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Gastrointestinal Imaging

E1066. Ignore, excise or embolize?: How the Radiologist should approach splenic lesions.

Petrov D,  Singh K,  Hartman M. Allegheny Health Network, Pittsburgh, United States

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Background Information: The purpose of this exhibit is to educate the reader on the various diagnostic approaches to splenic lesions both benign and malignant, potential caveats and splenic trauma. A second goal is to educate the general radiologist/trainee on interventional techniques (biopsy, embolization, drainages), indications and contraindications for these techniques and how to apply them in a practical manner.

Educational Goals/Teaching Points: 1.) Describe the differential diagnosis and approach for incidental splenic lesions found on CT/US/MRI/PET-CT. 2.) Describe the radiologic findings of splenic trauma. 3.) Discuss which splenic injuries are amenable to embolization and which are suited for surgical intervention. 4.) Describe CT findings of splenic abscesses and approach to percutaneous drainage. 5.) Describe "Do not touch", congenital anomalies and lesions which should not be biopsied. 6.) Describe approach to biopsy of suspicious lesions.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: 1) Normal appearance of the spleen on imaging and nuclear medicine studies. 2) Congenital splenic anomalies. 3) Incidental mass lesions: benign, indeterminate and malignant; pseudolesions. 4) Diffuse infiltrative processes within the spleen. 5) Autosplenectomy, infarcts and calcifications. 6) Splenic rupture: AAST grading, approach to imaging, surgical considerations. 7) Celiac trunk arterial anatomy and variants. 8) Approach and technique of splenic embolization in trauma and pre-operative settings. 9) Approach and technique to biopsy of suspicious splenic lesions. 10) Approach and technique for draining splenic abscess.

Conclusion: After reading this exhibit, the reader should have the knowledge to approach splenic lesions in practice from both a diagnostic and interventional perspective with confidence. The reader should be able to discuss the splenic trauma with their interventional radiology and surgical colleagues in an informed multidisciplinary fashion.