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
