Air following splenic embolization: infection or incidental finding?

Area of Science:

• Radiology
• Interventional Radiology
• Infectious Disease

Background:

• Splenic embolization is increasingly used for nonoperative management of splenic injuries.
• Air within splenic infarction post-embolization is a frequent finding, raising questions about its infectious etiology.

Purpose of the Study:

• To determine if air within splenic infarction after embolization indicates infection or is an incidental finding.
• To correlate the presence and amount of air with clinical signs of infection.

Main Methods:

• Retrospective review of 96 inpatients undergoing splenic embolization over 3 years.
• Analysis of pre- and postembolization computed tomography scans for intraparenchymal and subcapsular air.
• Correlation of imaging findings with clinical signs of infection and culture results.

Main Results:

• 12 of 96 patients (12.5%) showed air within splenic infarction.
• Six patients with intraparenchymal air and no symptoms were managed conservatively.
• Two patients with subcapsular air/fluid underwent drainage with negative cultures; four with large air collections underwent splenectomy, with two showing infection (17% overall infection rate in patients with air).

Conclusions:

• Air within splenic infarction post-embolization is often an incidental finding.
• Infection is more likely in patients with large air collections and clinical signs of infection (50% infection rate in this series).
• Evaluation for infection via percutaneous sampling or splenectomy is indicated in symptomatic patients with significant air.