Milztorsion

Imaging

findings of splenic emergencies: a pictorial review. Splenic torsion in a patient with wandering spleen. (a) Coronal contrast-enhanced CT image reveals ‘ectopic wandering spleen’ (arrow) in the pelvis. (b) Axial contrast-enhanced CT at superior level than pelvis further demonstrates ‘whirling’ appearance (arrow) of splenic vessels, suggesting ‘torsion of the spleen’ as well. Normal parenchymal enhancement indicates lack of infarction

insightsimaging.springeropen.com • Open Access

Wandering

spleen • Wandering spleen with partial torsion - Ganzer Fall bei Radiopaedia

Bilodeau L, Wandering spleen with partial torsion. Case study, Radiopaedia.org (Accessed on 04 Dec 2022) https://doi.org/10.53347/rID-57990 • CC by-nc-sa 3.0 (modified)

Imaging

findings of splenic emergencies: a pictorial review. Splenic torsion. (a) Axial, (b) coronal and (c) sagittal contrast-enhanced CT images of a 17-year-old female with a history of recurrent abdominal pain and suspected Familial Mediterranean Fever show anteromedially displaced spleen (arrows). No contrast enhancement was observed in spleen parenchyma (asterisks), suggesting splenic infarct secondary to splenic torsion. Stomach (arrowheads) is posteromedially compressed by enlarged and torsed spleen

insightsimaging.springeropen.com • Open Access

Teenager with

abdominal pain and increased WBC and CRP. Axial CT with contrast of the upper abdomen in the portal venous phase (above left) shows the spleen is absent from the left upper quadrant and is instead seen in the midline of the pelvis (above right). Coronal (below left) and sagittal (below right) CT in the delayed phase show the spleen to be in the midline of the pelvis above the bladder. The splenic vascular pedicle had a whirlpool appearance (not provided). The diagnosis was splenic volvulus.

pediatricimaging.org • CC-by-nc-sa 4.0

Radiopaedia • CC-by-nc-sa 3.0 • de

Splenic volvulus (rare plural: volvuli) may be seen as a complication of a wandering spleen due to weakness of the splenic ligaments .

Clinical presentation

abdominal pain: mild to severe in intensity which depends on the degree of torsion
abdominal mass
abdominal discomfort
acute abdomen

Pathology

Laxity of splenic ligaments may lead to a wandering spleen . The spleen is identified anywhere in the abdomen or in the pelvis that ultimately results in splenic torsion that will lead to congestion, torsion, infarction or in severe cases splenic rupture .

The spleen wanders due to increased mobility-related to ligamentous laxity of its peritoneal attachments. Various factors of ligamentous laxity which encompass congenital and acquired etiology. In the congenital form, there is the failure of development of the normal splenic suspensory ligaments, including the lienorenal and gastrosplenic ligaments. The acquired form can happen in situations that weaken the ligaments, such as pregnancy (with subsequent high estrogen level) or trauma.

Radiographic features

Diagnosis is primarily done with Doppler ultrasound and CT .

Ultrasound

Ultrasonography reveals a round, hypoechoic, solid-looking mass in an ectopic or orthotopic location .

CT

CT scan is the gold standard test in cases of splenic volvulus .

ectopically located or malpositioned spleen
splenic vascular pedicle demonstrates a whirlpool configuration
contrast-enhanced CT demonstrates a low-density spleen with peripheral enhancement or no enhancement

Treatment and prognosis

Open or laparoscopic splenopexy is a spleen-saving technique that can be performed in cases of lack of infarction. Surgical intervention is mandatory in most of the cases .