Correspondence Value of Power Doppler Sonography in the Evaluation of Torsion in a Wandering Spleen We found the report by Danacı et al, “Power Doppler Sonographic Diagnosis of Torsion in a Wandering Spleen,” 1 very useful in the diagnosis of a similar case seen at our institution recently. Our patient was an 11-year-old girl who pre- sented with a history of progressively increasing abdominal pain of 1 month’s duration. Physical examination revealed that the spleen was en- larged (palpable 6 cm below the left costal mar- gin) and tender. Sonograms obtained 2 weeks pre- viously at another institution had documented a displaced spleen lying in the center of the abdo- men. Gray-scale sonography at our institution, using a Sonoline Versa scanner (Siemens, Er- langen, Germany) and a 3.5-MHz convex-array transducer, revealed that the displaced spleen was enlarged and hypoechoic and its hilum faced toward the left side. Power Doppler and duplex Doppler examination (Figure 1) revealed no blood flow in the splenic parenchyma or hilar blood ves- sels. The pancreatic tail was in the normal loca- tion, and the rest of the abdomen appeared nor- mal. The findings suggested a diagnosis of wander- ing spleen with torsion and infarction, and the patient underwent laparotomy. The diagnosis was confirmed at surgery, during which an en- larged spleen with torsion of its elongated pedicle and thrombosis of the splenic artery and vein were observed. The splenic hilum faced toward the left side. The pancreatic tail and bowel were uninvolved. A splenectomy was performed, and the postoperative clinical course was uneventful. The usual sonographic manifestations of wan- dering spleen have been well documented in the literature. 1–3 In our case, the spleen was not only enlarged, hypoechoic, and displaced inferiorly from its usual left subdiaphragmatic location, but in addition, its hilum faced toward the left side, which can be an important sign for the diagnosis of wandering spleen if the displacement from the splenic fossa is not significant. Additionally, this J Clin Ultrasound 29:60–63, January 2001 © 2000 John Wiley & Sons, Inc. FIGURE 1. Axial power Doppler sonogram showing a hypoechoic spleen and its hilum displaced laterally. No vascularity is seen within the parenchyma or hilum. Duplex Doppler interrogation shows no waveforms within the hilar vessels. 60 JOURNAL OF CLINICAL ULTRASOUND