They are due to infection elsewhere in the body and are small, multiple, and clinically silent, thus constituting incidental findings at autopsy .
Symptoms
. Clinically obvious splenic abscesses are usually solitary and are due to: 1) systemic bacteremia originating elsewhere in the body; 2) penetrating or blunt trauma (with superinfection of the hematoma ), soft infarction (in patients with hemoglobinopathies , especially sickle cell trait or SC hemoglobin disease) or other diseases ( malaria , hydatid cyst ), or 3) extension of a contiguous infection ( eg, a subphrenic abscess ). The most common causative germs are staphylococci , streptococci , anaerobes and aerobic gram-negative rods , including Salmonella Candida, which can cause infection in immunocompromised hosts .
The main symptoms are fever and subacute onset pain, often pleuritic in nature, on the left side of the abdomen , flank, upper abdomen, or lower chest , which may radiate to the left shoulder. The left upper quadrant is often painful, and splenomegaly is typical . On rare occasions, splenic friction is heard. The leukocytosis is common and blood cultures sometimes reveal causal germs.
Signs and diagnosis
CT is the most reliable test, but radiographs may show a mass in the left upper quadrant, extraintestinal gas in the abscess if it is due to gas-forming germs, displacement of other organs, including the kidney , colon and stomach , elevation of the left hemidiaphragm and left pleural effusion. Ultrasonography can show intrasplenic defects in abscesses of 2 to 3 cm.
Complications and treatment
Complications of untreated abscesses include bleeding into the abscess cavity or rupture to the peritoneum , intestine , bronchi, or pleural space. Splenic abscess is a rare cause of sustained bacteremia in endocarditis , despite adequate chemotherapy .
Treatment consists of systemic antibiotics and drainage of pus by percutaneous catheter , splenotomy, or splenectomy .