Imaging

Vulvovaginal Cancer

Preliminary Diagnosis: Splenic abscess

I. What imaging technique is first-line for this diagnosis

  • Gray scale and color Doppler ultrasound

II. Describe the advantages and disadvantages of this technique for diagnosis of splenic abscess.

Advantages

  • Does not expose patients to ionizing radiation

  • Highly portable and inexpensive imaging modality.

  • Highly sensitive for diagnosing a splenic abscess.

  • May help guide treatment.

Disadvantages

  • Overall, findings are less specific for diagnosing a splenic abscess than other modalities

  • Less adept in detecting and characterizing any secondary complications.

III. What are the contraindications for the first-line imaging technique?

  • No specific contraindications to sonographic imaging exist.

IV. What alternative imaging techniques are available?

  • CT with contrast

  • MR with contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of splenic abscess.

CT with contrast

Advantages

  • Gold standard in diagnosing a splenic abscess and detecting any secondary complications.

  • Offers more exquisite detail of the surrounding osseous, soft tissue, and vascular structures to evaluate for any secondary involvement compared with MR imaging.

  • May help guide treatment planning and therapy.

Disadvantages

  • Exposes patients to ionizing radiation.

  • Less portable compared with MR imaging.

MR with contrast

Advantages

  • Does not expose patients to ionizing radiation.

  • Highly sensitive and specific in characterizing a splenic infectious process.

Disadvantages

  • Expensive

  • Time-consuming

  • Requires significant patient cooperation to minimize motion artifact

  • Offers less exquisite detail of the surrounding osseous structures compared with other imaging modalities

VI. What are the contraindications for the alternative imaging techniques?

CT with contrast

  • May be contraindicated in pregnant patients.

  • Relative contraindication for contrast use in patients with renal failure

  • Relative contraindication for contrast use in patients with contrast allergy

MR with contrast

  • Contraindicated in patients with non-MR compatible hardware.

  • Gadolinium contrast is contraindicated in patients with a GFR less than or equal to 30.

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