Persistent fever + LUQ pain, suspected splenic abscess
Recommended: CT Abdomen with IV contrast is the preferred imaging study for persistent fever + luq pain, suspected splenic abscess. Often hematogenous (endocarditis, IVDU).
Recommended study
CT Abdomen with IV contrast
Often hematogenous (endocarditis, IVDU). Single or multiple low-density lesions, rim enhancement.
If the default doesn't apply
Bedside drainage planning
US
Ultrasound + image-guided drainage
No contrast
Watch-outs
Source identification
Image for endocarditis (TTE / TEE) and other septic foci.
Pearls
- Microabscesses (multiple small) suggest fungal etiology in immunocompromised.
- Klebsiella, Staph aureus, Streptococcus most common bacteria.
- Splenectomy historically standard; image-guided drainage increasingly successful.