• Gary R. SchoolerEmail author
  • Alison R. Hart
  • Nathan C. Hull
  • Edward Y. Lee


The spleen is the largest accumulation of lymphoid tissue in the human body. A wide variety of disorders may be encountered in the pediatric spleen, including congenital, neoplastic, infectious, and traumatic abnormalities. In addition, the spleen may be the primary site of pathology or manifest abnormalities as part of a systemic disorder. Magnetic resonance (MR) imaging can yield important diagnostic information about an array of pediatric splenic disorders and help direct clinical decision making. This chapter reviews up-to-date MR imaging techniques; splenic anatomy including embryology, normal development, and anatomic variants; and selected disorders affecting the spleen in the pediatric population.


Pediatric Spleen Magnetic resonance (MR) imaging Normal splenic development Congenital splenic disorders Splenic tumors Splenic cyst Splenic infections Splenic trauma Portal hypertension 


  1. 1.
    Varga I, Babala J, Kachlik D. Anatomic variations of the spleen: current state of terminology, classification, and embryological background. Surg Radiol Anat. 2018;40(1):21–9.PubMedGoogle Scholar
  2. 2.
    Courtier J, Rao AG, Anupindi SA. Advanced imaging techniques in pediatric body MRI. Pediatr Radiol. 2017;47(5):522–33.PubMedGoogle Scholar
  3. 3.
    Jaimes C, Kirsch JE, Gee MS. Fast, free-breathing and motion-minimized techniques for pediatric body magnetic resonance imaging. Pediatr Radiol. 2018;48(9):1197–208.PubMedGoogle Scholar
  4. 4.
    Chavhan GB, Babyn PS, Vasanawala SS. Abdominal MR imaging in children: motion compensation, sequence optimization, and protocol organization. Radiographics. 2013;33(3):703–19.PubMedGoogle Scholar
  5. 5.
    Antonov NK, Ruzal-Shapiro CB, Morel KD, Millar WS, Kashyap S, Lauren CT, et al. Feed and wrap MRI technique in infants. Clin Pediatr (Phila). 2017;56(12):1095–103.Google Scholar
  6. 6.
    Mirowitz SA, Brown JJ, Lee JK, Heiken JP. Dynamic gadolinium-enhanced MR imaging of the spleen: normal enhancement patterns and evaluation of splenic lesions. Radiology. 1991;179(3):681–6.PubMedGoogle Scholar
  7. 7.
    Soares BP, Lequin MH, Huisman T. Safety of contrast material use in children. Magn Reson Imaging Clin N Am. 2017;25(4):779–85.PubMedGoogle Scholar
  8. 8.
    Jaspan ON, Fleysher R, Lipton ML. Compressed sensing MRI: a review of the clinical literature. Br J Radiol. 2015;88(1056):20150487.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Vasanawala SS, Alley MT, Hargreaves BA, Barth RA, Pauly JM, Lustig M. Improved pediatric MR imaging with compressed sensing. Radiology. 2010;256(2):607–16.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Varga I, Galfiova P, Adamkov M, Danisovic L, Polak S, Kubikova E, et al. Congenital anomalies of the spleen from an embryological point of view. Med Sci Monit. 2009;15(12):RA269–76.PubMedGoogle Scholar
  11. 11.
    Adler DD, Glazer GM, Aisen AM. MRI of the spleen: normal appearance and findings in sickle-cell anemia. AJR Am J Roentgenol. 1986;147(4):843–5.PubMedGoogle Scholar
  12. 12.
    Donnelly LF, Emery KH, Bove KE, Bissett GS. Normal changes in the MR appearance of the spleen during early childhood. AJR Am J Roentgenol. 1996;166(3):635–9.PubMedGoogle Scholar
  13. 13.
    Elsayes KM, Narra VR, Mukundan G, James S, Lewis J, Menias CO, Heiken JP. MR imaging of the spleen: spectrum of abnormalities. Radiographics. 2005;25(4):967–82.PubMedGoogle Scholar
  14. 14.
    Chavhan GB, AlSabban Z, Babyn PS. Diffusion-weighted imaging in pediatric body mr imaging: principles, technique, and emerging applications. Radiographics. 2014;34(3):E73–88.PubMedGoogle Scholar
  15. 15.
    Gayer G, Hertz M, Strauss S, Zissin R. Congenital anomalies of the spleen. Semin Ultrasound CT MR. 2006;27(5):358–69.PubMedGoogle Scholar
  16. 16.
    Klingler PJ, Tsiotos GG, Glaser KS, Hinder RA. Laparoscopic splenectomy: evolution and current status. Surg Laparosc Endosc. 1999;9:1):1–8.PubMedGoogle Scholar
  17. 17.
    Paterson A, Frush DP, Donnelly LF, Foss JN, O'Hara SM, George S, Bisset IA. Pattern-oriented approach to splenic imaging in infants and children. Radiographics. 1999;19(6):1465–85.PubMedGoogle Scholar
  18. 18.
    Reisner DC, Burgan CM. Wandering spleen: an overview. Curr Probl Diagn Radiol. 2018;47(1):68–70.PubMedGoogle Scholar
  19. 19.
    Richman M, Hiyama DT, Wasson E. Wandering spleen. Surgery. 2014;155(4):728.PubMedGoogle Scholar
  20. 20.
    Perrotta S, Gallagher PG, Mohandas N. Hereditary spherocytosis. Lancet. 2008;372(9647):1411–26.PubMedGoogle Scholar
  21. 21.
    Manciu S, Matei E, Trandafir B. Hereditary spherocytosis–diagnosis, surgical treatment and outcomes. A literature review. Chirurgia (Bucur). 2017;112(2):110–6.Google Scholar
  22. 22.
    Gungor A, Yarali N, Fettah A, Ok-Bozkaya I, Ozbek N, Kara A. Hereditary spherocytosis: retrospective evaluation of 65 children. Turk J Pediatr. 2018;60(3):264–9.PubMedGoogle Scholar
  23. 23.
    Gaetke-Udager K, Wasnik AP, Kaza RK, Al-Hawary MM, Maturen KE, Udager AM, et al. Multimodality imaging of splenic lesions and the role of non-vascular, image-guided intervention. Abdom Imaging. 2014;39(3):570–87.PubMedGoogle Scholar
  24. 24.
    Ranganath SH, Lee EY, Eisenberg RL. Focal cystic abdominal masses in pediatric patients. AJR Am J Roentgenol. 2012;199(1):W1–W16.PubMedGoogle Scholar
  25. 25.
    Ito K, Mitchell DG, Honjo K, Fujita T, Uchisako H, Matsumoto T, et al. MR imaging of acquired abnormalities of the spleen. AJR Am J Roentgenol. 1997;168(3):697–702.PubMedGoogle Scholar
  26. 26.
    Lynn KN, Werder GM, Callaghan RM, Sullivan AN, Jafri ZH, Bloom DA. Pediatric blunt splenic trauma: a comprehensive review. Pediatr Radiol. 2009;39(9):904–16.. quiz 1029-30PubMedGoogle Scholar
  27. 27.
    Thipphavong S, Duigenan S, Schindera ST, Gee MS, Philips S. Nonneoplastic, benign, and malignant splenic diseases: cross-sectional imaging findings and rare disease entities. AJR Am J Roentgenol. 2014;203(2):315–22.PubMedGoogle Scholar
  28. 28.
    Lennon P, Crotty M, Fenton JE. Infectious mononucleosis. BMJ. 2015;350:h1825.PubMedGoogle Scholar
  29. 29.
    Jenson HB. Acute complications of Epstein-Barr virus infectious mononucleosis. Curr Opin Pediatr. 2000;12(3):263–8.PubMedGoogle Scholar
  30. 30.
    Hilmes MA, Strouse PJ. The pediatric spleen. Semin Ultrasound CT MR. 2007;28(1):3–11.PubMedGoogle Scholar
  31. 31.
    Luna A, Ribes R, Caro P, Luna L, Aumente E, Ros PR. MRI of focal splenic lesions without and with dynamic gadolinium enhancement. AJR Am J Roentgenol. 2006;186(6):1533–47.PubMedGoogle Scholar
  32. 32.
    Kamaya A, Weinstein S, Desser TS. Multiple lesions of the spleen: differential diagnosis of cystic and solid lesions. Semin Ultrasound CT MR. 2006;27(5):389–403.PubMedGoogle Scholar
  33. 33.
    Semelka RC, Kelekis NL, Sallah S, Worawattanakul S, Ascher SM. Hepatosplenic fungal disease: diagnostic accuracy and spectrum of appearances on MR imaging. AJR Am J Roentgenol. 1997;169(5):1311–6.PubMedGoogle Scholar
  34. 34.
    Harisinghani MG, McLoud TC, Shepard JA, Ko JP, Shroff MM, Mueller PR. Tuberculosis from head to toe. Radiographics. 2000;20(2):449–70; quiz 528–9, 32PubMedGoogle Scholar
  35. 35.
    De Backer AI, Vanhoenacker FM, Mortele KJ, Vanschoubroeck IJ, De Keulenaer BL, Parizel PM. MRI features of focal splenic lesions in patients with disseminated tuberculosis. AJR Am J Roentgenol. 2006;186(4):1097–102.PubMedGoogle Scholar
  36. 36.
    Polat P, Kantarci M, Alper F, Suma S, Koruyucu MB, Okur A. Hydatid disease from head to toe. Radiographics. 2003;23(2):475–94.. quiz 536-7PubMedGoogle Scholar
  37. 37.
    Abbott RM, Levy AD, Aguilera NS, Gorospe L, Thompson WM. From the archives of the AFIP. Radiographics. 2004;24(4):1137–63.PubMedGoogle Scholar
  38. 38.
    Dufau JP, le Tourneau A, Audouin J, Delmer A, Diebold J. Isolated diffuse hemangiomatosis of the spleen with Kasabach-Merritt-like syndrome. Histopathology. 1999;35(4):337–44.PubMedGoogle Scholar
  39. 39.
    Ramani M, Reinhold C, Semelka RC, Siegelman ES, Liang L, Ascher SM, et al. Splenic hemangiomas and hamartomas: MR imaging characteristics of 28 lesions. Radiology. 1997;202(1):166–72.PubMedGoogle Scholar
  40. 40.
    Kaza RK, Azar S, Al-Hawary MM, Francis IR. Primary and secondary neoplasms of the spleen. Cancer Imaging. 2010;10:173–82.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Darden JW, Teeslink R, Parrish A. Hamartoma of the spleen: a manfestation of tuberous sclerosis. Am Surg. 1975;41(9):564–6.PubMedGoogle Scholar
  42. 42.
    Morgenstern L, McCafferty L, Rosenberg J, Michel SL. Hamartomas of the spleen. Arch Surg. 1984;119(11):1291–3.PubMedGoogle Scholar
  43. 43.
    Chen G, Li M, Wu D, Tang H, Tang D. Primary splenic angiosarcoma in a 2.5-year-old boy with hepatic metastasis. Pediatr Surg Int. 2012;28(11):1147–50.PubMedGoogle Scholar
  44. 44.
    Winde G, Sprakel B, Bosse A, Reers B, Wendt M. Rupture of the spleen caused by primary angiosarcoma. Case report. Eur J Surg. 1991;157(3):215–7.PubMedGoogle Scholar
  45. 45.
    Kaneko K, Onitsuka H, Murakami J, Honda H, Kimura M, Shiraishi N, et al. MRI of primary spleen angiosarcoma with iron accumulation. J Comput Assist Tomogr. 1992;16(2):298–300.PubMedGoogle Scholar
  46. 46.
    Karakas HM, Demir M, Ozyilmaz F, Cakir B. Primary angiosarcoma of the spleen: in vivo and in vitro MRI findings. Clin Imag. 2001;25(3):192–6.Google Scholar
  47. 47.
    Guillerman RP, Voss SD, Parker BR. Leukemia and lymphoma. Radiol Clin N Am. 2011;49(4):767–97.. viiPubMedGoogle Scholar
  48. 48.
    Saboo SS, Krajewski KM, O'Regan KN, Giardino A, Brown JR, Ramaiya N, et al. Spleen in haematological malignancies: spectrum of imaging findings. Br J Radiol. 2012;85(1009):81–92.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Paes FM, Kalkanis DG, Sideras PA, Serafini AN. FDG PET/CT of extranodal involvement in non-Hodgkin lymphoma and Hodgkin disease. Radiographics. 2010;30(1):269–91.PubMedGoogle Scholar
  50. 50.
    Rabushka LS, Kawashima A, Fishman EK. Imaging of the spleen: CT with supplemental MR examination. Radiographics. 1994;14(2):307–32.PubMedGoogle Scholar
  51. 51.
    Bhatia K, Sahdev A, Reznek RH. Lymphoma of the spleen. Semin Ultrasound CT MR. 2007;28(1):12–20.PubMedGoogle Scholar
  52. 52.
    Punwani S, Cheung KK, Skipper N, Bell N, Bainbridge A, Taylor SA, et al. Dynamic contrast-enhanced MRI improves accuracy for detecting focal splenic involvement in children and adolescents with Hodgkin disease. Pediatr Radiol. 2013;43(8):941–9.PubMedGoogle Scholar
  53. 53.
    Lam KY, Tang V. Metastatic tumors to the spleen: a 25-year clinicopathologic study. Arch Pathol Lab Med. 2000;124(4):526–30.PubMedGoogle Scholar
  54. 54.
    Borhani AA, Hosseinzadeh K, Almusa O, Furlan A, Nalesnik M. Imaging of posttransplantation lymphoproliferative disorder after solid organ transplantation. Radiographics. 2009;29(4):981–1000; discussion -2PubMedGoogle Scholar
  55. 55.
    Wilde GE, Moore DJ, Bellah RD. Posttransplantation lymphoproliferative disorder in pediatric recipients of solid organ transplants: timing and location of disease. AJR Am J Roentgenol. 2005;185(5):1335–41.PubMedGoogle Scholar
  56. 56.
    Donnelly LF, Frush DP, Marshall KW, White KS. Lymphoproliferative disorders: CT findings in immunocompromised children. AJR Am J Roentgenol. 1998;171(3):725–31.PubMedGoogle Scholar
  57. 57.
    Pickhardt PJ, Siegel MJ. Posttransplantation lymphoproliferative disorder of the abdomen: CT evaluation in 51 patients. Radiology. 1999;213(1):73–8.PubMedGoogle Scholar
  58. 58.
    Santschi M, Echave V, Laflamme S, McFadden N, Cyr C. Seat-belt injuries in children involved in motor vehicle crashes. Can J Surg. 2005;48(5):373–6.PubMedPubMedCentralGoogle Scholar
  59. 59.
    Tinkoff G, Esposito TJ, Reed J, Kilgo P, Fildes J, Pasquale M, et al. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the national trauma data bank. J Am Coll Surg. 2008;207(5):646–55.PubMedGoogle Scholar
  60. 60.
    Gordic S, Alkadhi H, Simmen HP, Wanner G, Cadosch D. Characterization of indeterminate spleen lesions in primary CT after blunt abdominal trauma: potential role of MR imaging. Emerg Radiol. 2014;21(5):491–8.PubMedGoogle Scholar
  61. 61.
    Rees DC, Williams TN, Gladwin MT. Sickle-cell disease. Lancet. 2010;376(9757):2018–31.PubMedGoogle Scholar
  62. 62.
    Roshkow JE, Sanders LM. Acute splenic sequestration crisis in two adults with sickle cell disease: US, CT, and MR imaging findings. Radiology. 1990;177(3):723–5.PubMedGoogle Scholar
  63. 63.
    Wood JC, Cohen AR, Pressel SL, Aygun B, Imran H, Luchtman-Jones L, et al. Organ iron accumulation in chronically transfused children with sickle cell anaemia: baseline results from the TWiTCH trial. Br J Haematol. 2016;172(1):122–30.PubMedGoogle Scholar
  64. 64.
    Hill SC, Damaska BM, Ling A, Patterson K, Di Bisceglie AM, Brady RO, et al. Gaucher disease: abdominal MR imaging findings in 46 patients. Radiology. 1992;184(2):561–6.PubMedGoogle Scholar
  65. 65.
    Lanir A, Hadar H, Cohen I, Tal Y, Benmair J, Schreiber R, et al. Gaucher disease: assessment with MR imaging. Radiology. 1986;161(1):239–44.PubMedGoogle Scholar
  66. 66.
    Regenboog M, Bohte AE, Somers I, van Delden OM, Maas M, Hollak CE. Imaging characteristics of focal splenic and hepatic lesions in type 1 Gaucher disease. Blood Cells Mol Dis. 2016;60:49–57.PubMedGoogle Scholar
  67. 67.
    Tsokos M, Erbersdobler A. Pathology of peliosis. Forensic Sci Int. 2005;149(1):25–33.PubMedGoogle Scholar
  68. 68.
    Urrutia M, Mergo PJ, Ros LH, Torres GM, Ros PR. Cystic masses of the spleen: radiologic-pathologic correlation. Radiographics. 1996;16(1):107–29.PubMedGoogle Scholar
  69. 69.
    Lashbrook DJ, James RW, Phillips AJ, Holbrook AG, Agombar AC. Splenic peliosis with spontaneous splenic rupture: report of two cases. BMC Surg. 2006;6:9.PubMedPubMedCentralGoogle Scholar
  70. 70.
    Dietz WH Jr, Stuart MJ. Splenic consumptive coagulopathy in a patient with disseminated lymphangiomatosis. J Pediatr. 1977;90(3):421–3.PubMedGoogle Scholar
  71. 71.
    Ito K, Murata T, Nakanishi T. Cystic lymphangioma of the spleen: MR findings with pathologic correlation. Abdom Imaging. 1995;20(1):82–4.PubMedGoogle Scholar
  72. 72.
    Dobritz M, Nomayr A, Bautz W, Fellner FA. Gamna-Gandy bodies of the spleen detected with MR imaging: a case report. Magn Reson Imaging. 2001;19(9):1249–51.PubMedGoogle Scholar
  73. 73.
    Sagoh T, Itoh K, Togashi K, Shibata T, Nishimura K, Minami S, et al. Gamna-Gandy bodies of the spleen: evaluation with MR imaging. Radiology. 1989;172(3):685–7.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Gary R. Schooler
    • 1
    Email author
  • Alison R. Hart
    • 2
  • Nathan C. Hull
    • 3
  • Edward Y. Lee
    • 4
  1. 1.Department of RadiologyDuke University Medical CenterDurhamUSA
  2. 2.Diagnostic Imaging, Rhode Island Hospital, Brown UniversityProvidenceUSA
  3. 3.Department of Radiology, Mayo ClinicRochesterUSA
  4. 4.Division of Thoracic Imaging, Department of RadiologyBoston Children’s Hospital, Harvard Medical SchoolBostonUSA

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