Chapter 6: Spleen (Penny)

white and red pulp

composed of specialized tissues called ________ and ______ pulp

1. tuberculosis 2. sarcoidosis (systemic disease that results in the development of granulomas throughout the body) 3. histoplasmosis (disease that results from the inhalation of airborne fungus that can affect the lungs and may spread to other organs)

granulomatous disease is found in patients with:

Epstein-Barr infection

herpes-virus that can lead to infectious mononucleosis that results in splenomegaly in children

angiosarcoma

primary malignant tumor of the spleen that is rare and derived from red blood vessels

peripheral blood

primary objective of the spleen is to filter the __________

granulomatous disease

small echogenic calcifications that result from inflammation of the tissue in that area are seen in what disease?

small, echogenic foci that may shadow

sonographic findings of granulomatous disease?

-well defined, hyper echoic mass

sonographic findings of splenic hemangioma:

white pulp

specialized lymphatic tissue within the spleen that produces lymphocytes to aid in the immune response, is performed by the ______ pulp

red

specialized tissue within the spleen that performs the phagocytic function (destroy pathogens) is performed by the ______ pulp

splenic hemangioma sono: well defined, hyperechoic mass.

the MOST COMMON BENIGN tumor of the spleen composed of Red blood vessels

intra-peritoneal, LUQ

the spleen is a _____ organ located in the _______ quadrant of the abdomen below the diaphragm

lymphatic

the spleen is the largest ______ organ

splenic

vascularity of the spleen is provided via the _________ artery and vein

c. accessory spleen

1. A 25 year old female patient presents to the ultrasound department for a complete abdominal sonogram. She complains of RLQ pain and nausea. The right upper abdomen appears normal. A small mass is noted in the area of the splenic hilum. this mass appears isoechoic to the spleen. What does this most likely represent? a. pancreatic cystadenocarcinoma b. splenic hemangioma c. accessory spleen d. neuroblastoma

a. intraperitoneal organ

10. The spleen is a/an: a. intraperitoneal organ b. retroperitoneal organ

b. white pulp

11. The type of tissue within the spleen that is responsible for its lymphatic function is the: a. red pulp b. white pulp c. culling ligament d. pitting segment

a. posterior aspect of the pancreatic body and tail

12. The splenic vein marks the: a. posterior aspect of the pancreatic body and tail b. anterior aspect of the pancreatic body and tail c. medial surface of the pancreatic body and tail d. later surface of the pancreatic body and tail

d. destruction of phagocytic cells

13. All of the following are functions of the spleen except: a. storage of iron b. defense against disease c. blood reservoir d. destruction of phagocytic cells

c. splenic hilum

14. Where is the most common location of an accessory spleen? a. superior to the spleen b. medial to the diaphragm and left kidney c. splenic hilum d. anterior to the pancreatic body

d. pancreatitis

15. All of the following can be associated with splenomegaly except: a. trauma b. hemolytic abnormalities c. mononucleosis d. pancreatitis

a. splenomegaly

16. Diffuse involvement of lymphoma or leukemia of the spleen will often lead to: a. splenomegaly b. splenic atrophy c. Epstein-barr infection d. splenic torsion

c. celiac trunk

17. the splenic artery originates at the: a. SMA b. Inf. phrenic artery c. celiac trunk d. GDA

d. multiple granulomas

18. A 35 year old male presents to ultrasound lab for an abdominal ultrasound and presents with abdominal pain and histoplasmosis. what are you most likely to identify in the spleen? a. multiple histomas b. multiple hemangiomas c. multiple metastatic lesions d. multiple granulomas

c. splenic hematoma

19. A 14 year old male patient presents to you after falling from his bicycle. Ultrasound reveals a complex appearing mass within the spleen. this most likely represents a: a. splenic hemangioma b. splenic granuloma c. splenic hematoma d. splenic infarct

b. angiosarcoma

2. a rare malignant tumor of the spleen that consists of blood vessels is an: a. lymphoma b. angiosarcoma c. hemangioma d. granuloma

c. splenomegaly

20. Sickle cell disease will often lead to: a. splenic metastasis b. sarcoidosis c. splenomegaly d. wandering spleen

a. herpes-virus that can lead to infectious mononucleosis in children

21. Epstein-Barr infection is best described as a. herpes-virus that can lead to infectious mononucleosis in children b. herpes-virus that is often associated with splenic granulomatous disease c. infection that results in sickle cell anemia in children d. an infection within a splenic hematoma following blunt trauma

b. culling

22. the spleen removes irregular cells from the blood stream and retains them through a process called: a. pitting b. culling c. crimping d. amassing

c. splenic infarct

23. an area within the spleen that has become necrotic because of a lack of oxygen is called: a. splenic hemangioma b. splenic hematoma c. splenic infarct d. granuloma

b. sarcoidosis

24. what systemic disease results in the development of granulomas within the spleen and throughout the body? a. granulomatosis b. sarcoidosis c. sickle cell anemia d. histoplasmosis

c. hydatid cyst

25. a complex cyst that results from the parasitic infestation of the spleen by a tape worm: a. bacterial endocarditic cyst b. choledocha cyst c. hydatid cyst d. candidiasis

d. none

26. From the list below, what is the most likely clinical finding of a patient who has a splenic hemangioma? a. fever b. decreased hematocrit c. elevated WBC d. none

a. hodgkin lymphoma

27. in a patient with suspected lymphoma, the presence of Reed-Sternberg cells indicates: a. hodgkin lymphoma b. non-hodgkin lymphoma c. metastatic liver disease d. splenic infarction

c. the spleen has a convex inferior margin and concave superior border

28. All of the following are true of the spleen except: a. it is the largest structure of the reticulo-endothelial system b. the primary objective of the spleen is to filter the peripheral blood c. the spleen has a convex inferior margin and concave superior border d. spleen is considered the largest lymphatic organ

b. SMV

29. The splenic vein joins with what structure posterior to the pancreatic neck to form the portal vein? a. IMA b. SMV c. IMA d. main hepatic vein

a. splenic infarct

3. A 48 year old male patient with a hx of severe sudden onset of the LUQ pain without trauma presents to the ultrasound department for a sonogram of the spleen. You visualize a wedge shaped hypo echoic area within the spleen. This most likely represents: a. splenic infarct b. splenic hematoma c. splenic hemangioma d. splenic metastasis

c. multiple benign granulomas

30. Small echogenic foci scattered throughout the spleen most likely represent: a. multiple benign hemangioma b. multiple benign hematomas c. multiple benign granulomas d. malignant lymphoma

a. echogenic

4. what is the most common sonographic appearance of a splenic hemangioma? a. echogenic b. hypoechoic c. anechoic d. complex

a. erythropoiesis

5. The process of making RBC's is termed: a. erythropoiesis b. leukopoiesis c. histopoiesis d. anemia

b. superior aspect of the pancreatic body and tail

6. The splenic artery marks the: a. posterior aspect of the pancreatic body and tail b. superior aspect of the pancreatic body and tail c. medial surface of the pancreatic body and tail d. later surface of the pancreatic body and tail

b. portal hypertension

7. The most common cause of splenomegaly is: a. hepatitis b. portal hypertension c. lymphoma d. trauma

a. red pulp

8. The type of tissue within the spleen that is responsible for its phagocytic function is the: a. red pulp b. white pulp c. culling pulp d. pitting pulp

d. hemangioma

9. A 32 year old female patient present to the ultrasound lab for an abdominal sonogram. An evaluation of the spleen reveals a 1cm, rounded, echogenic mass that does not produce acoustic shadowing. What is the most likely diagnosis? a.pheochromocytoma b. lipoma c. splenic metastasis d. hemangioma

yes

Can splenic cysts be complex?

asymptomatic

Clinical findings of granulomatous disease?

-asymptomatic -pain can occur with hemorrhage

Clinical findings of simple splenic cysts?

-asymptomatic -pain when hemorrhaging

Clinical findings of splenic hemangioma:

sudden LUQ pain

Clinical findings of splenic infarct:

-palpable, enlarged spleen -trauma -infection -possible elevated WBC's and or RBC count -hemolytic abnormalities

Clinical findings of splenomegaly

1. acute hemorrhage- isoechoic 2. later stages of hemorrhage- anechoic or echogenic 3. complex appearance or calcified walls

In cases of blunt trauma to the spleen, patients can complain of severe LUQ pain and the patient will have decreased hematocrit indicating active bleeding. What will the appearance of splenic trauma be on ultrasound?

portal hypertension

Most common cause of splenomegaly is

-AID's -sickle cell anemia (inherited disease in which body produces abnormally shaped RBC's) -leukemia -lymphoma -infection -trauma -mononucleosis

Other causes of splenomegaly is:

-iron storage -blood reservoir -destruction and removal of flawed RBC's and platelets -defense against disease -hematopoiesis or erythropoiesis

Other functions of the spleen include:

-diffuse: splenomegaly -focal: hypoechoic mass

Sonographic findings of angiosarcoma:

-acute: hypoechoic, wedge shaped mass within spleen -chronic: hyperechoic, wedge shaped mass within the spleen

Sonographic findings of splenic infarct:

enlargement of spleen - > 12cm length and > 5cm thickness

Sonographic findings of splenomegaly

bacterial endocarditis (infection of the surface of the heart that can spread to other organs)

Splenic infarct can be caused by ________ ___________

splenomegaly should never measure more than 12cm in length and 5cm in thickness. clinical: palpable, possible elevated RBC or WBC count. sono: enlargement

The most common abnormality of the spleen in which it is enlarged is known as:

isoechoic

The spleen is (isoechoic/hypoechoic) to the liver although it may be slightly less echogenic.

-patient LLD -inhale deeply

The spleen is best visualized with which patient position?

12cm, 5cm

The spleen should never measure more than _____ cm in length and _______ cm in width (thickness)

PV

The splenic vein exits the spleen and travels along the posterior border of the panc. tail and body to join with the SMV posterior to the panc. neck to form the _________

True

True or False. Most often, splenic cysts have thin walls, an anechoic center, and posterior enhancement.

produces lymphocytes and monocytes

What is the function of the spleen in adults?

fights infection

What is the function of the spleen in children?

erythropoiesis (making RBC's)

What is the function of the spleen in the fetus?

lymphoma

_________ is the most common malignancy of the spleen

Extramedullary hematopoiesis

___________ ____________ can occur when a patient has severe anemia causing the spleen hematopoietic function to return

accessory spleen

a small, round island of splenic tissue near the splenic hilum or near the tail of the pancreas is known as a ________ spleen

Splenic infarct

an area within the spleen that has become necrotic because of lack of oxygen