Imaging Department

March 6th, 2012

Reported by Dr. Le Giang

Name: Pham Thanh SonSex: maleAge: 9yDept: Outpatient. Dept.

Clinical

Mild abdominal pain at Left upper quadrant Fever: 38,5 ºC Palpable mass in LUQ No history of trauma or infection.

US : Large Cyst in LUQ abdomen

Dx: Abdominal Cyst

CT findings(Pre C+)

Spleen: Large Hypodense mass in lower pole (70x60mm) Solitary , well-define, spherical Thin wall , Fluid intracyst : not clear (25HU) No calcification

CT findings(Post C+)

Thin septations in upper pole of cyst No enhancement of septations

CT findings(Post C+)

Thin wall Sharp interface to normal splenic tissue No rim or intracystic enhancement

CT findings(Post C+)

No ascites Another viscera: normal .

US findings

Large hypoechoic mass in lower pole of Spleen (70x60mm)Large hypoechoic mass in lower pole of Spleen (70x60mm) Smooth border with thin wall & septations Smooth border with thin wall & septations Fluid: not clearFluid: not clear No calcified wallNo calcified wall

Laboratory test

Blood cultures: normalCRP: 0,1 mg/l

Diagnosis

Splenic Epidermoid Cyst

Top Differential Diagnoses

1. Splenic Cyst post-traumatic.

2. Splenic Lymphangioma

3. Splenic Abscess

Top Differential DiagnosesEpidermoid Cyst Cyst post-

traumaticLymphangioma Abscess

General features Congenital cyst: genetic defect of mesothelial migration

Acquired with traumatic history (end stage of hematoma)

Lymphatic malformation

Acquired with infection history

Account 10- 25% of splenic cyst

80% of splenic cyst Rare Variable

Size Small - Large Usually Small Variable Usually small

Location Lower pole, subcapsular

Variable Usually subcapsular Multi-location

CT findings Solitary, water HU, well-define,smooth border, thin wall & septa, no enhancement

Solitary, water HU , thick wall with calcification, no enhancement

Multicystic hypodense mass, thin wall & septa, mild enhancement

Multiple with gas bubble, irregular border, rim or wall& septation enhancement

Microscopic feature

Endothelial lining present

Endothelial lining abcent

Endothelial cell Liquefactive necrosis, Pus…

Thank you for attention!