Diagnostic value of the ultrasonographic description of a splenic mass or nodule as cavitated in 106 dogs with nontraumatic hemoabdomen

OBJECTIVE To assess the diagnostic value of the ultrasonographic description of a splenic mass or nodule as cavitated in dogs with nontraumatic hemoabdomen. ANIMALS 106 dogs with a nontraumatic hemoabdomen that underwent abdominal ultrasonography and splenectomy with histologic examination of splenic lesions between 2005 and 2018. PROCEDURES Medical records were reviewed for abdominal ultrasonographic and histologic findings. Diagnostic performance of ultrasonographic description of a splenic mass or nodule as cavitated as evidence of hemangiosarcoma or any malignancy was evaluated. RESULTS Ultrasonographic description of splenic lesions as cavitated had poor diagnostic utility in predicting presence of hemangiosarcoma or malignancy. Sensitivity and specificity of this test were 41.9% (95% CI, 30.5% to 54.3%) and 51.2% (95% CI, 36.8% to 65.4%), respectively, for detecting hemangiosarcoma, with positive and negative predictive values of 55.3% (95% CI, 41.2% to 68.6%) and 37.9% (95% CI, 26.6% to 50.8%), respectively. Results were similar for detecting malignancy. Cavitated lesions outside of the spleen were too rare for statistical analysis to be of value. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that relying on ultrasonographic description of cavitation to diagnose splenic lesions as malignant in dogs with nontraumatic hemoabdomen is unfounded. Other preoperative diagnostic tests may be more valuable in determining short- and long-term prognoses.

Primary splenic diffuse large B-cell lymphoma with multinucleated giant cells in a horse

A diagnosis of a diffuse splenic large B-cell lymphoma with multinucleated giant cells in a 5-year-old mare was made based upon the clinical, pathological, and immunohistochemical findings. The enormous primary splenic mass weighed 51.75 kg. To the best of our knowledge, this is the biggest reported splenic mass and the first case of an equine diffuse large B-cell lymphoma with multinucleated giant cells.

Primary Carcinosarcoma of the Spleen: A Rare Case Report of Incidental Finding after Splenic Trauma

Primary carcinosarcoma of the spleen is a rare, aggressive splenic malignancy. To date, seven cases have been reported in the literature. We report a first case of primary carcinosarcoma of the spleen in France. A 75-year-old woman with a medical history of hysterectomy for uterine adenocarcinoma presented with left hypochondrium pain following blunt abdominal trauma. A splenic mass was noted on computed tomography (CT) scan. A splenectomy was performed by laparotomy. Histology revealed a malignant mixed Mullerian tumor. The PET scan allowed us to confirm that it was a primary lesion of the spleen. She is currently undergoing adjuvant chemotherapy despite the tumor progression. The interest of this case lies in the rarity of primary carcinosarcomas of the spleen and the circumstances of its diagnosis.

1550. Beyond Skin Deep: Cellulitis Induced Splenic Abscess

Background A 51 year old male presented with splenic abscess from chronic eczema with cellulitis. Coronal plane view of the CT abdomen showing the splenic abscess. CT abdomen without contrast in the transverse plane showed a splenic mass measuring 7.8 x 8.8 x 6.9 cm, similar in size to the results found on ultrasound examination. Methods The patient had poor medical compliance, diabetes, hypertension, hyperlipidemia, COPD, and chronic eczema with cellulitis presented with fever, malaise, abdominal pain and distension. The patient denied any previous intravenous drug use. CT abdomen showed a splenic mass measuring 7.8 x 8.8 x 6.9 cm. A TTE showed normal ejection fraction and normal mitral valve structure and function. The patient underwent a CT guided drainage with tube placement in the spleen. MRI of the spine showed some osteomyelitis of the L4 vertebrae, which likely developed from the splenic abscess. Subsequent cultures of the splenic abscess showed MRSA. Abdominal ultrasound with 2-D grayscale sector imaging shows a cystic mass in the spleen measuring roughly 8 x 8 x 6.5 cm in dimensions. No vascular flow was identified within the mass. CT chest showed a prominent left sided pleural effusion, lower lobe lung consolidation air bronchograms. An air-filled and regular cystic area in the posterior dependent portion of the left lower lobe was noted (possibly a small pneumatocele). Patchy infiltrates in right lung were noted as well. Results Endocarditis is the most common primary source of splenic abscess, with urinary tract infections, appendicitis, pneumonia, and wound infections as other primary etiologies. Organisms that can be involved are Streptococci, Staphylococci, and Escherichia coli, Enterococcus and Klebsiella pneumoniae. Splenic abscess follows a bimodal distribution, occuring in those younger than 40 and older than 70 years of age. Leukocytosis can be as high as the 18,000 cells/mL range or within the upper range of normal limits. The sensitivity of abdominal ultrasonography in the diagnosis of splenic abscesses is roughly 75-93%. The abdominal CT diagnostic sensitivity for splenic abscess ranges from 92-96%. In tandem with the ultrasound examination, the diagnostic sensitivity is estimated at 94.7%. Treatment options entail intravenous antibiotics with CT-guided percutaneous aspiration or splenectomy. Previous studies noted a 70.8-100% mortality rate in patients with splenic abscess who were treated only with intravenous antibiotics. MRI of the spine with contrast showing some probable small osteomyelitis of L4 vertebrae at the anterior/inferior corner. Conclusion Characteristics of the patient population, geographic location, recent travel, possible vector exposures, predisposing medical conditions, and individual behaviors may be contributing factors in regards to the underlying etiologic organism(s) involved in each individual case of splenic abscess. This case study is especially rare in that the etiology of the splenic abscess was chronic eczematous cellulitis. Disclosures All Authors: No reported disclosures

Symptomatic Extra-Adrenal Myelolipoma in the Spleen

A 42-year-old male patient presented with intermittent abdominal pain and gastrointestinal discomfort present for 4 years. Work-up included ultrasound and computed tomography, which identified a fat-containing splenic mass 5.6 cm in size. Due to recurrent symptoms, the patient sought medical care again. Subsequent images showed an increase in size to 7.6 cm, which was concerning for neoplasm. This was removed via open splenectomy, which was challenging due to intra-abdominal adhesions despite never having had any abdominal surgery. The patient’s recovery was uncomplicated. Pathologic assessment indicated that the mass was a myelolipoma. Extra-adrenal myelolipomas are rare and typically found within the retroperitoneum but are extremely rare within the spleen. This case report adds the 6th such case to the literature and demonstrates the need for it to remain in the differential diagnosis of patients with fatty splenic masses, as well as that splenectomy is an appropriate treatment.