Splenic cyst

Clinical History

A 24-year-old female patient was admitted to our hospital referring epigastric pain and sense of fullness. Past medical history included irritable bowel syndrome. Body temperature was 37.6°C and WBC=12.000/μL. An abdominal ultrasound examination was requested.

Imaging Findings

The ultrasound examination revealed a large (maximal diameter around 10 cm) rounded splenic mass with inhomogeneous echotexture.
An abdominal CT was then performed that showed a sharply demarcated, unilocular cystic lesion with attenuation similar to water (a little higher).
The patient was treated with splenectomy and the obtained tissues were sent to the pathology laboratory for histological analysis.

Discussion

Splenic cysts are considered to be rare clinical entities. A practical classification distinguishes between primary (with endocystic epithelial coating) and secondary-false (without endocystic epithelial coating) cysts [1].Primary cysts can be either parasitic or non parasitic (probably deriving from mesothelial inclusions in the splenic parenchyma during development). Secondary cysts may derive from trauma or degenerative and infiammatory processes [2].
Clinical presentation depends upon the cyst's dimension. A large cyst may present as a palpable abdominal mass, or with symptoms related to space occupying effects (sense of fullness, nausea, vomiting, flatulence). They may also present with complications such as haemorrhage, rupture or infection. Sometimes they are discovered incidentally [3].
Abdominal ultrasonography is very useful on determining whether a splenic mass is cystic or solid but in case of doubt computed tomography and magnetic resonance can provide additional information regarding the morphology of the cyst and its relationship with other structures of the anatomical region [3, 4].
Treatment options are related to parameters such as the cyst's size and type. More conservative surgery options are preferred in order to preserve as much of splenic parenchyma as possible, and maintain the important immunologic splenic functions [5].

Differential Diagnosis List

Final Diagnosis

Primary non parasitic splenic cyst

URL:	https://www.eurorad.org/case/9844
DOI:	10.1594/EURORAD/CASE.9844
ISSN:	1563-4086