The purpose of our study was to evaluate the CT findings of malarial spleens.

We reviewed the patient records of 44 patients with malaria during a recent 3.5-year period and we selected 18 patients who underwent an abdominal CT scan. We retrospectively evaluated the CT findings of the malarial spleens and we compared then with those of a control group of 18 men. We analyzed the splenic size, whether or not there was mottled striped splenic enhancement during the arterial phase and the differences of splenic attenuation and the attenuation between the liver and spleen during the precontrast phase, the arterial phase and the portal phase between the two groups.

In malarial patients, the spleen was enlarged in all cases (p<0.001), and splenic attenuation and the degree of enhancement were significantly decreased during the precontrast phase, the arterial phase and the portal phase (p<0.001). Loss of mottled striped enhancement during the arterial phase was seen in 11 cases (61.1%) (p<0.001). The attenuation of the spleen was lower than that of the liver in 13 cases (72.2%) during the portal phase (p = 0.003) and in 1 case (5.6%) during the arterial phase (p = 1.000).

Splenomegaly, decreased splenic enhancement, the lack of mottled striped enhancement during the arterial phase and lower attenuation than that of the liver during the portal phase are helpful CT findings to diagnose the malarial spleen.