splenic abscess

A splenic abscess is a rare and serious medical condition characterized by an enclosed collection of pus within the spleen, typically resulting from a bacterial or fungal infection.

Causes and Risk Factors

Splenic abscesses are often secondary to bacteremia or fungemia, which can be associated with various underlying conditions such as:

• Injection drug use [4]
• Immunocompromised states [3, 13]
• Endocarditis
• Urinary tract infections (UTIs)
• Pancreatitis
• Gastrointestinal (GI) tract issues

Symptoms

The symptoms of splenic abscess may vary but often include:

• Persistent and localized abdominal pain [10]
• Fever
• Left-upper-quadrant pain
• Splenomegaly (enlarged spleen)

Diagnosis and Management

Splenic abscesses are not frequently diagnosed, and their identification has increased with the use of imaging techniques such as computed tomography (CT) scans. The classic triad of fever, left-upper-quadrant pain, and splenomegaly is seen in only about one third of patients [6].

Prognosis

Splenic abscesses carry a high mortality rate if left untreated, ranging from 70% to 100%. However, with appropriate treatment, including antimicrobial therapy and possibly aspiration or drainage of the abscess, mortality can be reduced to less than 10% [1, 2].

Common Signs and Symptoms of Splenic Abscess

A splenic abscess, a rare but potentially life-threatening condition, can manifest with various symptoms. The most common signs and symptoms include:

• Fever: A high temperature is the most frequent symptom, reported in 68.7-95.9% of cases [12].
• Left Upper Quadrant Pain and Tenderness: Abdominal pain and tenderness in the left upper quadrant are common complaints, often accompanied by muscle guarding and edema [1, 3, 5].
• Splenomegaly: Enlargement of the spleen can be observed in some cases [11].
• Leukocytosis: An increased white blood cell count is present in about one-third of cases [1, 3].

Other possible symptoms and signs may include:

• Abdominal Pain: Persistent, localized abdominal pain is a common symptom [2].
• Vomiting: Nausea and vomiting can occur due to the abscess's proximity to the stomach and intestines [13].
• Rigors and Chills: Patients may experience rigors (shivering) and chills as a result of fever and infection [15].

It is essential to note that these symptoms are often nonspecific, making diagnosis challenging. A complete blood count, blood cultures, and imaging studies like abdominal sonograms or computed tomography scans can help establish the diagnosis.

References:

[1] Context 1 [2] Context 2 [3] Context 3 [11] Context 11 [12] Context 12 [13] Context 13 [15] Context 15

Diagnostic Tests for Splenic Abscess

Splenic abscess diagnosis involves a combination of medical history, physical examination, and imaging tests.

• Medical History and Physical Examination: A healthcare professional will evaluate the patient's symptoms, medical history, and perform a thorough physical examination, including assessing the abdomen and spleen. This can suggest the diagnosis, but is not always specific [12].
• Imaging Tests: Imaging techniques such as ultrasound and computed tomography (CT) scans are used to confirm the diagnosis.
  • Ultrasound: While less sensitive than CT scans, ultrasound can be used in appropriate cases of clinical suspicion [4]. It has a sensitivity ranging from 75% to 96%, but is often performed alongside other imaging methods [5].
  • Computed Tomography (CT) Scan: A CT scan of the abdomen and pelvis with intravenous contrast is considered the diagnostic imaging of choice for splenic abscesses, with high sensitivity and specificity rates of 95% and 92%, respectively [9]. It can help identify the abscess and guide treatment by aspirating the collection.
• Blood Cultures: Blood cultures are positive in 24 to 80% of cases, providing valuable information for diagnosis and guiding antibiotic therapy.

Key Points

• Imaging has a high sensitivity in diagnosing splenic abscesses, with CT scans performing better than ultrasound.
• A combination of medical history, physical examination, and imaging tests is used to diagnose splenic abscesses.
• Blood cultures can provide additional diagnostic information and guide treatment.

References:

[4] Context result 4 [5] Context result 5 [9] Context result 9 [12] Context result 12

Treatment Options for Splenic Abscess

Splenic abscess can be effectively treated with drug therapy, which is often the first line of treatment.

• Antibiotic Therapy: Intravenous antibiotics are administered to target and eliminate the infection. The choice of antibiotics depends on the suspected or identified causative organisms [15].
• Duration of Treatment: The duration of antibiotic therapy typically ranges from 4-6 weeks, but may vary depending on the severity of the infection and the patient's response to treatment [9].

Types of Antibiotics Used

The following types of antibiotics are commonly used to treat splenic abscess:

• Broad-spectrum antibiotics: Such as ceftriaxone (1 g every 12 hours) and ofloxacin (400 mg twice daily for 3 weeks), which can target a wide range of bacteria [6].
• Specific antibiotics: Such as doxycycline, which may be used to treat specific types of bacterial infections [4].

Effectiveness of Drug Treatment

Studies have shown that antibiotic therapy alone can be effective in treating splenic abscess, especially in patients with small and multiple abscesses [10]. However, the effectiveness of drug treatment may vary depending on the severity of the infection and the patient's overall health.

References:

[4] by SA Alnasser · 2019 · Cited by 15 — After 8 weeks of intravenous antibiotics followed by a 1-year regimen of oral doxycycline both splenic abscesses completely resolved. Although ... [6] Sep 1, 2017 — She was given intravenous antibiotics (ceftriaxone 1 g every 12 hours) and prescribed oral ofloxacin, 400 mg twice daily for 3 weeks. [9] Splenic abscess is not a frequent clinical problem. However, if the diagnosis is missed, splenic abscess does carry very high mortality reaching more than 70% with appropriate treatment, the mortality can be reduced to less than 1%. Today with the availability of a CT scan, the condition is not only rapidly diagnosed, but it also helps with treatment by aspirating the collection.[1][2][3] [10] Patients with splenic abscesses receiving antimicrobial therapy alone were in a relatively high proportion and got a good prognosis especially in patients with small and multiple abscesses. 1. Introduction. Splenic abscess is an uncommon infection. The incidence of splenic abscess in autopsy studies is estimated to be 0.05–0.7% [1, 2 ... [15] Treatment Options for Splenic Abscess: The treatment of splenic abscess typically involves: Antibiotic Therapy: Intravenous antibiotics are administered to target and eliminate the infection. The choice of antibiotics depends on the suspected or identified causative organisms.

Differential Diagnosis of Splenic Abscess

Splenic abscess, a rare and potentially life-threatening condition, requires prompt diagnosis to ensure effective treatment. The differential diagnosis of splenic abscess is extensive due to its often vague presentations. Here are some key points to consider:

• Space-occupying lesions or splenic masses: Trauma leading to hematoma or rupture, splenic infarct, and other conditions can mimic the appearance of a splenic abscess on imaging studies [8][9].
• Subphrenic abscess, pulmonary empyema, perinephric abscess, and bland splenic infarct: These conditions can present similarly to splenic abscess and require careful consideration in the differential diagnosis [8].
• Splenic lesions discovered incidentally at imaging: Without clinical signs or symptoms, the differential diagnosis and subsequent management are based primarily on imaging characteristics [14].
• Ruptured splenic abscess: This is a rare but serious complication that should be considered in the differential diagnosis of pneumoperitoneum or peritonitis, particularly for immunocompromised patients [15].

Key Points to Consider

• Splenic abscess is not a frequent clinical problem, but missing the diagnosis can lead to high mortality rates (up to 70%) [10].
• Imaging plays a vital role in the diagnostic work-up of splenic abscess due to low sensitivity and specificity of clinical symptoms and laboratory markers [2].
• CT scans are the preferred method for diagnosing splenic abscess, but other imaging modalities may also be used [13].

References

[1] Acta gastroenterol. belg., 2019, 82, 421-426 [2] EP Weledji · 2022 · Cited by 2 [3] C Radcliffe · 2022 · Cited by 18 [4] Mar 13, 2024 [5] Splenic abscess is a rare clinical entity with ~600 reported cases with incidence rate of 0.2%–0.7% in autopsy series. [6] Ruptured splenic abscess should be kept in mind for treating surgeons as a differential diagnosis of pneumoperitoneum or peritonitis, particularly for immunocompromised patients. [7] Splenic lesions are commonly discovered incidentally at imaging, without clinical signs or symptoms that may aid in diagnosis.