case_images: PMC11439698_01
case_images: Plate 1, contrast-enhanced computed tomography (CECT) images. (A) Absence of the spleen in the left upper abdomen after plain CT scan. (B) CT scan indicated an elliptic soft tissue density shadow (yellow arrow) in the left upper quadrant. The hyperdense shadows in splenic veins suggested splenic vein thrombosis (red arrow). (C) The axial section showed a "whirl sign" (red arrow) of the splenic pedicle vessels counterclockwise, together with pancreatic tail torsion (green arrow). The white arrow indicated the absence of obvious enhancement in the spleen, showing a possibility of splenic infarction. (D) The visualized splenic veins showed dilatation and tortuosity (yellow arrow). Plate 2, computed tomography (CT) image showing elongated splenic pedicle vessels (yellow arrow). Plate 3, coronal and sagittal CT images. (A) Contrast-enhanced CT scan indicated splenomegaly. There was pelvic fluid induced by splenic infarction. (B) There was a filling of contrast agent in the upper segment of the vessels (yellow arrow), while there was no filling in the lower segment (red arrow). This indicated a block of the splenic artery.
case_images: fped-12-1429490-g001.jpg
case_images: PMC11439698_01_fped-12-1429490-g001.jpg
case_images: F1
case_images: A plain CT scan showed the spleen absent from the left upper quadrant (Figure 1, Plate 1A). The visualization of hyperdense splenic vessels suggested thrombosis of the splenic vein (Figure 1, Plate 1B). A contrast-enhanced CT scan showed a counterclockwise "whirl sign" in the splenic pedicle, along with pancreatic tail torsion and splenic infarction (Figure 1, Plate 1C). Furthermore, the visualized splenic veins showed dilatation and distortion (Figure 1, Plate 1D). Vascular reconstruction showed an elongated splenic pedicle vessel (Figure 1, Plate 2). The CT scan revealed an enlarged spleen with no enhancement in the arterial and venous phase, suggesting splenic ischemia and infarction (Figure 1, Plate 3).
case_images: Representative intraoperative images. (A) The twisted splenic pedicle. (B) The splenic tissues of the spleen.
case_images: fped-12-1429490-g002.jpg
case_images: PMC11439698_01_fped-12-1429490-g002.jpg
case_images: F2
case_images: Vascular reconstruction showed an elongated splenic pedicle vessel (Figure 1, Plate 2). For the treatment, splenectomy (Figure 2) was performed since the splenic ischemia showed no improvement even after splenic repositioning.