Chest radiographic findings in children with asplenia syndrome.
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Date
2010-08
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Abstract
Background: Early diagnosis of asplenia syndrome is important because prophylactic antibiotic and proper
vaccination will prevent serious infection. Most children with asplenia syndrome present with symptoms of
congenital heart disease. Chest X-ray is usually the first line imaging modality.
Objective: Define useful findings in chest radiograph that could suggest the diagnosis of asplenia syndrome.
Methods: Chest radiographs of pediatric patients who had asplenia syndrome diagnosed between January 1,
2002 and June 30, 2008 in a single institute were retrospectively reviewed for the positions of the visceral
organs in the chest and abdomen.
Results: Three hundred seventy one chest radiographs of 30 patients were reviewed. The mean age at diagnosis
was 3 years old. Asplenia was diagnosed by ultrasound in 27 patients, by CT scan in two patients, and by
damaged red blood cell scintigraphy in one patient. Six important findings detected from chest radiographs were,
1) bilateral minor fissures, 16 cases (53%), 2) bilateral eparterial bronchi, 16 cases (53%), 3) ipsilateral side of
stomach and liver, 12 cases (40%), 4) ipsilateral side of minor fissure or eparterial bronchus and stomach, 10 cases
(33%), 5) symmetrical transverse lie of the liver, nine cases (30%), and 6) contralateral side of minor fissure or
eparterial bronchus and the liver in seven cases (23%). All except two patients (93%) had at least one of the above
findings. All patients had congenital heart diseases. Most of the heart diseases were pulmonary atresia or
pulmonary stenosis (88%) and single ventricle (85%).
Conclusion: Chest radiographs have high sensitivity in suggesting the diagnosis of asplenia syndrome, when
detecting one or more of the above findings, particular in patients with congenital heart disease and decreased
pulmonary vasculature.
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Keywords
Asplenia, chest X-ray, children, congenital heart disease, heterotaxia, minor fissure, situs ambiguous
Citation
Asian Biomedicine (Research Reviews and News); Vol. 4 No. 4 Aug 2010; 585-594.