Pathology of the spleen

What is a rare and potentially fatal storage disease that most frequently involves the spleen? A. Amyloidosis B. Gaucher's Disease C. Niemann-Pick Disease

A. (Amyloidosis)

What is the disease of the spleen that is caused by a protein that can be abnormally deposited in excess in any tissue or organ? A. Amyloidosis B. Gaucher's Disease C. Niemann-Pick Disease

A. (Amyloidosis)

During ab US of a patient with portal hypertension and splenomegaly, you detect a calcified ring at the splenic hilum. What should you do? A. Evaluate the area with color Doppler B. Roll the patient into a decubitus position to see if the structure moves C. Have the patient drink 24 oz of water and rescan D. Have the patient return for a repeat study in 1 wk for comparison E. Nothing as this is not a significant finding

A. (Evaluate the area with color) (these findings are consistent with splenic artery aneurysm. Aneurysm of the splenic artery may be associated with splenomegaly due to portal hypertension. The patient may also have varices at the splenic hilum due to portal hypertension. Color should aid in the distinction btw these entities.)

An US exam shows a hyperechoic lesion of vascular and lymphoid tissue that is well defined but not encapsulated. There are solid and cystice components. What do you suspect? A. Hamartoma B. Cavernous Hemangioma C. Cystic Lymphangioma D. Lymphoma

A. (Hamartoma)

What is the most common primary benign neoplasm? A. Hamartoma B. Cavernous Hemangioma C. Cystic Lymphangioma D. Lymphoma

A. (Hamartoma)

What would you suspect in a patient that shows a proliferation of the reticuloendothelium in the spleen and liver. The spleen appears isoechoic. A. Reticuloendotheliosis B. Letterer-Siwe Disease C. Hand-Schuller-Christian Disease D. Leukemia

A. (Reticuloendothelisosis)

A 3yo patient comes in for US. The exam shows a small spleen with infarction and fibrosis. What do you suspect? A. Sickle cell B. Congenital spherocytosis C. Hemolytic Anemia D. Chronic anemia E. Polycythemia vera F. Thalassemia

A. (Sickle Cell)

A 5yo black patient comes in for an US. The history is a sudden decreased hematocrit. On US you find a small hypoechoic area in the periphery of the spleen. What do you suspect? A. Sickle cell B. Congenital spherocytosis C. Hemolytic Anemia D. Chronic anemia E. Polycythemia vera F. Thalassemia

A. (Sickle Cell)

Which Erythropietic Disease causes red pulp congestion, progeressive infarction and fibrosis and the spleen becomes small? A. Sickle cell B. Hereditary spherocytosis C. Hemolytic Anemia D. Chronic anemia E. Polycythemia vera F. Thalassemia

A. (Sickle cell)

Which Erythropietic Disease causes the spleen to be enlarged in the beginning and causes it to become a small mass of fibrosis tissue? A. Sickle cell B. Congenital spherocytosis C. Hemolytic Anemia D. Chronic anemia E. Polycythemia vera F. Thalassemia

A. (Sickle cell)

An US exam shows a hypoechoic spleen with a poor defined lesion with an anechoic area within that has thick irregular walls. A. Splenic Abscess B. Splenic Infection C. AIDS D. Splenic Infarction E. Splenic Trauma F. Splenic Cysts

A. (Splenic Abscess)

What would you suspect in a patient that has a history of drug use, bacterial endocarditis, fever LUQ pain? A. Splenic Abscess B. Splenic Infection C. AIDS D. Splenic Infarction E. Splenic Trauma F. Splenic Cysts

A. (Splenic Abscess)

What would you suspect in a patient with a history of septicemia, abdominal pain, left shoulder pain and left flank pain? A. Splenic Abscess B. Splenic Infection C. AIDS D. Splenic Infarction E. Splenic Trauma F. Splenic Cysts

A. (Splenic Abscess)

Which of the following is not a malignant neoplasm? A. cystic lymphangioma B. Hemangiosarcoma C. Lymphoma D. mets

A. (cystic lymphangioma)

During splenic US, you detect moderate splenomegaly and dilated, tortuous vessels at the splenic hilum. What condition do you suspect? A. Portal hypertension B. Histoplasmosis C. Lymphoma D. Splenic rupture E. Splenic pseudocyst

A. (portal hypertension) (dilated varices are commonly seen at the splenic hilum. Splenomegaly is almost always present)

What type of cyst contains epithelial lining and is congenital? A. Primary cysts B. Secondary cysts C. False cysts D. True cysts E. B and C

A. (primary cysts)

What are the 2 types of splenic congestion?

Acute and Chronic

What are the 3 storage diseases of the spleen?

Amyloidosis, Gaucher's Disease, Niemann-Pick disease

During routine US evaluation of the spleen, you detect a small, rounded mass at the splenic hilum that is homogeneous and isoechoic with the spleen. You have most likely detected: A. Exophytic splenic cyst B. Accessory spleen C. Enlarged lymph node D. Splenic mets E. Splenic hemangioma

B. (Accessory spleen)

An US exam shows a large inhomogeneous echogenic mass with small hypoechoic areas. The patient is asymptomatic. What would you suspect? A. Hamartoma B. Cavernous Hemangioma C. Cystic Lymphangioma D. Lymphoma

B. (Cavernous Hemangioma)

What is the neoplasm called that is a jumbled growth of blood vessels? A. Hamartoma B. Cavernous Hemangioma C. Cystic Lymphangioma D. Lymphoma

B. (Cavernous Hemangioma)

You have a 5yo patient come in for US. The blood tests show an abnormality of red cells causing them to be shaped like spheres. The child is anemic. The US shows splenomegaly. What do you suspect? A. Sickle cell B. Congenital spherocytosis C. Hemolytic Anemia D. Chronic anemia E. Polycythemia vera F. Thalassemia

B. (Congenital spherocytosis)

What storage disease occurs then fat and proteins are deposited abnormally in the body? A. Amyloidosis B. Gaucher's Disease C. Niemann-Pick Disease

B. (Gaucher's Disease)

Which storage disease affects, children, interferes the the normal functioning of organs? A. Amyloidosis B. Gaucher's Disease C. Niemann-Pick Disease

B. (Gaucher's Disease)

Which storage disease produces diffuse inhomogenicity of the spleen with multiple nodules? A. Amyloidosis B. Gaucher's Disease C. Niemann-Pick Disease

B. (Gaucher's Disease)

Which storage disease results form an enzyme deficiency sometimes called glucocerebrosidase deficiency? A. Amyloidosis B. Gaucher's Disease C. Niemann-Pick Disease

B. (Gaucher's Disease)

Which of the following appears like a cavernous hemangioma? A. cystic lymphangioma B. Hemangiosarcoma C. Lymphoma D. mets

B. (Hemangiosarcoma)

Which of the following is a primary splenic CA? A. cystic lymphangioma B. Hemangiosarcoma C. Lymphoma D. mets

B. (Hemangiosarcoma)

Which of the following is composed of vascular endothelium and likely to cause bleeding? A. cystic lymphangioma B. Hemangiosarcoma C. Lymphoma D. mets

B. (Hemangiosarcoma)

A 2yo patient comes in with a history of fever, hepatosplenomegaly and a proliferation of reticuloendothelial cells in all tissues, especially in splenic lymph nodes and bone marrow. What would you suspect? A. Reticuloendotheliosis B. Letterer-Siwe Disease C. Hand-Schuller-Christian Disease D. Leukemia

B. (Letterer-Siwe Disease)

What disease is AKA nonlipid reticuloendotheliosis? A. Reticuloendotheliosis B. Letterer-Siwe Disease C. Hand-Schuller-Christian Disease D. Leukemia

B. (Letterer-Siwe Disease)

A patient comes in with left flank pain, fever and the US exam shows a mass with a "bulls eye" or "wheels within wheels" pattern. What would you suspect? A. Splenic Abscess B. Splenic Infection C. AIDS D. Splenic Infarction E. Splenic Trauma F. Splenic Cysts

B. (Splenic Infection)

An immunocompromised patient comes in for an US exam. The exam shows irregular masses with the spleen that have a hypoechoic ring with an echogenic central core. What would you suspect? A. Splenic Abscess B. Splenic Infection C. AIDS D. Splenic Infarction E. Splenic Trauma F. Splenic Cysts

B. (Splenic Infection)

What would you suspect in a patient with fever, LUQ pain, left shoulder pain and a history of being immunologically compromised? A. Splenic Abscess B. Splenic Infection C. AIDS D. Splenic Infarction E. Splenic Trauma F. Splenic Cysts

B. (Splenic Infection)

Sickle Cell Anemia produces cells that are A. flattened, biconcave disks B. crescent shaped C. spheres D. central color spot in the area of pallor E. target cells

B. (crescent shaped)

What type of disorder would you suspect from an US exam that shows an isoechoic US pattern and the parenchyma is hypoechoic when compared to the liver? A. Storage diseases B. myeloproliferative disorder C. granulocytopoietic abnormalities D. Erythropoietic diseases

B. (myeloproliferative disorder)

You are performing an abdominal US scan and detect a hypoechoic, wedge-shaped lesion within the spleen. This is the typical appearance of which of the following entities? A. Splenic hemangioma B. Splenic infarction C. Splenic mets D. Granulomatous disease of the spleen E. Splenic abscess

B. (splenic infarct) (splenic infarct classically appears as a hypoechoic, wedge-shaped lesion. With time, the infarct may become hyperechoic. Some infarcts may have a more nodular shape)

What organs do mets usually spread from?

BLOCKS P Breast Lung Ovary Colon Kidney Stomach Prostate

A patient comes in with a history of Candida, Pneumonia, Mycobacterium and Kaposi's Sarcoma with the past 2 years. The US findings include multiple focal splenic lesions that are hypoechoic and well defined. What would you suspect? A. Splenic Abscess B. Splenic Infection C. AIDS D. Splenic Infarction E. Splenic Trauma F. Splenic Cysts

C. (AIDS)

What is the neoplasm called that is a malformation of the lymphatics that can affect one or multiple organs? A. Hamartoma B. Cavernous Hemangioma C. Cystic Lymphangioma D. Lymphoma

C. (Cystic Lymphangioma)

What would you suspect in a 3yo child that has a history of granulomas in the skull, skin and viscera and diabetes? A. Reticuloendotheliosis B. Letterer-Siwe Disease C. Hand-Schuller-Christian Disease D. Leukemia

C. (Hand-Schuller-Christian Disease)

What would you suspect in a patient that has a history of rapid rate of destruction of the erythrocytes? A. Sickle cell B. Congenital spherocytosis C. Hemolytic Anemia D. Autoimmune Hemolytic anemia E. Polycythemia vera F. Thalassemia

C. (Hemolytic Anemia)

Which type of following is the most common type of blood CA in US? A. cystic lymphangioma B. Hemangiosarcoma C. Lymphoma D. mets

C. (Lymphoma)

Which is a type of lysosome storage disease? A. Amyloidosis B. Gaucher's Disease C. Niemann-Pick Disease

C. (Neimann-Pick Disease)

Which storage disease is very fast and very fatal disease? A. Amyloidosis B. Gaucher's Disease C. Niemann-Pick Disease

C. (Neimann-Pick Disease)

Which storage disease affects mostly female infants? A. Amyloidosis B. Gaucher's Disease C. Niemann-Pick Disease

C. (Niemann-Pick Disease)

Which storage disease has the clinical findings of hepatomegaly, digestive disturbances and lymphadenopathy? A. Amyloidosis B. Gaucher's Disease C. Niemann-Pick Disease

C. (Niemann-Pick Disease)

Which storage disease has the sonographic finding of a very enlarged Spleen, lipid accumulation, echogenic? A. Amyloidosis B. Gaucher's Disease C. Niemann-Pick Disease

C. (Niemann-Pick Disease)

What would you suspect in a patient with a history of previous granulomatous infections, calcium in the splenic artery and problems creating WBC's? A. Storage diseases B. myeloproliferative disorder C. granulocytopoietic abnormalities D. Erythropoietic diseases

C. (granulocytopoietic abnormalities)

Congenital Spherocytosis produces cells that are A. flattened, biconcave disks B. crescent shaped C. spheres D. central color spot in the area of pallor E. target cells

C. (spheres)

What are the causes of splenic congestion? There are 5 name 3

Cirrhosis of the liver, portal hypertension, cystic fibrosis, portal or splenic vein thrombosis, heart failure

Most common causes of splenomegaly, there are 5, name 3

Congestion, Neoplasms, Infection, Hemolytic anemia, trauma

Thalassemia produces cells that are A. flattened, biconcave disks B. crescent shaped C. spheres D. central color spot in the area of pallor E. target cells

D and E

A patient comes in for US. The history is lethargy, short of breath and paleness. The patient is also suffering from lymphoma and mononucleosis. Blood tests show anemia. The US exam shows splenomegaly. What do you suspect? A. Sickle cell B. Congenital spherocytosis C. Hemolytic Anemia D. Autoimmune Hemolytic anemia E. Polycythemia vera F. Thalassemia

D. (Autoimmune Hemolytic anemia)

A patient comes in with a history of swelling of the lymph nodes in the neck, armpits and groin, fatigue, night sweats, wt loss and itching? What would you suspect? A. cystic lymphangioma B. Hemangiosarcoma C. Lymphoma D. Hodgkins lymphoma E. Non Hodgkins lymphoma

D. (Hodgkins Lymphoma)

What would you suspect is a patient with a history of itching, that has diffuse or small nodular lesions in the spleen on US? A. cystic lymphangioma B. Hemangiosarcoma C. Lymphoma D. Hodgkins lymphoma E. Non Hodgkins lymphoma

D. (Hodgkins Lymphoma)

What would you suspect in a patient with a history of night sweats, bleeding easily, painful belly, swollen lymph nodes in the armpit, neck and groin and has been getting a lot of infections? A. Reticuloendotheliosis B. Letterer-Siwe Disease C. Hand-Schuller-Christian Disease D. Leukemia

D. (Leukemia)

What would you suspect in a patient with fever, bruising easily, bone pain, swollen belly, swollen lymph nodes in the armpit, neck and groin, losing wt and lethargy? A. Reticuloendotheliosis B. Letterer-Siwe Disease C. Hand-Schuller-Christian Disease D. Leukemia

D. (Leukemia)

Which is not a benign neoplasm? A. Hamartoma B. Cavernous Hemangioma C. Cystic Lymphangioma D. Lymphoma

D. (Lymphoma)

You are imaging the spleen of a 27 yo male with AIDS. What is the most common finding in the spleen in patients with AIDS? A. Abscess B. Mets C. Accessory spleen D. Moderate splenomegaly E. Lymphoma

D. (Moderate splenomegaly) (The spleen may also be involved with focal lesions caused by opportunistic infections such as Candida, pneumocystis or mycobacterium. The spleen may also be involved in Kaposi's sarcoma or lymphoma)

You are performing an ab US on a patient with histoplsmosis. What findings of the spleen are commonly seen with this condition? A. small, shrunken spleen B. Multiple hypoechoic masses throughout the spleen C. Splenic abscess D. Mutiple focal, bright echogenic granulomatous lesions throughout the spleen E. Solitary cyst with calcified walls

D. (Multiple focal, bright echogenic granulomatous lesions throughout the spleen) (this same pattern may be seen with TB and sarcoidosis involving the spleen)

What is the most common cause of focal splenic lesions? A. Splenic Abscess B. Splenic Infection C. AIDS D. Splenic Infarction E. Splenic Trauma F. Splenic Cysts

D. (Splenic Infarction)

What would you suspect if an US exam showed a spleen with wedge shaped hypoechoic lesions? A. Splenic Abscess B. Splenic Infection C. AIDS D. Splenic Infarction E. Splenic Trauma F. Splenic Cysts

D. (Splenic Infarction)

What type of cysts is solitary but rarely contain calcifications? A. Primary cysts B. Secondary cysts C. False cysts D. True cysts E. B and C

D. (True cysts)

Which of the following is not a feature you would detect in a splenic cyst? A. Smooth border B. Posterior acoustic enhancement C. Anechoic D. Increased attenuation E. Rounded shape

D. (increased attenuation) (Cysts show decreased sound attenuation that result in the US appearance of posterior acoustic enhancement.)

You are performing an US study on a patient with malignant melanoma. Your US findings reveal multiple hyperechoic masses within the spleen. This most likely represents: A. Histoplasmosis B. TB C. Pseudocysts D. mets E. Infarction

D. (mets)

Which type of Amyloidosis involves the red pulp?

Diffuse

What type of cyst is the result of previous trauma, has no lining and accounts for 80% of nonparasitic cysts? A. Primary cysts B. Secondary cysts C. False cysts D. True cysts E. B and C

E. (B and C)

You are scanning a patient with moderate splenomegaly. Which of the following is a cause of mild to moderate spleomegaly? A. Portal hypertension B. Infection C. AIDS D. Lymphoma E. A, B and C only

E. (Causes of mild to moderate splenomegaly include portal hypertension, infection, and AIDS. Leukemia, lymphoma and myelofibroisis result in marked splenomegaly)

What would you suspect in a patient that has swollen lymph nodes in neck, armpit and groin, fever, fatigue, wt loss and abdominal pain? A. cystic lymphangioma B. Hemangiosarcoma C. Lymphoma D. Hodgkins lymphoma E. Non Hodgkins lymphoma

E. (Non Hodgkins Lymphoma)

A 45 yo male comes in with a history of weakness, fatigue, vertigo, tinnitus and blue and black spots on the trunk. The blood tests show increased RBC, WBC and platelets. The US exam shows enlargement of the spleen, with infarcts and thrombosie. What do you suspect? A. Sickle cell B. Congenital spherocytosis C. Hemolytic Anemia D. Autoimmune Hemolytic anemia E. Polycythemia vera F. Thalassemia

E. (Polycythemia Vera)

An US exam shows a spleen with irregular borders, hematoma, free intraperitoneal blood and left pleural effusion. What would you suspect? A. Splenic Abscess B. Splenic Infection C. AIDS D. Splenic Infarction E. Splenic Trauma F. Splenic Cysts

E. (Splenic Trauma)

What would you suspect in a patient that comes in from the ER with LUQ pain, dizziness, tenderness over LUQ, decreased hemoglobin? A. Splenic Abscess B. Splenic Infection C. AIDS D. Splenic Infarction E. Splenic Trauma F. Splenic Cysts

E. (Splenic Trauma)

What would you suspect in an US exam that shows an intraperitoneal hematoma in a patient that was involved in a motor vehicle accident? A. Splenic Abscess B. Splenic Infection C. AIDS D. Splenic Infarction E. Splenic Trauma F. Splenic Cysts

E. (Splenic Trauma)

You are performing an US study on a patient with a history of recent blunt left sided trauma in a MVA. Which finding below is not associated with this history? A. splenic laceration B. Subcapsular hematoma of the spleen C. Free fluid D. Perisplenic hematoma E. calcified splenic cyst

E. (calcified splenic cyst) (a calcified splenic cyst may be associated with a past hx of trauma but is not an acute finding.)

What is an other name for Hydatid disease?

Echinoccus - splenic cysts

A patient comes in with a history of being out of the country for a few months. US exam shows a solic mass with fine internal echoes and poor posterior enhancement. What would you suspect? A. Splenic Abscess B. Splenic Infection C. AIDS D. Splenic Infarction E. Splenic Trauma F. Splenic Cysts

F. (Splenic Cysts - parasitic)

An US exam shows a smooth lesion. The fluid appears clear. What would you suspect? A. Splenic Abscess B. Splenic Infection C. AIDS D. Splenic Infarction E. Splenic Trauma F. Splenic Cysts

F. (Splenic cysts)

A 18 yo patient comes in with a history of slowed growth, delayed puberty and brittle bones. There is a LUQ fullness. The blood tests reveal target cells. What do you suspect? A. Sickle cell B. Congenital spherocytosis C. Hemolytic Anemia D. Autoimmune Hemolytic anemia E. Polycythemia vera F. Thalassemia

F. (Thalassemia)

A 25 yo patient comes in with a history of poor appetite, slowed growth, jaudice, enlarged spleen, liver and heart. The blood tests show a deficiency in hemoglobin and an abnormal RBC. The erythrocytes have a central color spot in the area of pallor. The US exam shows an extremely large spleen. What do you suspect? A. Sickle cell B. Congenital spherocytosis C. Hemolytic Anemia D. Autoimmune Hemolytic anemia E. Polycythemia vera F. Thalassemia

F. (Thalassemia)

A patient comes in from ER after an accident. He has left flank pain, hypotension and decreased hemoglobin. The splenic borders are irregular. Besides the spleen what else should you look for?

Fluid in the other 3 abdominal quadrants

What are the clinical symptoms of splenomegaly?

LUQ pain, LUQ fullness

What are the 3 types of Diffuse Diseases?

Myeloproliferative, Granulocytopoietic, and Erythropoietic

Which type of Amyloidosis involves the follicles?

Nodular

What are the two types of Amyloidosis?

Nodular and diffuse

Which lymphoma is more common and by how much?

Non Hodgkins lymphoma by 5X

What are the 2 classifications of splenic cysts?

Parasitic and nonparasitic

What is the most common cause of splenic congestion?

cirrhosis of the liver

The most common disease processs of the spleen

splenomegaly