PMC4861893_01
CT demonstrates loculated fluid and air in the left basilar pleural space (thick arrow), communicating with the colon at the splenic flexure (thin white arrow) through a fistulous connection in the spleen (curved arrow).
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CRP (158 mg/L); his basic metabolic profile and liver panel were within normal limits. CT demonstrated loculated fluid and air in the left basilar pleural space (Fig. 1A; thick arrow), communicating with the colon at the splenic flexure (thin white arrow) through a fistulous connection in the spleen (curved arrow). The colosplenopleural fistula is appreciated on all images as a band of low attenuation running obliquely through the spleen (Fig. 1B; thick arrow). This band likely represents infected fluid and is seen on the sagittal CT image (Fig. 1B) to be continuous with the pleural space adjacent to focally consolidated lung (Fig. 1B, curved arrow). More medially (Fig. 1C), the low-attenuation fistulous tract through the spleen can be seen with direct extension to the colon at the splenic flexure (Figure 1A, Figure 1C, white arrow).