Cysts, tumors and abscesses of the spleen Flashcards
What percentage of splenic cysts are parasitic?
5%
Most common parasitic organism found in splenic cysts
Echinococcus granulosus
Treatment of parasitic splenic cysts
Medical management followed by splenectomy
CT appearance of nonparasitic splenic cysts
Solitary cyst with occasional wall calcifications
Accounts for 90% of all nonparacystic cysts
Epidermoid cysts
Etiology of most secondary splenic cysts or pseudocysts
Trauma
When is surgical intervention indicated for splenic cysts?
Size greater than 5 cm, or symptomatic
Why can noninfectious cysts less than 5 cm be managed nonoperatively?
Often resolve on their own
Surgical options for intervention for splenic cysts
unroofing cyst, complete or partial splenectomy or fenestration
How much spleen must remain to preserve splenic function?
25%
Most common malignancy involving the spleen?
Non Hodgkin’s lymphoma
Does splenectomy affect survival in NHL
No. There is no increase in survival
What percentage of patients with stage I or II Hodgkin’s lymphoma have splenic disease?
Up to 35%
What benefit does splenectomy give patients with CLL?
No increase in survival, but reduction in transfusion requirements, and lowers lymphocyte count.
What is the role of splenectomy in myelofibrosis?
Plays a palliative role, reducing transfusion requirements and improving quality of life. Myelofibrosis is universally fatal, with a mean survival of 5 years.
Cancers known to metastasize to the spleen
Breast, Lung, Melanoma, Ovarian/Endometrial, Gastric, Colonic and prostate
What percentage of patients with NHL have splenic involvement?
40%
Most common benign tumor of the spleen
Hemangioma
Risks of splenic hemagiomas
Rupture and hemorrhage
Splenic lymphangiomas are associated with similar lesions in what other locations?
lymphangiomas of the liver, lung, skin and bone
Treatment of malignant splenic lesions
Splenectomy
When do benign splenic tumors require surgical treatment?
To alleviate symptoms or confirm a diagnosis
Causes of splenic abscess?
Hematogenous spread from distant primary septic focus (endocarditis, intraabdominal infections, pyelonephritis), IV drug use, or secondary after trauma.
Most common cultured bacteria in splenic abscesses
Staphylococcus and Streptococcus
What organisms are more common in immunocompromised individuals with splenic abscesses?
Candida and Aspergillosis (8%).
What is the definitive treatment for splenic abscesses?
Splenectomy
What are the failure rates in percutaneous drainage of splenic abscesses?
50-60%
If unable to administer vaccinations prior to surgery, when should they be given post splenectomy?
2 weeks post splenectomy
When is inicidence of OPSS highest postoperatively?
One year post splenectomy
What is advocated for the first one to two years post splenectomy in high risk patients?
Prophylactic antibiotics (ususally pencilliins)
