Tonolini Massimo, Bianco Roberto
Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157 Milan, Italy.
Emerg Radiol. 2013 Aug;20(4):323-32. doi: 10.1007/s10140-013-1103-2. Epub 2013 Jan 15.
The spleen is commonly involved in a wide spectrum of hematologic, immunologic, neoplastic, infectious, and vascular systemic disorders. Sometimes overlooked on imaging studies outside the trauma setting, the spleen may harbor severe infections, and occasionally undergoes spontaneous bleeding or rupture. This pictorial essay reviews common and unusual causes of nontraumatic acute abnormalities primarily involving the spleen, and their cross-sectional imaging appearances. Emphasis is placed on multidetector computed tomography (MDCT) imaging, which represents the modality of choice to comprehensively assess acute splenic disorders including partial or complete infarctions, vascular diseases such as venous thrombosis, abscess collections, bleeding, and rupture. State-of-the-art magnetic resonance imaging represents a problem-solving technique. Borrowing from experience with grading abdominal trauma according to the traditional American Association for the Surgery of Trauma scale, spontaneous splenic injuries are confidently detected and characterized at MDCT. Furthermore, MDCT allows to identify or exclude coexistent perisplenic and intraperitoneal hemorrhage, presence and source of active bleeding, and contained vascular injury. Occasionally idiopathic, spontaneous splenic injuries should be suspected when acute abdominal manifestations and signs of hemodynamic compromise occur in a background of acute viral infections, endocarditis or sepsis, malaria, immune suppression, hematological disorders, malignancies, coagulopathy, or therapeutic anticoagulation. These uncommon yet life-threatening conditions require prompt diagnostic evaluation that allows correct triage between conservative, medical, interventional, and surgical treatment, and may obviate splenectomy. Finally, MDCT imaging allows differentiation of splenic rupture from other rare causes of spontaneous hemoperitoneum, and reliable follow-up of nonsurgically treated patients.
脾脏常累及多种血液学、免疫学、肿瘤学、感染性及血管系统性疾病。在创伤情况以外的影像学检查中，脾脏有时会被忽视，它可能隐匿严重感染，偶尔会发生自发性出血或破裂。这篇图文并茂的文章回顾了主要累及脾脏的非创伤性急性异常的常见及罕见病因，以及它们的横断面影像表现。重点在于多排螺旋计算机断层扫描（MDCT）成像，它是全面评估急性脾脏疾病（包括部分或完全梗死、静脉血栓形成等血管疾病、脓肿、出血及破裂）的首选检查方法。先进的磁共振成像则是一种解决问题的技术。借鉴根据传统美国创伤外科学会分级标准对腹部创伤进行分级的经验，MDCT能够可靠地检测和鉴别自发性脾脏损伤。此外，MDCT还能识别或排除并存的脾周及腹腔内出血、活动性出血的存在及来源，以及隐匿性血管损伤。自发性脾脏损伤偶尔为特发性，当在急性病毒感染、心内膜炎或败血症、疟疾、免疫抑制、血液系统疾病、恶性肿瘤、凝血病或治疗性抗凝的背景下出现急性腹部表现及血流动力学不稳定体征时，应怀疑此病。这些罕见但危及生命的情况需要迅速进行诊断评估，以便在保守治疗、药物治疗、介入治疗及手术治疗之间进行正确的分类，且可能避免脾切除术。最后，MDCT成像能够区分脾脏破裂与其他罕见的自发性腹腔积血原因，并对非手术治疗患者进行可靠的随访。
