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Splenic Pseudocyst

Naveed Yousuf, MD
Madeleine D Kraus, MD
Steven E Seltzer, MD

March 16, 1994

Presentation

A 32-year-old woman presented with left upper quadrant discomfort and palpable mass.

Imaging Findings

Computed Tomography
Gross Pathology
Microscopic Pathology

CT of the abdomen demonstrates an 11x14x16 cm cystic mass (arrow) losely attached to the medial surface of spleen. There is irregular nodularity and a septum (arrow) associated with the mass at the inferior lateral border on the splenic aspect. The mass is otherwise well-circumscribed and homogeneous. It displaces the stomach to the right, and the head of the pancreas is displaced into porta hepatis. There is no ascites. Liver, pancreas and spleen are otherwise normal.

Differential Diagnosis

This includes splenic cyst, pancreatic pseudocyst, and exophytic cyst from the left lobe of the liver. Splenic cyst is the most likely diagnosis, due to close association of the mass with spleen and rightward displacement of stomach. A liver cyst in the left lobe would displace stomach posteriorly and a pancreatic mass would displace stomach anteriorly. Moreover, in the absence of clinical and radiographic stigmata of pancreatitis, pancreatic pseudocyst is less likely.

Diagnosis

Splenic pseudocyst

Discussion

Radiology

Eighty percent of splenic cysts are pseudocysts (lacking epithelial lining) and result from prior splenic trauma. Less common are congenital (epidermoid) cysts and echinococcal cysts, and absence of calcifications makes these even more unlikely.

Pathology

Cystic lesions of the spleen may be of infectious (e.g. echinococcal), developmental (e.g. true cyst), traumatic or idiopathic (e.g. false cyst) in origin. In this case, the cyst lacked an epithelial lining, and is therefore a "false" cyst, or pseudo-cyst. In females, cystic splenic lesions may be lined with columnar ciliated epithelium, and can be considered on the developmental/reactive spectrum of endosalpingiosis.

ARROWS: Long arrow - cyst contents. Short arrow - absence of epithelial lining at splenic border.

References

1. Taveras JM, Ferrucci JT. Radiology of the General Abdomen. In: Radiology Diagnosis-Imaging-Interventions, Vol.4. Philadelphia: Lippincott, 1987.

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