Splenic Abscess Detection
Splenic Abscess Detection
Splenic Abscess Detection
JDMXXX10.1177/8756479312442110McKi
Case Studies
Abstract
The finding of a splenic abscess is rare, with only 500 to 600 cases ever having been reported internationally. Prior
to the advent of sonography and computed tomography, the survival rate for an individual with a splenic abscess was
0%. Present-day real-time imaging with sonography allows for accurate diagnosis of an abscess in the spleen versus
rupture, hematoma, splenomegaly, or cyst within the spleen or left kidney. Until recently, the prescribed treatment
was splenectomy. The increased understanding of splenic abscess etiology and advancements in pharmacology have
allowed the treatment to progress from surgical removal of the entire spleen to draining the abscess using fine-needle
aspiration with the use of strong broad-spectrum intravenous antibiotics.
Keywords
splenic abscess, ultrasonography, sonography, sepsis
Case Report
A man in his mid-50s underwent a transrectal sonographyguided prostate biopsy due to elevated prostate-specific
antigen (PSA). Bactrim, a preparation of sulfamethoxazole
and trimethoprim, had been given for perioperative prophylaxis. Four days after the procedure, the patient
returned to the emergency room (ER) with a high-grade
fever and abdominal pain. The urinalysis was positive for
E coli, and urosepsis was determined to be secondary to
the transrectal sonography-guided prostate biopsy.
Antibiotic therapy using IV vancomycin (a drug choice
usually reserved for treatment of bacterial infections
resistant to other drugs) was administered. Nineteen days
after the procedure, the patient presented a second time
to the ER with a moderate-grade fever, chills, rigors, and
increased abdominal pain in the left upper quadrant. A
complete abdominal sonographic examination was done
using a Philips IU22 system (Koninklijke, The Netherlands)
with a curved linear-array 6-MHz transducer that showed
an abscess in the spleen. The abscess was noted to be
located in the posterior spleen. Abscess volume of 90.4;
mL was calculated using the splenic volume calculation
1
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McKinney
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Discussion
Splenic abscess is a rare finding caused by infectious
sources external to the spleen, direct trauma to the
spleen, or a result of sepsis.3,4,69 They are found more
often in adults as a singular unilocular abnormality and
more often in children as multiple or multilocular abnormalities. Sepsis may be secondary to a variety of sources
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McKinney
In the case presented, a splenic abscess was a result of
a prior medical procedure, a transrectal sonographyguided prostate biopsy, which allowed E coli to become
translocated via the bloodstream to the spleen. A potential
contributing factor in this particular case was the patients
prior history of chronic obstructive pulmonary disease
(COPD) and osteoarthritis. He was taking albuterol to
help manage the COPD, a steroid that reduces the bodys
inflammatory response. This may have reduced the ability of the patients immune system to respond to the
infection resulting from the transrectal sonographyguided prostate biopsy.
Transrectal sonography-guided prostate biopsy is frequently associated with minor complications (60%79%
of cases) but rarely with major complications that require
hospitalization (0.4%3.5% of cases).1214 Early complications of transrectal sonography-guided prostate biopsy
include hematuria (70.8%) and rectal bleeding (8.3%).
Delayed complications of transrectal sonography-guided
prostate biopsy, at 3 to 7 days postbiopsy, include persistent hematuria (47.1%), vague pelvic discomfort (13.2%),
hematochezia (rectal bleeding) (9.1%), dysuria (9.1%),
and hematospermia (blood in the semen) (9.1%). Even
though complications from transrectal sonography-guided
prostate biopsies are fairly common, a study by Paterson
et al12 determined that only 0.23% of 4749 outpatients in
whom transrectal sonography-guided prostate biopsies
were performed between 2001 and 2006 were positive for
urosepsis. A recently tested protocol included obtaining
colon swabs from the patient prior to the transrectal
sonography procedure to determine the sensitivity of the
flora.14 Antibiotic prophylaxis was then selected to reflect
the organisms encountered and their susceptibilities,
decreasing the infective complications.
Sonography was an essential element in the diagnosis
and surveillance during the course of treatment in this
case of splenic abscess. Sonography allowed a noninvasive, rapid accurate diagnosis of an abscess in the spleen
versus possible diagnoses of rupture, hematoma, splenomegaly, or cyst. The ability of sonography to monitor the
splenic abscess allowed the treatment with strong broadspectrum IV antibiotics to run its course without the need
for splenectomy or other invasive procedures.
Conclusion
The use of imaging modalities such as sonography can
confirm or rule out a splenic abscess in a febrile patient
with left upper quadrant pain. If such an abscess is not
detected and treated with antibiotics early, it may become
severe and rapidly life-threatening with a mortality rate
up to 47%.9 The ability of sonography to monitor the
effectiveness of the antibiotics being administered has
Funding
The author received no financial support for the research and/or
authorship of this article.
References
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page=2
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JDMXXX10.1177/8756479312452706JDMS
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c. Four
d. Five
174
7. If not treated early and aggressively, the mortality secondary to splenic abscess can be as high
as
a. 35%40%
b. 45%50%
c. 55%60%
d. 65%70%
10. Urosepsis occurs with approximately what frequency following sonography-guided prostate
biopsy?
a. 2%
b. 1%
c. 0.5%
d. 0.25%