. CT semiotics of traumatic and bon-traumatic spleen injures. Medical Visualization. 2021;25(2):50–62. (In Russ.). doi: 10.24835/1607-0763-946

2. Hwang H, Baeg MK, Kim P, Kim YJ, Kang SH. Asymptomatic Splenic Cysts in an Immunocompromised Patient: Should They Be Investigated. Korean J Gastroenterol. 2018 Oct 25;72(4):209–212. doi: 10.4166/kjg.2018.72.4.209

3. Lee MC, Lee CM. Splenic Abscess: An Uncommon Entity with Potentially Life-Threatening Evolution. Can J Infect Dis Med Microbiol. 2018 Jan 31;2018:8610657. doi: 10.1155/2018/8610657

4. Lotfollahzadeh S., Mathew G., Zemaitis M.R. Splenic Abscess. 2021 Dec 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. PMID: 30137831.

5. Schafer JM, Welwarth J, Novack V, Balk D, Beals T, Naraghi L, et al. Detection of splenic microabscesses with ultrasound as a marker for extrapulmonary tuberculosis in patients with HIV : A systematic review. S Afr Med J. 2019 Jul 26;109(8):570–576. doi: 10.7196/samj.2019.v109i8.13783

6. Davido B, Dinh A, Rouveix E, Crenn P, Hanslik T, Salomon J. Abcès de la rate : du diagnostic au traitement [Splenic abscesses: From diagnosis to therapy]. Rev Med Interne. 2017 Sep;38(9):614–618. French. doi: 10.1016/j.revmed.2016.12.025

7. Lotfollahzadeh S, Mathew G, Zemaitis MR. Splenic abscess. StatPearls. 2020. URL: https://www.ncbi.nlm.nih.gov/books/NBK519546/. Date of application: 01/21/2021.

8. Mitkov VV. Practical guide to ultrasound diagnostics. 2^nd ed. Мoscow: "Vidar-M" Publ.; 2008, 698 p. (In Russ.).

9. Yurik IG, Grigoryuk AA, Kilin SD. Experience of minimally invasive treatment of spleen abscess under ultrasound control in a patient with a high operational risk. Pacific Medical Journal. 2021;2(84):96–98. (In Russ.).

10. Jaffe TA, Nelson RC. Image-guided percutaneous drainage : a review. Abdom Radiol (NY). 2016 Apr;41(4):629–636. doi: 10.1007/s00261-016-0649-3

11. Aktas A, Kayaalp C, Gundogan E, Gunes O, Pıskın T. Percutaneous Drainage of a Splenic Abscess via Laparoscopic Trocar in a Kidney Transplant Patient. Exp Clin Transplant. 2022 Jun;20(6):613–615. doi: 10.6002/ect.2018.0191

12. Lee HW, Han SB. Large Splenic Abscess Caused by Non-Typhoidal Salmonella in a Healthy Child Treated with Percutaneous Drainage. Children (Basel). 2020 Aug 3;7(8):88. doi: 10.3390/children7080088

13. Cho SY, Cho E, Park CH, Kim HJ, Koo JY. Septic shock due to Granulicatella adiacens after endoscopic ultrasound-guided biopsy of a splenic mass: A case report. World J Gastroenterol. 2021 Feb 28;27(8):751–759. doi: 10.3748/wjg.v27.i8.751

14. Puchkov SS, Faller AP. Challenges in diagnosing splenic abscesses in HIV-infected patients. Bulletin of the Medical Institute of Continuing Education. 2023;3(1):44–51. (In Russ.). EDN: GGITLB

15. Gutama B, Wothe JK, Xiao M, Hackman D, Chu H, Rickard J. Splenectomy versus Imaging-Guided Percutaneous Drainage for Splenic Abscess : A Systematic Review and Meta-Analysis. Surg Infect (Larchmt). 2022 Jun;23(5):417–429. doi: 10.1089/sur.2022.072