Splenic abscess


  • A 48 years old lady
  • Underlying DM and HPT
  • Presented with left flank pain for 2 weeks
  • Associated with fever
Abdominal radiograph AP supine view

Radiographic findings:

  • Prominent soft tissue shadow at left lumbar region.
  • Minimal indentation to medial wall of bowel loops.
  • No calcification seen. Bones are unremarkable.

Ultrasound findings:

  • A well-defined homogenous subcapsular splenic collection with layering sediments is seen compressing the splenic parenchyma, measuring about 10.7cm x 5.0cm.
  • No vascularity or calcification within.
  • Otherwise the spleen is normal in size and splenic parenchyma appears homogenous.
CT scan of abdomen in axial planes, post contrast soft tissue window.

CT scan findings:

  • The spleen is enlarged. Presence of a large subcapsular collection mainly laterally measuring about 10.3cm (AP) x 4.3cm (W) x 8.6cm (CC).
  • There is associated fat streakiness adjacent to the collection.
  • No septation, calcification or solid component is seen within the collections.
  • The left hemi-diaphragm appears elevated and thickened with adjacent minimal left pleural effusion seen.
  • Presence of left pleural effusion and basal atelectasis on the left side.

Diagnosis: Splenic abscess


  • Splenic abscesses are uncommon
  • The main causes include immunodeficiency conditions, hematogenous spread of distant infection, contiguous infection from adjacent infection such as perinephric abscess, trauma or from splenic infarction.
  • Ultrasound appearance ranges from predominantly hypoechoic to hyperechoic with internal echoes. They may contain septa of varying thickness.
  • CT scan normally shows low density (HU20-40) with minimal peripheral enhancement. Ascites and adjacent pleural effusion is commonly seen.

Progress of patient:

  • Percutaneous drainage of abscess done
  • Patient treated with antibiotic
  • HIV, Hepatitis screening negative
  • Connective tissue screening is also negative
  • Cytology report of splenic aspirate consistent with abcess. No suspicious cell seen.
  • Culture of splenic aspirate grows E.coli.
  • AFB negative
Author: radhianahassan