Skip to main content

A review of anatomy, pathology, and disease spread in the perisplenic region

Abstract

The perisplenic region is a complex anatomical area involving multiple peritoneal and subperitoneal structures, which influence the presentation and behavior of various pathologic processes. This review is a comprehensive resource for perisplenic anatomy and pathology with associated clinical presentations and imaging findings. Understanding the pathophysiologic intricacies of the perisplenic region assists the radiologist in building a helpful differential diagnosis and recognizing predictable disease patterns.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

References

  1. 1.

    Meyers MA, Oliphant M, Berne AS, Feldberg MAM. The peritoneal ligaments and mesenteries: Pathways of intraabdominal spread of disease. Radiology. 1987;163(3):593-604.

    CAS  Article  Google Scholar 

  2. 2.

    Bentley-Hibbert S, Abdelbaki A, Elsayes KM. Cross-Sectional Imaging of the Spleen. In: Elsayes KM, ed. Cross-Sectional Imaging of the Abdomen and Pelvis: A Practical Algorithmic Approach. New York, NY: Springer New York; 2015:229–262.

  3. 3.

    Pannu HK, Oliphant M. The subperitoneal space and peritoneal cavity: basic concepts. Abdom Imaging. 2015;40(7):2710-2722.

    Article  Google Scholar 

  4. 4.

    Sharma M, Rai P, Rameshbabu CS, Senadhipan B. Imaging of peritoneal ligaments by endoscopic ultrasound (with videos). Endosc Ultrasound. 2015;4(1):15-27.

    Article  Google Scholar 

  5. 5.

    Skandalakis PN, Celhorn GL, Skandalakis LJ, Richardson DD, Mitchell WE, Skandalakis JE. The surgical anatomy of the spleen. Surg Clin North Am. 1993;73(4):747-768.

    CAS  Article  Google Scholar 

  6. 6.

    Ostermann P, Schreiber H, Lierse W. [The ligament system of the spleen and its significance for surgical interventions]. Langenbecks Arch Chir. 1987;371(3):1207-1216.

    Article  Google Scholar 

  7. 7.

    Sharma M, Madambath JG, Somani P, et al. Endoscopic ultrasound of peritoneal spaces. Endosc Ultrasound. 2017;6(2):90-102.

    Article  Google Scholar 

  8. 8.

    Mortelé KJ, Mortelé B, Silverman S. CT Features of the Accesory Spleen. AJR. 2004;183:1653-1657.

    Article  Google Scholar 

  9. 9.

    Dogan NU, Uysal II, Demirci S, Dogan KH, Kolcu G. Accessory spleens at autopsy. Clin Anat. 2011;24(6):757-762.

    Article  Google Scholar 

  10. 10.

    Valls C, Monés L, Gumà A, López-Calonge E. Torsion of a wandering accessory spleen: CT findings. Abdom Imaging. 1998;23(2):194-195.

    CAS  Article  Google Scholar 

  11. 11.

    Termos S, Redha A, Zbibo R, et al. Torsion of huge wandering accessory spleen. Case report and review of literature. Int J Surg Case Rep. 2017;38:131–135.

  12. 12.

    Sadro CT & Lehnert, BE. Torsion of an accessory spleen: Case report and review of the literature. Radiology Case Reports. 2013; 8(1):802.

    Article  Google Scholar 

  13. 13.

    Jang KM, Kim, SH, Lee, SJ, Park, MJ, Lee, MH, & Choi, D. Differentiation of an Intrapancreatic Accessory Spleen from a Small (<3-cm) Solid Pancreatic Tumor: Value of Diffusion-weighted MR Imaging. Radiology. 2013; 266(1), 159-167.

    Article  Google Scholar 

  14. 14.

    Raissaki M, Prassopoulos P, Daskalogiannaki M, Magkanas E, Gourtsoyiannis N. Acute abdomen due to torsion of wandering spleen: CT diagnosis. Eur Radiol. 1998;1412(8):1409-1412.

    Article  Google Scholar 

  15. 15.

    Lake, ST, Johnson, PT, Kawamoto, S., Hruban, RH, & Fishman, EK. CT of Splenosis: Patterns and Pitfalls. American Journal of Roentgenology. 2012;199: W686-W693.

    Article  Google Scholar 

  16. 16.

    Uy PPD, Francisco DM, Trivedi A, O’Loughlin M, Wu GY. Vascular Diseases of the Spleen: A Review. J Clin Transl Hepatol. 2017;5: 152-164.

    PubMed  PubMed Central  Google Scholar 

  17. 17.

    Bedford PD, Lodge B. Aneurysm of the splenic artery. Gut. 1960; 1:312–320.

    CAS  Article  Google Scholar 

  18. 18.

    Moore SW, Guida PM, Schumacher HW. Splenic artery aneurysm. Bull Soc Int Chir. 1970; 29:210–218

    CAS  PubMed  Google Scholar 

  19. 19.

    Pasha SF, Gloviczki, P, Stanson, AW, & Kamath, PS.. Splanchnic artery aneurysms. Mayo Clinic Proceedings. 2007; 82(4), 472-9.

    Article  Google Scholar 

  20. 20.

    Stanley JC, Thomas NW, Fry WJ. Splanchnic artery aneurysms. Arch Surg. 1970; 101:689–697.

    CAS  Article  Google Scholar 

  21. 21.

    Busuttil RW, Brin BJ. The diagnosis and management of visceral artery aneurysms. Surgery. 1980; 88:619–624.

    CAS  PubMed  Google Scholar 

  22. 22.

    Stanley, JC, Wakefield TW, Graham LM, Whitehouse WM Jr, Zelenock GB, Lindenauer SM. Clinical importance and management of splanchnic artery aneurysms. J Vasc Surg. 1986; 3:836–840.

    CAS  Article  Google Scholar 

  23. 23.

    Trastek VF, Pairolero PC, Bernatz PE. Splenic ar- tery aneurysms. World J Surg. 1985; 9:378–383.

    CAS  Article  Google Scholar 

  24. 24.

    Agrawal G, Johnson P, Fishman E. Splenic Artery Aneurysms and Pseudoaneurysms: Clinical Distinctions and CT Appearances. AJR. 2007; 188:992–999.

    Article  Google Scholar 

  25. 25.

    Khosa F, Krinsky G, Macari M, Yucel EK, Berland, L. Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings. J Am Coll Radiol. 2013;10:789-794.

    Article  Google Scholar 

  26. 26.

    Woods M, Traverso, L, Kozarek, R, Brandabur, J & Hauptmann, E. Successful Treatment of Bleeding Pseudoaneurysms of Chronic Pancreatitis. Pancreas. 1995;10(1), 22-30.

    CAS  Article  Google Scholar 

  27. 27.

    Cho KC, Patel YD, Wachsberg RH, Seeff J. Varices in portal hypertension: evaluation with CT. Radiographics. 1995;15(3):609-622.

    CAS  Article  Google Scholar 

  28. 28.

    Narra RK, Jehendran MV. Ruptured splenic abscess causing pneumoperitoneum: A rare cause revisited. BMJ Case Rep. 2015;2015:2014-2016.

    Article  Google Scholar 

  29. 29.

    Nunspeet L van. Uncommon cause of pneumoperitoneum. World J Gastrointest Surg. 2013;5(12):329.

    Article  Google Scholar 

  30. 30.

    Meyers MA, Charnsangavej C, Oliphant M. Intraperitoneal Spread of Infections and Seeded Metastases. In: Meyers’ Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy. New York, NY: Springer New York; 2011:69–107.

  31. 31.

    Saboo SS, Krajewski, KM, Oregan, KN, Giardino, A, Brown, JR, Ramaiya, N, & Jagannathan, JP. Spleen in haematological malignancies: Spectrum of imaging findings. The British Journal of Radiology. 2012;85(1009), 81-92.

    CAS  Article  Google Scholar 

  32. 32.

    Ahmann DL, Kiely JM, Harrison EGJ, Payne WS. Malignant Lymphoma of the Spleen. A review of 49 cases in which the diagnosis was made at splenectomy. Cancer. 1966;19:461–469.

  33. 33.

    Montemayor P, Caggiano V. Primary Hemangiosarcoma of the Spleen Associated with Leukocytosis and Abnormal Spleen Scan. Int Surg. 1980;65(4):369–373.

    CAS  PubMed  Google Scholar 

  34. 34.

    Karakas HM, Demir M, Ozyilmaz F, Cakir B. Primary angiosarcoma of the spleen: In vivo and in vitro MRI findings. Clin Imaging. 2001;25(3):192-196.

    CAS  Article  Google Scholar 

  35. 35.

    Kaza, R., Azar, S., Al-Hawary, M., & Francis, I. (2010). Primary and secondary neoplasms of the spleen. Cancer Imaging, 10, 173-182, 10000–10000. https://doi.org/10.1102/1470-7330.2010.0026

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Abbott RM, Levy, AD, Aguilera, NS, Gorospe, L, & Thompson, WM. Primary Vascular Neoplasms of the Spleen: Radiologic-Pathologic Correlation. RadioGraphics. 2004;24(4), 1137-1163.

    Article  Google Scholar 

  37. 37.

    Compérat E, Bardier-Dupas A, Camparo P, Capron F, Charlotte F. Splenic metastases: Clinicopathologic presentation, differential diagnosis, and pathogenesis. Arch Pathol Lab Med. 2007;131(6):965-969.

    Article  Google Scholar 

  38. 38.

    Levy AD, Shaw, JC. & Sobin, LH. Secondary Tumors and Tumorlike Lesions of the Peritoneal Cavity: Imaging Features with Pathologic Correlation. RadioGraphics. 2009;29(2), 347-373.

    Article  Google Scholar 

  39. 39.

    Mortelé KJ, Mergo PJ, Taylor HM, Ernst MD, Ros PR. Splenic and perisplenic involvement in acute pancreatitis: Determination of prevalence and morphologic helical CT features. J Comput Assist Tomogr. 2001;25(1):50-54.

    Article  Google Scholar 

  40. 40.

    Iliescu L, Orban C, Ioanitescu S, Toma L. Splenic abscess due to acute pyelonephritis. BMJ Case Rep. 2014;2:1-2.

    Google Scholar 

  41. 41.

    Lee DH, Smith DS. Splenic Abscess After Acute Pyelonephritis. Am J Med. 2017;130(3):e109-e110.

    Article  Google Scholar 

  42. 42.

    Morioka H, Yanagisawa N, Suganuma A, Imamura A, Ajisawa A. Bilateral emphysematous pyelonephritis with a splenic abscess. Intern Med. 2013;52(1):147-150.

    Article  Google Scholar 

  43. 43.

    Ielpo B, Mazzetti C, Venditti D, Buonomo O, Petrella G. A case of metachronous splenic metastasis from renal cell carcinoma after 14 years. Int J Surg. 2010;8(5):353-355.

    Article  Google Scholar 

  44. 44.

    Liu Z, Chow MWL, Lua AHC, Tan RBW. Rare isolated synchronous splenic metastasis in a patient with type II papillary renal cell carcinoma. AME Case Reports. 2018;2:9-9.

    Article  Google Scholar 

  45. 45.

    Costantini M, Tuderti G, Minisola F, et al. Metachronous Isolated Splenic Metastasis in a Young Patient With Renal Cell Carcinoma: Case Report and Literature Review. Urology. 2019;127:13-18.

    Article  Google Scholar 

  46. 46.

    Kugel V, Dekel Y, Konichezky M, Baniel, J, Livne, PM, & Koren, R. Unusual Splenic Metastasis from Renal Cell Carcinoma. A Case Report and Review of the Literature. Pathology - Research and Practice. 2003;199(11), 739–743.

Download references

Author information

Affiliations

Authors

Contributions

A.E. designed the concept, performed literature search, drafted/edited/revised the manuscript, and compiled the image examples. C.O.M. provided close mentorship in the design of the concept, provided imaging examples, and reviewed/edited the manuscript. D.G. provided close mentorship in the design of the concept, provided imaging examples, and reviewed/edited the manuscript. N.C. performed literature search, added references, compiled image examples, and denoted imaging findings in case examples. A.M. performed literature search, added references, drafted portions of the manuscript, and provided patient case examples. A.S. and S.J. provided imaging examples and reviewed/edited the manuscript. K.M.E. provided close mentorship in the design of the concept, provided imaging examples, and reviewed/edited/approved the manuscript.

Corresponding author

Correspondence to Khaled M. Elsayes.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to disclose.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Ethics approval

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

CME activity

This article has been selected as the CME activity for the current month. Please visit https://ce.mayo.edu/node/103261 and follow the instructions to complete this CME activity.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Etchison, A., Menias, C.O., Ganeshan, D.M. et al. A review of anatomy, pathology, and disease spread in the perisplenic region. Abdom Radiol 46, 805–817 (2021). https://doi.org/10.1007/s00261-020-02736-8

Download citation

Keywords

  • Anatomy
  • Radiology–pathology correlation
  • Perisplenic region
  • Peritoneal disease