Management of Small Subcentimeter Hypodense Splenic Lesions

Diagnostic Approach and Management

• The American College of Radiology suggests that MRI with contrast may provide better characterization than CT for subcentimeter lesions, with ADC values helping differentiate benign from malignant lesions with 92-93% accuracy 1

Intervention and Treatment

• Percutaneous catheter drainage (PCD) is the preferred initial intervention for accessible splenic abscesses after antibiotic stabilization, as it preserves splenic function 2
• PCD failure rates for splenic abscess range from 14.3-75%, with splenectomy reserved for failed drainage, no favorable window for PCD, high bleeding risk, or multiple complex abscesses 3, 4
• If splenectomy is required, lifelong vaccination protocols (pneumococcal, meningococcal, and Haemophilus influenzae type B) and antibiotic prophylaxis are mandatory to prevent overwhelming post-splenectomy infection (OPSI) 5, 6