From the Guidelines
The diagnostic workup for splenic issues in an infant typically involves a combination of imaging studies, including ultrasonography (US) and computed tomography (CT) scans.
Diagnostic Procedures
- Ultrasonography (US) is considered a less invasive and useful initial diagnostic tool, especially in stable patients 1.
- Complete abdominal US may avoid the use of CT in stable patients, and Doppler US and contrast-enhanced US are useful to evaluate splenic vascularization 1.
- Contrast-enhanced CT scan is the gold standard in pediatric splenic trauma, particularly in patients at risk for head and thoracic injuries, need for surgery, recurrent bleeding, or other abdominal injuries 1.
Imaging Guidelines
- A positive E-FAST examination in children should be followed by an urgent CT in stable patients 1.
- CT scan is suggested in children with hemodynamic stability and absence of other internal injuries requiring surgery 1.
- Injury grade on CT scan, free fluid amount, contrast blush, and the presence of pseudo-aneurysm do not predict non-operative management (NOM) failure or the need for operative management (OM) 1.
Clinical Considerations
- Hemodynamic stability is crucial in evaluating children, and clinical judgment is fundamental in assessing the need for further diagnostic workup or intervention 1.
- NOM is recommended as the first-line treatment for hemodynamically stable pediatric patients with blunt splenic trauma, but it should only be attempted in centers capable of precise diagnosis and intensive management 1.
From the Research
Diagnostic Workup for Splenic Issues in Infants
The diagnostic workup for splenic issues in infants involves a pattern-oriented approach to imaging evaluation, categorizing splenic anomalies into different types, such as:
- Anomalies of splenic shape, location, number, or size
- Solitary lesions, such as cysts, lymphangiomas, hemangiomas, and hamartomas
- Multiple focal lesions, such as trauma, infection, and inflammation, neoplasms, and storage disorders
- Diffuse disease without focal lesions, such as infarction, heavy metal deposition, and hemangioendotheliomas 2
Imaging Modalities
A variety of imaging modalities can be used in splenic assessment, including:
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
- Ultrasound
- Technetium-99m scintigraphy 2, 3 Ultrasound is often used most often in children due to its non-invasive nature and lack of radiation exposure 3
Diagnostic Approach
The imaging appearance of the pediatric spleen depends on the patient's age and the modality used. Familiarity with the spectrum of radiologic patterns of splenic involvement will facilitate correct diagnosis and prompt treatment 2. A diagnostic approach using imaging techniques can help determine the features of splenic anomalies, both congenital and acquired, and enable a correct diagnostic approach, avoiding unnecessary surgical procedures or biopsies 3
Specific Considerations
In cases of non-traumatic spleen disorders, imaging techniques can help correlate clinical symptoms, serology, and histology 3. For noncystic splenic lesions, contrast-enhanced MRI is recommended for imaging workup, as it can enable definitive diagnosis of most benign lesions 4. PET or PET/CT can be used to diagnose malignant splenic lesions and help exclude malignancy in benign lesions 4