Calcified Splenic Cyst: Advanced Radiologic Diagnosis, Pathophysiology, and Comprehensive Clinical Management

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Keywords: Calcified Splenic Cyst, Splenic Cyst Imaging, Splenic Cyst CT, Calcified Splenic Lesion, Splenic Cyst Diagnosis, Splenic Cyst Treatment, Abdominal CT Findings, Splenic Pathology, Radiology Case Study

 

Abstract

Calcified splenic cysts represent a rare yet clinically significant splenic pathology that may arise from congenital, traumatic, infectious, or degenerative processes. Their radiologic recognition is crucial for proper diagnosis, risk stratification, and treatment planning. This comprehensive expert-level review integrates advanced radiologic interpretation, updated global literature, and case-based discussion to explore the pathophysiology, epidemiology, clinical presentation, imaging characteristics, differential diagnosis, diagnostic workflow, therapeutic strategies, and prognosis of calcified splenic cysts. A detailed imaging review is complemented by interactive quizzes and current evidence-based references.

Introduction

Calcified splenic cysts are uncommon cystic lesions of the spleen characterized by partial or complete wall calcification. Although frequently asymptomatic, large or complicated lesions may cause abdominal discomfort, compressive symptoms, rupture, hemorrhage, or infection. With the widespread availability of advanced cross-sectional imaging, incidental detection has increased, emphasizing the importance of accurate radiologic interpretation and clinical correlation.

Case Presentation

Clinical History

A 45-year-old male presented with two months of persistent left upper quadrant discomfort. His medical history was remarkable for a motor vehicle accident 20 years earlier. Physical examination demonstrated mild tenderness in the left upper quadrant, without a palpable mass.


 Figure 1. Simple Abdomen Radiograph

A large, well-demarcated calcified mass is identified in the left upper quadrant (arrow), strongly suggestive of a chronic splenic lesion with dystrophic calcification.

The coarse curvilinear calcification strongly suggests a chronic splenic pseudocyst, likely secondary to prior trauma.

Figure 2. Axial Contrast-Enhanced Abdominal CT
A well-defined cystic lesion measuring 8 × 9 × 11 cm with peripheral calcification is visualized within the splenic parenchyma.

The lesion demonstrates thin peripheral calcification, low attenuation fluid content, and absence of enhancing solid components, consistent with a calcified splenic cyst, most compatible with a post-traumatic pseudocyst.

Pathophysiology of Calcified Splenic Cyst

Calcified splenic cysts develop through multiple mechanisms:

1. Post-Traumatic Pseudocysts (Most Common)

  • Results from organized intraparenchymal hematomas after blunt trauma
  • Progressive liquefaction and fibrosis lead to pseudocyst formation
  • Dystrophic calcification develops over time

2. Congenital (True) Cysts

  • Lined by epithelial cells
  • Includes epidermoid cysts and lymphangiomas
  • Calcification occurs due to chronic degeneration and hemorrhage

3. Parasitic Cysts (Echinococcal)

  • Caused by Echinococcus granulosus
  • Peripheral calcification is a classic feature of inactive hydatid cysts

4. Inflammatory or Ischemic Etiologies

  • Chronic infarction
  • Abscess organization

Epidemiology

  • Splenic cysts account for <1% of all splenic lesions
  • Incidence: 0.07–0.2%
  • Post-traumatic pseudocysts represent 75–80% of cases
  • Most commonly detected in young and middle-aged adults
  • Male predominance in traumatic etiologies

Clinical Presentation

Most calcified splenic cysts remain asymptomatic and are discovered incidentally.

Common Symptoms:

  • Left upper quadrant pain
  • Early satiety
  • Abdominal fullness
  • Nausea
  • Palpable mass

Complications:

  • Rupture
  • Intracystic hemorrhage
  • Infection
  • Hypersplenism
  • Portal hypertension (rare)

Imaging Features

Figure 3. Abdominal Ultrasound
A well-defined hypoechoic cystic lesion with echogenic peripheral rim calcification and internal low-level echoes.

Ultrasound demonstrates posterior acoustic shadowing due to wall calcification and internal debris consistent with chronic hemorrhagic contents.

Figure 4. Axial Non-Contrast CT
A splenic cystic lesion with wall calcification (long arrow), rupture point (short arrow), and perisplenic fluid (open arrow).

Findings indicate partial rupture of a calcified splenic cyst, complicated by localized hemoperitoneum.


Figure 5. Congenital Splenic Cyst: (A) Ultrasound, (B) Axial CT, (C) Contrast-enhanced CT

A unilocular, thin-walled cyst with minimal internal echoes and peripheral calcification, typical of epidermoid cyst.

Differential Diagnosis

Category

Differential

Congenital

Epidermoid cyst, lymphangioma

Traumatic

Pseudocyst

Infectious

Hydatid cyst, bacterial abscess

Neoplastic

Hemangioma, lymphoma, cystic metastasis

Inflammatory

Pancreatic pseudocyst extension

Diagnostic Approach

  1. Clinical history (trauma, infection, endemic exposure)
  2. Ultrasound – Initial screening
  3. CT scan – Gold standard
  4. MRI – Characterization of cyst content
  5. Serology – If hydatid disease is suspected

Treatment Strategies

Observation

  • Asymptomatic
  • <5 cm diameter
  • Stable imaging

Surgical Indications

  • Symptomatic cysts

·         5 cm size

  • Complications

Surgical Options

  • Partial splenectomy
  • Total splenectomy
  • Laparoscopic cystectomy
  • Percutaneous drainage + sclerosis (selected cases)

Prognosis

  • Excellent for asymptomatic lesions
  • Surgical outcomes: >95% success rate
  • Recurrence rate: <5% after complete excision

Quiz

Question 1. Which imaging feature is most characteristic of a post-traumatic calcified splenic pseudocyst?

A. Central enhancing mural nodules
B. Peripheral rim calcification
C. Diffuse splenomegaly
D. Multiple septations
E. Fat-fluid level

Answer: B. Explanation: Peripheral rim calcification is classic for chronic post-traumatic splenic pseudocysts.

Question 2. Which imaging modality provides the best anatomical detail for calcified splenic cyst evaluation?

A. Ultrasound
B. MRI
C. CT
D. Plain X-ray
E. PET-CT

Answer: C. Explanation: CT offers superior spatial resolution, calcification detection, and surgical planning detail.

Question 3. Which is the most common cause of calcified splenic cysts worldwide?

A. Congenital epithelial cyst
B. Hydatid disease
C. Post-traumatic pseudocyst
D. Splenic abscess
E. Metastasis

Answer: C. Explanation: Remote blunt trauma accounts for 75–80% of calcified splenic cysts.

Conclusion

Calcified splenic cysts represent a rare but clinically relevant pathology. Radiologic expertise remains the cornerstone for accurate diagnosis, differentiation from malignant lesions, and appropriate management planning. With modern imaging techniques, most patients achieve excellent outcomes through individualized treatment strategies.

References

  1. Morgenstern L. "Nonparasitic splenic cysts: Pathogenesis, classification, and treatment." J Am Coll Surg, 2002.
  2. Robbins FG, et al. "Splenic epithelial cysts." Ann Surg, 1978.
  3. Dachman AH, et al. "Nonparasitic splenic cysts: A report of 52 cases." Radiology, 1986.
  4. Karfis EA, et al. "Primary splenic cyst: A case report." Cases J, 2009.
  5. Hansen MB, et al. "Splenic cysts." Surg Laparosc Endosc Percutan Tech, 2004.
  6. Balzan SM, et al. "Post-traumatic splenic pseudocyst." World J Gastroenterol, 2003.
  7. Pedrosa I, et al. "MR imaging of splenic lesions." Radiographics, 2009.

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