Radiology in the diagnosis of splenic abscess

Radiologic findings in 20 patients with splenic abscesses were reviewed. Chest roentgenograms frequently showed abnormalities which were nonspecific and nondiagnostic. Results of barium sulfate studies were normal in 66.7% of patients tested. Gas beneath the left side of the diaphragm or within the splenic shadow was revealed by abdominal plain film or barium sulfate study in three patients. Focal splenic abnormalities were present in 50% of the patients who underwent 99mTc sulfur colloid scans; in 71.4% of patients who underwent 67Ga scans, increased uptake of isotope was seen in the left upper quadrant of the abdomen. In only one of six patients who underwent both 99mTc and 67Ga scans did results show corresponding abnormalities. Pathologic findings in the left upper quadrant of the abdomen were detected by ultrasonography in three of five patients. Angiography confirmed splenic abscess in one patient. Abnormal splenic lucencies were seen on computed tomography in four patients, although one repeat scan was interpreted as normal. Although no one technique consistently detected splenic abscesses and data from several studies are combined, computed tomography appears the best modality. The diagnosis of splenic abscess and the decision for surgical intervention should be based on clinical impressions, even in the absence of unequivocal radiologic findings.