perisplenitis

Perisplenitis is acute inflammation of the splenic capsule and its peritoneal covering.

Epidemiology

It is seen uncommonly but there is no data on its actual incidence.

Clinical Presentation

It is seen usually in young and middle-aged patients, with acute left hypochondrial or lower chest pain which may simulate left pleuritic pain or an acute abdomen.

Pathology

Acute edematous inflammation of the splenic capsule and peritoneal covering. Recurrent attacks may lead to capsular thickening and calcification. It is usually associated with splenomegaly caused by diseases such as sickle cell disease, thalassemia, bilharzia, malaria, and lymphoma.

Radiographic features

CT imaging reveals a persistent, non-enhancing, circumferential subcapsular thin rim of edematous marginal splenic tissue. CT can aid in identifying complications such as splenic abscess formation. Finally, CT helps to exclude other differential diagnoses with similar clinical presentations like splenic infarcts or rupture.

Treatment and prognosis

Treatment is with anti-inflammatories +/- prophylactic antibiotics in the acute stage. In recurrent perisplenitis, a splenectomy may be considered. A complication of untreated perisplenitis is a splenic abscess.

Differential diagnosis

splenic infarct: usually focal, wedge-shaped and deep in location
splenic abscess: ring enhancing collection