Gonzalez Veronica,  Aupy Ariane,  Lulkin Solange

Final Pr. ID: Poster #: CR-007 (S)

Introduction: Accessory spleen is an abnormality represented by ectopic splenic tissue detached from the main body of the spleen. Torsion is a possible complication and it occurs exceptionally. Clinically it is characterized by a nonspecific acute or recurrent abdominal pain.
Case: A 12 years old female with recurrent abdominal pain and palpable mass on her left iliac fossa, that has been noticed a month before consultation. At the emergency service she was checked and complementary exams were requested.
US: In the left iliac fossa it was found a solid, rounded formation, with well-defined edges, which moved when the patient changed her position. It showed positive Doppler examination except for a focal hypoechogenic area, which was not vascularized. The structure reminded the spleen echogenicity.
CT: normal spleen parenchyma, shape and edges. At left iliac fossa, next to the lower pole of the kidney, a rounded well-defined image which showed heterogeneous EV enhancement with no opacification of the lower corner due to ischemia areas was seen. This image had a vascular hilum that connected to the main spleen vascular hilum. Further images where taken changing the patient position, where the movement of the mass was corroborated.
As a result of this exams we realized that the recurrent abdominal pain of the girl was due to an ectopic spleen that has been torsioned - detorsioned several times.
Conclusions: Usually, accessory spleen is asymptomatic. Torsion and infarction, rupture with bleeding, and infection with abscess are a very rare complications. Intermittent torsion-detorsion may produce recurrent episodes of abdominal pain caused by short-lasting ischemia of the accessory spleen or from direct mechanical irritation of surrounding organs.
To sum up, torsion of an accessory spleen is extremely rare and is still a diagnostic dilemma. So we should consider this any time a patient with abdominal pain (acute or recurrent) comes to us and other diagnosis failed to explain it. Read More

Authors:  Gonzalez Veronica , Aupy Ariane , Lulkin Solange

Keywords:  spleen, accesory, torsion

Sharma Priya,  Estrin Yvonne,  Loubriel Daphne,  Rajderkar Dhanashree

Final Pr. ID: Poster #: EDU-118

Learning Objective: This educational exhibit will review a variety of pediatric splenic lesions and their appearance on various specific multimodality imaging finding as seen on ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). This exhibit will also review an algorithm to approaching non-cystic splenic lesions in pediatrics. Read More

Authors:  Sharma Priya , Estrin Yvonne , Loubriel Daphne , Rajderkar Dhanashree

Keywords:  Splenic Lesions, Spleen, Algorithm

Silva De Campos Meneses Marcus Otavio,  Braojos Fernanda,  Prodigios Joice,  Guarilha Taísa,  Rodrigues Santos Luiz Antonio,  Souza Antonio

Final Pr. ID: Poster #: EDU-034

The spleen is frequently involved in a wide range of pathological processes, yet is insufficiently addressed in the radiology literature for the pediatric population. Understanding the embryological development of the spleen – originating as a mesodermal derivative that initially manifests as a condensation of mesenchymal cells within the dorsal mesogastrium and later translocates to the left side of the abdominal cavity as the stomach rotates – and recognizing its normal appearance in imaging methods are crucial for the accurate diagnosis of pathological processes. These processes vary from focal to diffuse spleen involvement and include anatomical variants (e.g., splenunculus), variations in size (e.g., splenomegaly), in number (e.g., polysplenia and asplenia), and in location (e.g., wandering spleen), as well as vascular (e.g., hemangioma and infarction), traumatic (e.g., lacerations), infectious (e.g., abscess), genetic (e.g., sickle cell disease) and neoplastic abnormalities (e.g., lymphoma and metastasis). Ultrasound is typically the first imaging modality in evaluating the spleen and its lesions; however, CT can provide detailed information in some contexts (e.g., trauma), and MRI offers excellent soft tissue contrast and is useful in cases requiring etiology differentiation (e.g., tumor). Therefore, it is important to understand how these different entities present in different imaging modalities, and what makes them unique. We aim to provide a comprehensive overview of spleen embryological development, and a visual differentiation of both common and uncommon splenic lesions in the pediatric population, highlighting high-yield clinical cases that illustrate key findings. Read More

Authors:  Silva De Campos Meneses Marcus Otavio , Braojos Fernanda , Prodigios Joice , Guarilha Taísa , Rodrigues Santos Luiz Antonio , Souza Antonio

Keywords:  Spleen, Multimodality, Splenic

Davis James,  Gebarski Kathleen,  Strouse Peter

Final Pr. ID: Poster #: EDU-030

While the most common abnormalities of the spleen are splenomegaly and trauma, many additional disease states can be manifested in the spleen which should be considered when evaluating the abdomen on cross sectional imaging. We composed a pictorial guide of a wide variety of variants and diseases for education and reference.
Read More

Authors:  Davis James , Gebarski Kathleen , Strouse Peter

Keywords:  Spleen

Koutrouveli Eleni,  Pitsoulaki Evangelia,  Antoniou Maria,  Fezoulidi Georgia,  Alatza Maria,  Sarri Vrisiis,  Kouriotis Apostolos,  Vakaki Marina

Final Pr. ID: Poster #: CR-008

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. Read More

Authors:  Koutrouveli Eleni , Pitsoulaki Evangelia , Antoniou Maria , Fezoulidi Georgia , Alatza Maria , Sarri Vrisiis , Kouriotis Apostolos , Vakaki Marina

Keywords:  Spleen, Thrombosis, Ultrasonography

Misiura Anne,  Urbine Jacqueline,  Poletto Erica,  Malik Archana,  Mallon Mea

Final Pr. ID: Poster #: EDU-032

The spleen is rarely the first organ to come to mind in discussing pathology of the abdomen, and indeed may often be the last. However, there are a multitude of splenic processes and abnormalities that should be kept in mind when discussing the pediatric abdomen. Additionally, splenic abnormalities, or lack thereof, can also be clues to diagnosis in more difficult cases. Read More

Authors:  Misiura Anne , Urbine Jacqueline , Poletto Erica , Malik Archana , Mallon Mea

Keywords:  Spleen, gastrointestinal, abdomen

Adu John,  Mcdonald Kirsteen

Final Pr. ID: Poster #: EDU-028

In a child the abdominal organs are more at risk from blunt injury, the reasons for this include the fact that the organs are relatively more anterior and inferior and lie inferior to the ribs rather than behind them as in an adult. Additionally, paediatric ribs are cartilaginous and so although rib fractures are less likely, compressive injuries secondary to the relative elasticity of the rib cage are far more common. The computed tomography (CT) features of abdominal visceral injury include lacerations, subcapsular or parenchymal haematomas, active haemorrhage, and vascular injuries, all of which the radiologists must be familiar with. Although there is an increasing trend toward non-operative management of abdominal solid organ injury, radiologists must also be aware of the key imaging features that suggest the need for surgical or interventional radiology input.

Based on our experience as one of the largest Level 1 trauma centres in Europe, the aims of this educational exhibit are to:
(i) Provide a pictorial review the spectrum of findings in blunt injury to the liver, kidneys and spleen as demonstrated on CT.
(ii) Discuss the role of Interventional Radiology in cases of associated vascular injury. Read More

Authors:  Adu John , Mcdonald Kirsteen

Keywords:  trauma, liver, kidney, spleen, laceration