Abstracts

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E2391. Splenic Infarcts: A Review in the Setting of Lymphoma
Authors
  1. Azfar Basunia; SUNY Upstate Medical University
  2. David Ola; SUNY Upstate Medical University
  3. Abtin Jafroodifar; SUNY Upstate Medical University
  4. David Lubin; SUNY Upstate Medical University
Background
The spleen is a highly vascular organ that participates in important hematologic and immunologic functions. Splenic infarction occurs when blood flow to the spleen is impeded causing tissue ischemia and necrosis [1]. Radiologic testing is often required to detect splenic infarction; underlying etiologies, such as lymphoma, can have overlapping imaging features [1,2,3,4]. Proper identification of an infarct and its etiology is necessary as management and treatment goals can vary widely from supportive care to emergent surgical interventions [1,2]. The purpose of this exhibit is to illustrate key radiologic findings for new trainees to properly identify splenic infarction which we will highlight using an interesting case from our institution.

Educational Goals / Teaching Points
Relevant anatomy will be presented first and various etiologies and their pertinent pathogenesis, presentation and management will be reviewed from current literature. Important differential diagnosis will be highlighted as well. Key imaging features using a multimodality approach, including ultrasound (US), CT, MRI and molecular imaging, will be emphasized. Differentiating splenic lymphoma (seen in 30 - 40% lymphoma patients) and splenic infarction (common complication of splenic lymphoma) will be highlighted with a patient case of splenic infarction secondary to Diffuse Large B-cell Lymphoma (DLBCL) from our institution.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Splenic infarction may result from both arterial or venous occlusion by thrombogenic or septic emboli as well as congestion by abnormal, inflammatory or neoplastic cells [1,2]. Thus, a large number of underlying etiologies have been implicated. In fact, splenic infarction may be the first clue of the presence of an underlying process. For example, splenic infiltration by lymphoma causing splenomegaly, or splenic infarction in the setting of DLBCL, may both present as left sided abdominal pain [1]. Radiographic testing is crucial for detection and differentiation as management goals are different. Chronic infarcts appear as cystic and hypoechoic foci on CT, hypo- or anechoic areas with absent doppler flow on US and non-enhancing hypointense areas on T1- and T2-weighted MR images. Unfortunately, these multimodal imaging findings can look identical to those from lymphoma infiltration [3,4]. Alternatively, PET/CT will show marked FDG-avidity in splenic lymphoma compared to splenic infarct [4]. Lymphomatous lesions in surrounding organs (liver, vertebral body, lymph nodes) should also clue new trainees to consider lymphoma as opposed to splenic infarction [3,4].

Conclusion
Splenic infarction diagnosis requires radiologic imaging and its management goals can vary widely depending on the underlying etiology. Splenic lymphoma and splenic infarction in the setting of lymphoma may present with similar clinical and radiologic findings. Timely diagnosis requires knowledge of typical imaging patterns and pitfalls. This educational exhibit aims to review the most important factors when assessing for splenic infarction in order to allow new trainees to make a reasonable diagnosis via multimodality approach.