Title:Torsion of Wandering Spleen: Importance of Splenic Density and Liver-to- Spleen Attenuation Ratio on CT
Volume: 16
Author(s): Yusuf Kenan Cetinoglu*, Sebnem Karasu, Turan Acar, Muhsin Engin Uluc, Mehmet Haciyanli and Ozgur Tosun
Affiliation:
- Department of Radiology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Karabaglar, Izmir,Turkey
Keywords:
Wandering spleen, torsion, infarction, computed tomography, density, splenectomy, splenopexy.
Abstract: Background: Wandering spleen (WS) is a rare clinical condition which may cause fatal
complication like torsion with subsequent infarction. Determination of splenic parenchyma viability
is very important in deciding whether splenopexy rather than splenectomy is an option. Contrast-
enhanced computed tomography (CECT) is important for the diagnosis of WS and assessment
of the viability of spleen.
Discussion: We reviewed the CT studies of four cases with WS. We measured the mean splenic
and liver density and calculated liver-to-spleen attenuation ratio (LSAR). We also assessed the CT
findings for each patient. Mean splenic density was measured as 40.77 Hounsfield Unit (HU) in
cases with infarction, 127.1 HU in case without infarction. LSAR was calculated as 2.55 in cases
with infarction, 0.99 in case without infarction. We detected whirlpool sign, intraperitoneal free
fluid, splenic arterial enhancement in all patient, parenchymal and splenic vein enhancement in one
patient without infarction, fat rim sign in three patients with infarction, capsular rim sign in one patient
with infarction.
Conclusion: CECT should be obtained for the diagnosis of WS and assessment of the viability of
spleen. CECT could suggest the diagnosis of infarction of the spleen with following findings; absence
of parenchymal enhancement, very low density of spleen (<45 HU), and LSAR which is
greater than 2.
