What are the types of splenic cysts?
Classification determines tactics. True cysts are congenital, lined with cells from the inside and are usually detected in young people. False ones are more common and form at the site of a hematoma after an abdominal injury, after a splenic infarction or inflammation; they do not have their own lining. Parasitic cysts are caused by echinococcus, a tapeworm that a person becomes infected with through water, unwashed vegetables or contact with animals. Separately, a splenic abscess is considered - a purulent cavity that requires urgent treatment, and vascular formations that look like a cyst on a regular ultrasound.
- True - innate, with internal lining
- False - after injury, heart attack, inflammation
- Parasitic - echinococcal
- Spleen abscess - requires urgent treatment
- Vascular formations simulating a cyst
Reasons for appearance
Congenital cysts are formed in the prenatal period due to impaired development of organ tissue. False ones are most often associated with blunt trauma to the abdomen: the hematoma inside the spleen gradually resolves, and in its place a cavity with fluid remains, so the history often includes a fall, blow, or road accident several months or years before the discovery. Parasitic cysts occur when infected with echinococcus, which is especially important in rural areas and when working with livestock and dogs. Less commonly, cavities remain after infections and infarctions of the spleen.
- Impaired development of spleen tissue
- Past blunt trauma to the abdomen
- Splenic infarction
- Echinococcus infection
- Past severe infections
- Complications after abdominal surgery
How it manifests itself
Cysts up to several centimeters usually do not manifest themselves in any way and remain an accidental discovery. As you grow, a feeling of heaviness and fullness appears in the left hypochondrium, aching pain, which sometimes radiates to the left shoulder and shoulder blade. A large cyst puts pressure on neighboring organs, causing rapid satiety when eating, nausea, and less commonly, intestinal dysfunction and shortness of breath when the diaphragm is high. The danger is posed by complications: rupture with internal bleeding, suppuration with high fever, and with echinococcus - a severe allergic reaction when the cyst is opened.
- Heaviness and pain in the left hypochondrium
- Pain radiating to the left shoulder and shoulder blade
- Rapid satiety and nausea
- Increased abdominal volume
- High temperature during suppuration
- Sharp pain and weakness upon rupture
Survey
The first and main method remains ultrasound: it shows the size, contents and location of the cyst. To clarify the structure and connection with the vessels, computed tomography with contrast or magnetic resonance imaging is performed - these methods make it possible to distinguish a simple cyst from a parasitic one, an abscess or a tumor formation. A mandatory step in our region is a blood test for antibodies to echinococcus, because with this diagnosis the tactics are fundamentally different, and puncture of the cyst is contraindicated. Additionally, a complete blood count and inflammation indicators are assessed.
- Abdominal ultrasound
- Computed tomography with contrast
- MRI for unclear picture
- Blood test for antibodies to echinococcus
- Complete blood count and C-reactive protein
- Control ultrasound in dynamics
Observation and treatment
Small asymptomatic cysts are not treated: it is enough to repeat the ultrasound examination at a frequency determined by the doctor and observe the size. Indications for surgery are large size, growth of formation, persistent complaints, as well as complications and parasitic nature. The modern approach is organ-preserving interventions, often laparoscopic: removal of the cyst wall or part of an organ while preserving the spleen. Complete removal of the organ is rarely performed because the spleen is important for protection against infection; after it, vaccination is required as prescribed by a doctor.
- Observation with control ultrasound for small sizes
- Surgery for large, growing and symptomatic cysts
- Laparoscopic removal of the cyst wall
- Resection of part of the spleen with preservation of the organ
- Special treatment for hydatid cysts
- Removal of an organ only for strict indications
- Vaccination after spleen removal
