The Spleen CH 6

splenic lymphangioma

benign tumor composed of lymph spaces

29. A sickle cell crisis will often lead to: a. Splenic metastasis b. Sarcoidosis c. Splenomegaly d. Wandering spleen

c. Splenomegaly

Non-Hodgkin's Lymphoma

cancer of the lymphatic tissues other than Hodgkin's lymphoma

20. A 26-year-old patient with a long-standing history of multiple sickle cell crises and subsequent splenic infarctions presents to the sonography department for an abdominal sonogram. After thoroughly evaluating the left upper quadrant, only a fraction of splenic tissue can be identified. This describes the process of: a. Splenomicroly b. Asplenia c. Splenosis d. Autosplenectomy

d. Autosplenectomy

blunt trauma

non-penetrating injury to the body

Granulomas

small echogenic calcifications that result from inflammation of the tissue in that area

red pulp

specialized tissue within the spleen that performs its phagocytic function

Culling

the splenic process of removing irregular red blood cells from the bloodstream

CLINICAL FINDINGS OF A SPLENIC INFARCT

1. Sudden onset of left upper quadrant pain

What is the most common mass of the spleen?

Benign hemangioma

Hodgkin's lymphoma

Carcinoma of the lymphocytes that has a relatively high recovery rate; cancer of the lymphatic system

Pitting

The splenic process of cleaning red blood cells of the lymphatic system

hemangioma

a benign tumor made up of newly formed blood vessels

30. Epstein-Barr infection is best described as: a. A herpesvirus that can lead to infectious mononucleosis b. A herpesvirus that is often associated with splenic granulomatous disease c. An infection that results in sickle cell anemia in children d. An infection within a splenic hematoma fol- lowing blunt trauma

a. A herpesvirus that can lead to infectious mononucleosis

1. The process of making red blood cells is termed: a. Erythropoiesis b. Leukopoiesis c. Histopoiesis d. Anemia

a. Erythropoiesis

asplenia

absence of a spleen or of spleen function

sickle cell anemia

an inherited form of anemia produced by a mutation in the hemoglobin protein that causes the red blood cells to assume a sickle shape

10. The most common cause of splenomegaly is: a. Hepatitis b. Portal hypertension c. Lymphoma d. Trauma

b. Portal hypertension

SONOGRAPHIC FINDINGS OF SPLENIC TRAUMA

1. Acute hemorrhage-complex or hypoechoic 2. Middle stage-echogenic (with clot formation) or isoechoic 3. Later stages of hemorrhage-anechoic or hypoechoic 4. Chronic hematomas may have a complex ap- pearance or calcified walls

SONOGRAPHIC FINDINGS OF A SPLENIC INFARCT

1. Acute infarct-hypoechoic, wedge-shaped mass within the spleen 2. Chronic infarct-hyperechoic, wedge-shaped mass within the spleen

CLINICAL FINDINGS OF GRANULOMATOUS DISEASE OF THE SPLEEN

1. Asymptomatic 2. May have a history of histoplasmosis, tuberculo- sis, or sarcoidosis

CLINICAL FINDINGS OF SIMPLE SPLENICC CYSTS

1. Asymptomatic 2. Pain can occur with hemorrhage

CLINICAL FINDINGS OF SPLENIC HAMARTOMA

1. Asymptomatic 2. Pain can occur with rupture 3. Patient may have a history of Beckwith-Weide- mann syndrome or tuberous sclerosis

CLINICAL FINDINGS OF A SPLENIC HEMANGIOMA

1. Asymptomatic 2. Pain occurs with hemorrhage

CLINICAL FINDINGS OF SPLENIC TRAUMA

1. Blunt trauma to the left upper quadrant 2. Severe left upper quadrant pain 3. Decreased hematocrit level indicating active bleeding

SONOGRAPHIC FINDINGS OF SPLENIC ABSCESS

1. Complex appearance 2. May contain debris or gas (that produces dirty shadowing) 3. Can be completely hypoechoic

Functions of the spleen

1. Defense against disease 2. Hematopoiesis/erythropoiesis 3. Destruction and removal of flawed red blood cells and platelets 4. Blood reservoir 5. Storage of iron

SONOGRAPHIC FINDINGS OF SPLENIC MALIGNANCY

1. Diffuse-splenomegaly 2. Focal-hypoechoic masses

SONOGRAPHIC FINDINGS OF SPLENOMEGALY

1. Enlargement of the spleen to greater than 12 to 13 cm in length or 6 cm in thickness 2. Spleen extends beyond the inferior pole of the left kidney

CLINICAL FINDINGS OF SPLENIC ABSCESS

1. Fever 2. Leukocytosis 3. Left upper quadrant tenderness 4. Left flank pain 5. Splenomegaly

SONOGRAPHIC FINDINGS OF SPLENIC HAMARTOMA

1. Hypoechoic mass or masses (echotexture can vary however) 2. Color Doppler may reveal hypervascularity

CLINICAL FINDINGS OF SPLENIC MALIGNANCY

1. LUQ pain 2. Fever 3. Weight loss 4. Malaise

SONOGRAPHIC FINDINGS OF SPLENIC LYMPHANGIOMA

1. Multicystic masses 2. Masses may contain hypoechoic or anechoic locules and hyperechoic septations

CLINICAL FINDINGS OF SPLENIC LYMPHANGIOMA

1. Nausea 2. LUQ pain 3. Abdominal distention

CLINICAL FINDINGS OF SPLENOMEGALY

1. Palpable, enlarged spleen 2. Hemolytic abnormalities (sickle cell) 3. Trauma 4. Infection 5. History of cirrhosis, trauma, leukemia, or lymphoma 6. Possible elevated white blood cell and/or red blood cell count

SONOGRAPHIC FINDINGS OF SIMPLE SPLENIC CYSTS

1. Round 2. Smooth-walled mass 3. Anechoic mass 4. Posterior enhancement

SONOGRAPHIC FINDINGS OF GRANULOMATOUS DISEASE OF THE SPLEEN

1. Small, echogenic foci that may shadow

SONOGRAPHIC FINDINGS OF A SPLENIC НЕМANGIOMA

1. Well-defined, hyperechoic mass

Heterotaxia sydromes

A situation in which the organs of the chest and abdomen or abnormally arranged

Splenic hamartoma

Benign splenic mass associated with beckwith-weidemann syndrome and tuberous sclerosis

2. A 25-year-old female patient presents to the sonography department for a complete abdominal sonogram. She complains of right lower quadrant 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

C. Accessory spleen

Splenosis

Implantation of ectopic splenic tissue possibly secondary to splenic rupture

Anatomy bordering the spleen

Inferior to the diaphragm Posterolateral to the stomach Superior to the left kidney Lateral to the adrenal gland and pancreatic tail

Is the spleen an intraperitoneal or retroperitoneal organ?

Intraperitoneal

What is the function of the spleen in the fetus?

It is responsible for erythropoiesis

What is the most common cause of splenomegaly?

Portal hypertension

Reed-Stemberg cells

The cells that indicate the presence of Hodgkin lymphoma

What is the largest structure of the reticuloendothelial system?

The spleen

How is the echogenicity of the spleen compared to the liver?

The spleen is typically either isoechoic or more hyperechoic to the liver.

Splenic torsion

The twisting of the splenic vasculature causing a disruption of the blood supply to the spleen and subsequent ischemia

Splenic cleft

a congenital anomaly in which the spleen is divided into two portions by a band of tissue

Hydatid cyst

a cyst that results from the parasitic infestation of an organ by a tapeworm

Histoplasmosis

a disease that results from the inhalation of an airborne fungus that can affect the lungs and may spread to other organs

Beckwith-Wiedemann syndrome

a growth disorder syndrome synonymous with enlargement of several organs including the skull, tongue, and liver

Epstein-Barr virus

a herpesvirus causing infectious mononucleosis and associated with certain cancers, for example Burkitt's lymphoma.

wandering spleen

a highly mobile spleen

Santa graphically how is a splenic infarct typically seen

a hypoechoic, wedge-shaped mass.

Angiosarcoma

a rare malignant tumor of the spleen that is derived from blood vessels

accessory spleen

a small, round island of splenic tissue often located near the splenic hilum or tail of pancreas

Sarcoidosis

a systemic disease that results in the development of granulomas throughout the body

Tuberous sclerosis

a systemic disorder that leads to the development of tumors within various organs

6. What is the most common sonographic of a splenic hemangioma? appearance a. Echogenic b. Hypoechoic C. Anechoic d. Complex

a. Echogenic

15. The spleen is alan: a. Intraperitoneal organ b. Retroperitoneal organ

a. Intraperitoneal organ

14. Which of the following is a benign lesion that is a congenital malformation of the lymphatic system: a. Lymphangioma b. Hemangioma c. Angiosarcoma d. Myeloma

a. Lymphangioma

23. What is the splenic process of cleaning red blood cells of unwanted material: a. Pitting b. Plucking c. Culling d. Coring

a. Pitting

18. 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. Lateral aspect of the pancreatic body and tail

a. Posterior aspect of the pancreatic body and tail

12. 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

a. Red pulp

4. A 48-year-old male patient with a history of severe, sudden onset of left upper quadrant pain without trauma presents to the sonography department for a sonogram of the spleen. You visualize a wedge-shaped, hypoechoic area within the spleen. This most likely represents a: a. Splenic infarct b. Splenic hematoma c. Splenic hemangioma d. Splenic metastasis

a. Splenic infarct

24. 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

a. Splenomegaly

Splenule

accessory spleen

splenic infarct

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

bacterial endocarditis

an infection of the surface of the heart that can spread to other organs

Granulomatous disease

an inherited disease that disrupts the normal immune system and causes it to malfunction resulting in immunodeficiency; chronic inflammation can lead to the development of granulomas in several organs

3. A rare malignant tumor of the spleen that consists of blood vessels is a/an: a. Lymphoma b. Angiosarcoma c. Hemangioma d. Granuloma

b. Angiosarcoma

17. Which of the following children would least likely suffer from sickle cell anemia? a. African-American b. Caucasian c. Middle Eastern d. Mediterranean

b. Caucasian

31. The spleen removes irregular cells from the bloodstream through a process called: a. Pitting b. Culling c. Crimping d. Amassing

b. Culling

8. Multiple, small echogenic foci scattered throughout the spleen in a patient with a history of toxoplasmosis most likely represent: a. Sarcoidosis b. Granulomas c. Lymphangiomas d. Hemangiomas

b. Granulomas

26. Which of the following is a congenital anomaly in which the spleen is divided into two portions by a band of tissue? a. Splenic infarct b. Splenic cleft c. Splenosis d. Splenic impertecta

b. Splenic cleft

9. 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. Lateral aspect of the pancreatic body and tail

b. Superior aspect of the pancreatic body and tail

16. The type of tissue within the spleen that is responsible for its lymphatic function is the: a. Red pulp b. White pulp c. Culling segment d. Pitting segment

b. White pulp

25. The splenic artery originates at the: a. Superior mesenteric artery b. Inferior phrenic artery c. Celiac trunk d. Gastroduodenal artery

c. Celiac trunk

28. A 14-year-old male patient presents to the sonography department after falling from his bicycle. An abdominal sonogram 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

c. Splenic hematoma

21. 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

c. Splenic hilum

32. An area within the spleen that has become necrotic because of a lack of oxygen is referred to as a: a. Splenic hemangioma b. Splenic hematoma c. Splenic infarct d. Granuloma

c. Splenic infarct

11. The splenic hamartoma may be discovered more often in individuals with a history of: a. HIV b. Splenic carcinoma c. Tuberous sclerosis d. Meckel-Gruber syndrome

c. Tuberous sclerosis

mononucleosis

condition caused by the Epstein-Barr virus and characterized by an increase in mononuclear cells (monocytes and lymphocytes) in the blood along with enlarged lymph nodes (lymphadenopathy), fatigue, and sore throat (pharyngitis)

Polysplenia

condition where there is more than one spleen

19. 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

d. Destruction of phagocytic cells

13. A 32-year-old female patient presents to the sonography department for an abdominal sonogram. An evaluation of the spleen reveals a 1-cm, rounded, echogenic mass that does not produce acoustic shadowing. What is the most likely diagnosis? a. Pheochromocytoma b. Lipoma c. Splenic metastasis d. Hemangioma

d. Hemangioma

27. A 35-year-old male patient presents to the sonography department for an abdominal sonogram with a history of abdominal pain and histoplasmosis. What are you more likely to identify within the spleen? a. Multiple histomas b. Multiple hemangiomas c. Multiple metastatic lesions d. Multiple granulomas

d. Multiple granulomas

22. All of the following can be associated with splenomegaly except: a. Trauma b. Hemolytic abnormalities c. Mononucleosis d. Pancreatitis

d. Pancreatitis

1. A 15-year-old male patient presents to the sonography department with a history of left sided trauma 5 years earlier. He currently has no LUQ discomfort. The sonographic findings of the spleen include a mass that contains calcification producing distinct posterior shadowing. What is the most likely diagnosis? a. Splenic hemangioma b. Splenic hamartoma c. Splenic lymphangioma d. Splenic hematoma

d. Splenic hematoma

5. A patient with a wandering spleen would have an increased risk for: a. Splenic infection b. Splenosis c. Splenic carcinoma d. Splenic torsion

d. Splenic torsion

-lysis

destruction

splenomegaly

enlargement of the spleen

portal hypertension

the elevation of blood pressure within the portal venous system

Autosplenectomy

the gradual fibrosis and dysfunction of the spleen secondary to a disease

Erythropoiesis

the process of red blood cell production

Extramedullary hematopoiesis

the spleen's hematopoietic function which can return in cases of severe anemia