EURORAD ESR

Case 15356

Torsion of wandering spleen without infarction

Author(s)
Nicola Tarallo1, Larissa Nocchi Cardim1, Valeria Molinelli1, Anna Leonardi1, Giorgia Ottini2, Stefano Rausei3, Carlo Fugazzola1

1 Ospedale di Circolo di Varese, University of Insubria, Department of Radiology; Viale Borri 57 21100 Varese, Italy; Email:laranocchi@gmail.com
2 Ospedale di Circolo di Varese, University of Insubria, Department of Anatomical Pathology; Viale Borri 57 21100 Varese, Italy
3 Ospedale di Circolo di Varese, University of Insubria, Department of Surgery; Viale Borri 57 21100 Varese, Italy
 
Patient
female, 35 year(s)
 
 
  • Figure 1
    US examination
     

    a) US axial scan shows an enlarged spleen (bipolar diameter 18 cm) with normal echogenicity located in pelvis.

     
    Area of Interest: Abdomen; Imaging Technique: Ultrasound; Procedure: Imaging sequences; Special Focus: Hyperplasia / Hypertrophy;

    b) Colour-Doppler scan of the splenic hilum demonstrates patency of the splenic artery without flow anomalies.

     
    Area of Interest: Abdomen; Imaging Technique: Ultrasound; Procedure: Imaging sequences; Special Focus: Hyperplasia / Hypertrophy;

    c) Colour-Doppler scans show patency of the spleno-portal confluence.

     
    Area of Interest: Abdomen; Imaging Technique: Ultrasound; Procedure: Imaging sequences; Special Focus: Hyperplasia / Hypertrophy;

    d) Colour-Doppler scans show patency of the portal vein.

     
    Area of Interest: Abdomen; Imaging Technique: Ultrasound; Procedure: Imaging sequences; Special Focus: Hyperplasia / Hypertrophy;
     
     
  • Figure 2
    CT axial examination
     

    a) (without contrast medium): enlarged spleen located in the pelvis; no haemorrhagic areas.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Hyperplasia / Hypertrophy;

    b) (after contrast medium, venous phase): the spleen shows homogeneous contrast enhancement without ischaemic areas. Heterogeneous peri-hilar fat is due to vascular congestion (arrow).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Hyperplasia / Hypertrophy;
     
     
  • Figure 3
    CT axial examination, caudocranial sections
     

    a) In arterial phase, the tortuous and spiraliform vascular pedicle path (whirl sign) is visualised with splenic artery in its core (arrow) and numerous patent collateral veins running a spiral course (arrowheads).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Hyperplasia / Hypertrophy;

    b) In venous phase, the tortuous and spiraliform vascular pedicle path (whirl sign) is visualised with numerous patent collateral veins running a spiral course (arrowhead); the pancreatic tail is not involved.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Hyperplasia / Hypertrophy;

    c) In venous phase, numerous varicoid collateral venous circles (arrows) are observed, suggesting a chronic history.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Hyperplasia / Hypertrophy;

    d) In venous phase, small gastric varices (arrow) are observed, suggesting a chronic history.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Hyperplasia / Hypertrophy;
     
     
  • Figure 4
    Contrast-enhanced CT reconstructions
     

    a) MIP-paracoronal reconstruction (venous phase): the spleen is located in the pelvis. Multiple collateral veins in whorled appearance are suggestive of pedicle torsion; splenic artery is present in its core (arrow).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Hyperplasia / Hypertrophy;

    b) 3D volume rendering reconstruction (arterial phase) shows the long splenic artery (arrows).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Hyperplasia / Hypertrophy;

    c) 3D volume rendering reconstruction (venous phase) demonstrates numerous varicoid collateral venous circles, located predominantly in the left quadrants (arrowheads).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Hyperplasia / Hypertrophy;
     
     
  • Figure 5
    Laparoscopic view

    Twisted vascular pedicle in "whirl" appearance to enter the splenic hilum, with helically engorged collateral veins (arrows); S (spleen).

     
    Area of Interest: Abdomen; Imaging Technique: Experimental; Procedure: Endoscopy; Special Focus: Hyperplasia / Hypertrophy;
     
     
  • Figure 6
    H&E stain, 4x

    Spleen congestion, characterised by B cell follicles thinning, expansion of red pulp with sinuses dilatation.

     
    Area of Interest: Abdomen; Imaging Technique: Experimental; Procedure: Imaging sequences; Special Focus: Hyperplasia / Hypertrophy;
     
     
a) US axial scan shows an enlarged spleen (bipolar diameter 18 cm) with normal echogenicity located in pelvis.
 
b) Colour-Doppler scan of the splenic hilum demonstrates patency of the splenic artery without flow anomalies.
 
c) Colour-Doppler scans show patency of the spleno-portal confluence.
 
d) Colour-Doppler scans show patency of the portal vein.
 
a) (without contrast medium): enlarged spleen located in the pelvis; no haemorrhagic areas.
 
b) (after contrast medium, venous phase): the spleen shows homogeneous contrast enhancement without ischaemic areas. Heterogeneous peri-hilar fat is due to vascular congestion (arrow).
 
a) In arterial phase, the tortuous and spiraliform vascular pedicle path (whirl sign) is visualised with splenic artery in its core (arrow) and numerous patent collateral veins running a spiral course (arrowheads).
 
b) In venous phase, the tortuous and spiraliform vascular pedicle path (whirl sign) is visualised with numerous patent collateral veins running a spiral course (arrowhead); the pancreatic tail is not involved.
 
c) In venous phase, numerous varicoid collateral venous circles (arrows) are observed, suggesting a chronic history.
 
d) In venous phase, small gastric varices (arrow) are observed, suggesting a chronic history.
 
a) MIP-paracoronal reconstruction (venous phase): the spleen is located in the pelvis. Multiple collateral veins in whorled appearance are suggestive of pedicle torsion; splenic artery is present in its core (arrow).
 
b) 3D volume rendering reconstruction (arterial phase) shows the long splenic artery (arrows).
 
c) 3D volume rendering reconstruction (venous phase) demonstrates numerous varicoid collateral venous circles, located predominantly in the left quadrants (arrowheads).
 
Twisted vascular pedicle in "whirl" appearance to enter the splenic hilum, with helically engorged collateral veins (arrows); S (spleen).
 
Spleen congestion, characterised by B cell follicles thinning, expansion of red pulp with sinuses dilatation.
 
 
 
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