Dr. Divakara. P
Internal Medicine
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 44 years old male. I have a 17 cm area of hypodensity within the spleen of uncertain etiology. A place of vascular compromise is present with infiltrative processes.
Hi,
Welcome to icliniq.com.
Your 17 cm area of hypodensity is of vascular origin, mostly splenic artery infarction (ccclusion of the splenic artery).
For this evaluation, MR (Magnetic resonance) angiogram of the abdomen is the best. Also, a metastasis is a second possibility that requires PET (positron emission tomography) scan of the stomach. Kindly revert.
Patient's Query
Thank you doctor.
There is evidence of splenic enlargement with the spleen reaching over 6.6 inches in length. However, today's evaluation, compared to reports that were taken 11 years back, shows a particular region of hypodensity within the spleen itself, which was not present in the previous evaluation. The arterial phase does show the spleen an area of vascular compromise should be considered. Other etiologies are not excluded. The liver and pancreas appear homogeneous, and the gallbladder shows no evidence of calculus or inflammation. Also, both kidneys show normal renal function and excretion without hydronephrosis or mass lesions. The aorta is within normal limits, and there is no retroperitoneal mass or adenopathy, but only a small benign 1.5 cm right adrenal cyst is identified.
Impression:
1. Again there is evidence of splenomegaly within the spleen reaching 6.6 inches in length. And an area of hypodensity within the spleen of uncertain etiology and an area of vascular compromise should be considered with other infiltrative processes.
2. There is no evidence of abdominal or pelvic acute lesion, and there is only a benign 1.5 cm right adrenal cyst present.
One day I went to the ER because I was suffering from pain under my left rib cage; I have never been in pain like this before. I ran a low-grade fever for a day, and the pain got more intense. Suddenly three days later, I got the problem on my back in the same spot as the front, so I went to my family doctor the next day and showed her the reports. I asked my doctor whether I can take an ultrasound or something to check my spleen, but my doctor said there is no need. Is this condition should be taken seriously, or there is no need to worry about it?
Hi,
Welcome back to icliniq.com.
Thanks for the follow-up. I feel sorry that you are going through pain. See, most of the spleen hypodensities are harmless, and I agree with your family doctor. But since you had pain under your left rib and then again the same after three days, I strongly feel that hypodensity is an infarct (blood flow to the spleen is less). And an ultrasound will not give you any further information. I recommend you start taking anti-platelet medications like Aspirin 150 mg (NSAID) once daily. Also, get your lipid profile tested. And once take serum amylase test as pancreatitis can cause the same kind of pain you suffered from.
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Internal Medicine
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