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Forty splenic infarcts in 23 patients were examined with ultrasound (US). At clinical presentation, splenic infarction was associated with severe left upper quadrant pain (n = 10) or diffuse abdominal pain (n = 4) or was asymptomatic (n = 9). In this retrospective study, predominantly wedge-shaped (n = 17) or round (n = 23), irregularly delineated (n = 33) or smooth (n = 7), hypoechoic (n = 40) and anechoic (n = 5) lesions were found at first examination. During follow-up observation, four patients died because of complications unrelated to infarct, and five patients underwent splenectomy as a consequence of US findings. Expanding intralienal liquefaction, increasing subcapsular hemorrhage, free peritoneal blood (even in spleens shown to have an intact surface at sonography), and flow phenomena in the area of infarction demonstrated at B-mode pulsed Doppler US were identified as infarct-related complications associated with the risk of splenic rupture. Despite the high self-healing tendency in splenic infarction, short-term follow-up with US is recommended for early recognition of these possible complications.

A case of symptomatic splenic infarct in an 11 year-old girl suffering from bacterial endocarditis is reported; this occurrence is a rare and serious condition in this disease. The diagnosis of haemorrhagic splenic infarct was suggested by ultrasonography and confirmed by MRI. No splenic abscess developed and this was correlated to a rapid improvement of the clinical state following an antibiotic treatment only. The authors discuss the role of sonography and MR in the etiologic diagnosis of splenic involvement in patients suffering from bacterial endocarditis.

In all the patients was performed angiography, while only 11 were studied by the means of Abdominal Ultrasonography. The Authors' aim is to evaluate the accuracy of these two methods and to define a correct diagnostic procedure. The results obtained with Angiography were 15 correct diagnosis and 1 false positive, whereas those obtained with Sonography were 7 correct diagnosis, 2 indicative diagnosis and 2 false negative. Therefore, when a patient is clinically suspected of having a traumatic spleen injury, the Authors suggest to perform an Abdominal Sonography at first. In case of evident spleen lesion, laparatomy will be directly carried out. However, if the sonographic result is negative or aspecific, it will be necessary for the patient to undergo Angiography in order to rule out possible false negative or establish the origin of endoabdominal bleeding correctly.

A 29 year old female with systemic lupus erythematosus had a splenic infarct. The echogram showed a 4 x 4 x 5 cm cluster of echoes. After splenectomy the preoperative echograms were matched to the gross pathological findings and a post mortem water bath scan. In this single patient, the echosplenograms were of considerable aid in confirming the accuracy of the diagnosis of splenic infarct.

The sonographic findings in eight cases of splenic infarct at their onset and at different phases of their development have been retrospectively analyzed. A wide range of appearances was seen (single or multiple, rounded or wedge-shaped, echo-free, hypoechoic, and hyperechoic lesions). In our opinion, such variable appearances are related to the age of the infarct (hypoechoic or echo-free in the earlier stages, hyperechoic in healed infarcts). A presumptive diagnosis is possible in the earlier stages since the detection of changes (in echogenicity and/or in size) over a period of time strongly suggests an infarct. On the other hand, a hyperechoic wedge-shaped lesion is fairly typical of healed infarcts.

Sonography of the spleen allows exact measurements of this organ. There are typical pictures in cysts or hematomas. Diffuse changes of the spleen however are hardly distinguishable in regard to differential diagnosis. Retroperitoneal masses can easily be recognized. Lymph-nodes can be identified and the results of therapeutic interventions can be judged. Hematomas or abscesses can be seen easily. Guided needle biopsy offers the possibility for histologic examinations.

After undergoing therapeutic transcatheter embolization of the splenic artery for treatment of portal hypertension, 11 consecutive patients were evaluated with sulfur colloid scintigraphy and real-time sonography of the left upper quadrant to determine which method was better for follow-up evaluation of the spleen. Six splenic infarcts were documented by both imaging methods; sonography, however, demonstrated the characteristic wedge shape of the infarct in four of the six cases. There were no cases of splenic abscess formation. Sonography should be the primary method for evaluation of the spleen after transcatheter embolization and can help in planning treatment to avoid abscess formation.

Focal changes in the spleen were rare findings in a large clinical material (less than 1% of cases). In a prospective study, which included 580 patients, lesions in the spleen were found in 40. Four focal lesions were due to infiltrates from non-Hodgkin's lymphoma. Twenty-one lesions with low echoes consisted of twelve infiltrates from Hodgkin's disease (six patients) or non-Hodgkin's lymphoma (six patients), five were due to fresh splenic infarcts and one each to an abscess, a metastasis from a carcinoma of the stomach, sarcoid and a haemorrhage. In only three of ten highly echogenic foci was a diagnosis possible (one leukaemic infiltrate and two scars following splenic infarcts). The significance of the sonographic demonstration of focal splenic lesions for diagnosis and treatment is discussed. The advantages of a sector scanner for evaluation of the spleen and splenic size are mentioned.

Twenty-five patients with focal splenic disease were analyzed retrospectively to determine the relative strengths and weaknesses of ultrasound and computed tomography (CT) in the detection and analysis of focal splenic lesions. Lesions were detected in all 25 patients by ultrasonography and in 22 of 25 patients by CT. Ultrasonography appears to be more sensitive in the detection of focal lymphoma within the spleen and may be slightly more sensitive in the detection of microabscesses. CT may offer more specific information regarding the nature of certain lesions, including the detection of cyst wall calcification, gas within an abscess, and the specific site of origin of tumor invading the spleen. Ultrasonography may at times be more specific in the diagnosis of cystic lesions. We recommend ultrasonography as the first method for splenic imaging with CT used when necessary for further characterization of focal lesions.

The computed tomographic (CT) findings in eight patients with splenic infarction are described and correlated with ultrasound (US) in three. The diagnosis was proven in four by splenectomy or autopsy, in three by comparison with CT, having been obtained shortly before infarction, and in two by angiography. In four patients the infarct occurred as a result of hepatic or splenic artery embolization. The CT features of infarction may be difficult to differentiate from those due to trauma, inflammation or tumor, and include either a diffuse, a well circumscribed or an irregularly marginated area of low density within the spleen. Classical wedge-shaped defects are occasionally seen in the periphery of spleen. The ultrasonographic feature is usually that of a hypoechoic or an anechoic area in the spleen. In one patient, it became necessary to perform an ultrasound guided aspiration biopsy to rule out splenic abscess.