Purpose or Case Report: Splenic vessel thrombosis is a rare but potentially serious condition in the pediatric population. It may occur secondary to systemic infections, sickle cell hemoglobinopathies, dehydration, hypercoagulable states, or inflammatory and traumatic abdominal processes. Clinical presentation is variable including pain and fever but may be quite nonspecific, especially in infants. Although CT and MRI can confirm the diagnosis, US remains the first-line imaging modality and the most appropriate for follow-up, as it is non-invasive, radiation-free, widely available, and easily repeatable.
We present four pediatric cases (three boys and one girl, aged 55 days to 2 years) from our institutional database, demonstrating the US spectrum and evolution of splenic vessel thrombosis. In the acute phase, US shows a hypoechoic spleen or ill-defined, wedge-shaped peripheral hypoechoic lesions. Doppler imaging reveals absent or markedly reduced flow in splenic arterial or/and venous branches. In later stages, the spleen appears small and diffusely echogenic. Crucially, preservation of even subtle vascularity within small central or peripheral splenic areas, and most importantly the presence of an accessory spleen, represent favorable prognostic signs. Accessory spleens and viable subcapsular parenchymal areas, as in 3 out of 4 our cases, enlarge and progressively hypertrophy over subsequent months, maintaining splenic function. High-frequency linear transducers are indispensable for detecting subtle flow signals and viable parenchymal remnants, which are missed with standard curvilinear probes or even cross-sectional imaging. US ability to reveal these early details has been proved crucial in all our cases in assessing thrombosis extent, monitoring evolution and predicting outcome.
In conclusion, although rare, splenic vessel thrombosis in children requires high clinical suspicion and meticulous US evaluation. The use of high-frequency probes and careful grayscale and Doppler interrogation are key to early detection and prognosis assessment. In skilled hands, US not only serves as the initial diagnostic tool but often provides the decisive detail that determines outcome.
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