The spleen is gone....believe me!
53 year old man brought in for intoxication. Blood alcohol level 0.301 g/dL. Blood pressure was soft, and free fluid was seen in the abdomen, so a CT scan was performed.
Obvious cirrhosis with large varices on CT. Spleen looks prominent, but otherwise not particularly noteworthy. Portal vein is patent. Small ascites.
Turn on spectral, and something surprising shows up. The entire spleen has no iodine uptake. This is confirmed with a nearly flat spectral curve. On 40 keV images, the splenic artery is patent to the hilum, but the splenic vein appears thrombosed.
Focal splenic infarcts are pretty easy to call, with wedge shaped defects. A global splenic infarct is unusual, and can be difficult. Global spleen infarct from venous thrombosis is even more unusual. Iodine map makes the diagnosis very easy, and also make it easy to convince skeptics!