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Splenic abscess
Other Resources UpToDate PubMed

Splenic abscess

Contributors: Michael W. Winter MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

A splenic abscess is a walled-off infection within the spleen. Splenic abscesses are rare, although their identification has increased with more readily available cross-sectional imaging. Trauma, immunosuppression, and infection are the primary risk factors for developing a splenic abscess. Infection can occur spontaneously, often in the setting of immunosuppression, seeding from endocarditis, or as a result of ischemic injury with secondary abscess formation.

Patients most typically present with fevers, emesis, and left upper quadrant abdominal pain. They may have splenomegaly. Causal organism varies by risk factor:
  • Streptococcus and Staphylococcus: seen in patients with endocarditis
  • Escherichia coli and Klebsiella pneumoniae: seen in patients with intraabdominal infections
  • Mycobacterium tuberculosis, Mycobacterium avium complex, Salmonella typhi, and Pneumocystis jiroveci: seen in patients with human immunodeficiency virus (HIV) disease and AIDS
  • Mycobacterium spp., fungi (Candida albicans), protozoa: seen in immunocompromised patients
Splenic abscesses can form fistulae within the gastrointestinal tract, pleural space, or lung parenchyma or they may perforate, leading to peritonitis.

Codes

ICD10CM:
D73.3 – Abscess of spleen

SNOMEDCT:
82053000 – Splenic abscess

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Gastroenteritis
  • Gastritis
  • Peptic ulcer disease
  • Chronic constipation
  • Splenic infarction
  • Splenic rupture or laceration
  • Acute pancreatitis, Pancreatic pseudocyst
  • Acute coronary syndrome
  • Pneumonia (Viral pneumonia, Streptococcus pneumoniae pneumonia)
  • Renal calculus
  • Pyelonephritis
  • Mesenteric ischemia (Acute mesenteric ischemia or Chronic mesenteric ischemia)
  • Ischemic colitis
  • Inflammatory bowel disease (Crohn disease or Ulcerative colitis)
  • Irritable bowel syndrome
  • Splenic pseudoaneurysm
  • Large bowel obstruction
  • Small bowel obstruction
  • Endometriosis
  • Abdominal wall pain
  • Familial Mediterranean fever
  • Mononucleosis
  • Hypersplenism
  • Sickle cell disease
  • Hemolytic anemia
  • Malaria
  • Splenic vein thrombosis
  • Budd-Chiari syndrome
  • Amyloidosis (AL amyloidosis, AA amyloidosis)
  • Sarcoidosis
  • Congestive heart failure
  • Malignancy (particularly Lymphoma / leukemia, metastasis, colorectal cancer)

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:02/06/2018
Last Updated:05/18/2020
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Splenic abscess
Copyright © 2024 VisualDx®. All rights reserved.