Congenital Splenic Cyst Treated with Percutaneous Sclerosis Using Alcohol

Abstract

We report a case of successful percutaneous treatment of a congenital splenic cyst using alcohol as the sclerosing agent. A 14-year-old female adolescent presented with a nonsymptomatic cystic mass located in the spleen that was believed to be congenital. After ultrasonography, a drainage catheter was placed in the cavity. About 250 ml of serous liquid was extracted and sent for microbiologic and pathologic studies to rule out an infectious or malignant origin. Immediately afterwards, complete drainage and local sclerotherapy with alcohol was performed. This therapy was repeated 8 days later, after having observed 60 ml of fluid in the drainage bag. One year after treatment the cyst has practically disappeared. We believe that treatment of splenic cyst with percutaneous puncture, ethanolization, and drainage is a valid option and it does not rule out surgery if the conservative treatment fails.

Splenic Cyst

“…(1) Computed tomography is more sensitive than ultrasound in identifying septa and calcifications. (5) Cystic lesions on CT are spherical, well-defined, with attenuation equivalent to the water, with a thin or imperceptible capsule. (6) Splenic cysts may contain areas with a high density due to bleeding, increased protein content, or purulent material into the cyst.…”

Cistos esplênicos não-parasitários

“…Computed tomography is more sensitive than ultrasound in the identification of septa (more common in true cysts) or calcifications (more common in false cysts) 44 . In MRI the cyst is hypointense on T1-weighted images, with strongly hyperintense images on T2, with signal intensity equal to water without reinforcement after contrast injection.…”

“…Due to the increased risk of complications, splenic cysts with a diameter greater than 4-5 cm should be surgically treated 10,12 , as conservative treatment options, such as percutaneous aspiration or sclerosis, do not result in good long term control 11 . Some studies have shown that splenic cyst sclerosis with alcohol was successful for small lesions (up to 11 mm) but not for large ones 44 . Treatment options are: partial splenectomy, total cystectomy, cyst marsupialization or decapsulation, with access either by laparotomy or laparoscopy 11,12,43 .…”

A Case of Post-Traumatic Pseudocyst in the Spleen Successfully Treated with Alcohol Sclerotherapy

“…Because of the immunologic role of the spleen, new surgical approaches, such as laparoscopic surgery, partial splenectomy, decapsulation and unroofing, have been proposed [ 5 ]. Recently, conservative treatment using percutaneous aspiration of the cyst contents with or without instillation of sclerosing agents has been generally accepted [ 6 ]. High success rates of alcoholic sclerotherapy in patients with renal and hepatic cysts have been reported [ 7 8 9 ].…”

“…High success rates of alcoholic sclerotherapy in patients with renal and hepatic cysts have been reported [ 7 8 9 ]. However, there are contradictory reports regarding congenital splenic cysts treated with percutaneous sclerosis using alcohol [ 6 10 ]. The optimal treatment of post-traumatic splenic pseudocysts is not well defined.…”