ARRT PENNY BOOK CHP. 6

The splenic artery originates at the...

celiac trunk

The process of making red blood cells is termed...

erythropoiesis

The spleen is a...

intraperitoneal organ

what is the spleen composed of?

is composed of white pulp and red pulp. White pulp produces lymphocytes to aid the immune response. Red pulp. which contains red blood cells and macrophages perform the phagocytic function of spleen. Phagocytes engulf and destroy pathogens.

Polysplenia

more than one spleen; associated with cardiac malformations

Splenic cyst

mostly caused by trauma, infection or infarction

Small echogenic foci scattered throughout the spleen most likely represents:

multiple benign granulomas

The splenic vein marks the:

posterior aspect of the pancreatic body and tail

All functions of the spleen:

storage of iron defense against disease blood reservoir

The splenic artery marks the...

superior aspect of the pancreatic body and tail

The splenic artery marks the:

superior aspect of the pancreatic body and tail

The splenic vein joins what structure posterior to the pancreatic neck to form the portal vein?

superior mesenteric vein

The splenic hamartoma is often discovered in individuals with a history of:

tuberous sclerosis

Anatomy bordering the spleen

-Inferior to the diaphragm -posterolateral to the stomach -superior to the left kidney -lateral to the adrenal and pancreatic tail

The spleen

-The largest structure of the reticuloendothelial system, is an intraperitoneal organ located within the left upper quadrant of the abdomen whose primary objective is to filter the peripheral blood.

Sonographic findings of splenic trauma

1. Acute hemorrhage- complex or hypoechoic 2. Middle stage- echogenic (with clot formation) 3. later stages of hemorrhage- anechoic or hypoechoic 4. chronic hematomas may have a complex appearance or calcified walls

Clinical findings of splenic cysts

1. Asymptomatic 2. Pain can occur with hemorrhage

Clinical findings of a splenic hemangioma

1. Asymptomatic 2. Pain occurs with hemorrhage

Clinical findings of granulomatous disease of the spleen

1. Asymptomatic 2. may have a history of histoplasmosis, tuberculosis or sarcoidosis

Clinical findings of splenic hamartoma

1. Asymptomatic 2. pain that occur with rupture 3. patient may have a history of Beckwith- Weidemann syndrome or tuberous sclerosis

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.

Functions of the spleen

1. Defense against disease 2. hematopoiesis/erythropoiesis 3. destruction and removal of flawed red blood 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 spleen greater than 12-13 cm in length and 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 plank pain 5. splenomegaly

Clinical findings of splenic malignancy

1. LUQ pain 2. fever 3. weight loss 4. malaise

Pediatric pathology of the spleen -Sonographic findings of splenic lymphangioma

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

Pediatric pathology of the spleen -Clinical findings of splenic lymphangioma

1. Nausea 2. LUQ pain 3. Abdominal distension

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 a splenic hemangioma

1. Well-defined, hyperechoic mass

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

Sonographic findings of splenic abscess

1. complex appearance 2. may contain debris or gas (that produce dirty shadowing) 3. can be completely hypoechoic

Sonographic findings of splenic hamartoma

1. hypoechoic mass or masses (echotexture can vary however) 2. color doppler may reveal hypervascularity

Sonographic findings of granulomatous disease of the spleen

1. small echogenic foci that may shadow

Clinical findings of a splenic infarct

1. sudden onset of LUQ pain

Epstein-Barr infection is best described as:

A herpes virus that can lead to infectious mononucleosis in children

Sarcoidosis

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

Asplenia

Absence of a spleen. Associated with cardiac malformations

Accessory spleen

Also referred as splenule, a splenunculus or supernumerary spleen. Small round island of splenic tissue is typically located near the splenic hilum or possibly the tail of the pancreas.

What is the primary malignant tumor of the spleen?

Angiosarcoma

Splenic hamartoma

Benign mass associated with Beckwith- Weidemann syndrome and tuberous sclerosis.

Wondering spleen

Case in which the splenic ligaments are absent and underdeveloped , allowing the spleen to be highly mobile and often positioned in the lower abdomen.

Splenomegaly

Enlargement of the spleen. Can lead to spontaneous splenic rupture.

In a patient with suspected lymphoma, the presence of Reed- Sternberg cells indicates:

Hodgkin lymphoma

Splenosis

Implantation of ectopic splenic tissue possibly secondary to splenic rupture

Echogenicity of the spleen

Isoechoic or more hyperechoic to the liver

Most common cause of splenomegaly

Portal hypertension.

The type of tissue within the spleen that is responsible for its phagocytic function is...

Red pulp

Pediatric pathology of the spleen -Sickle cell anemia

Sickle cell disease is a group of inherited blood disorders that include sickle cell anemia. Those with sickle cell anemia have abnormally crescent shape red blood cells that have a tendency to attach to each other and obstruct normal vascular channels. A child suffering from sickle cell disease often has enlarged spleen during a sickle cell crisis. It mainly affects African American, middle east, Mediterranean and Hispanic children of Caribbean descent in America.

Granulomatous disease in the spleen

Small echogenic foci seen throughout the spleen. Can be found in patients with a history of histoplasmosis, tuberculosis or sarcoidosis

Pediatric pathology of the spleen -Splenic lymphangioma

Splenic lymphangioma is a benign lesion that is a congenital malformation of the lymphatic system.

A sickle cell crisis will often lead to...

Splenomegaly

Describes the implantation of ectopic splenic tissue possibly secondary to splenic rupture:

Splenosis

The superior vein joins what structure posterior to the pancreatic neck and the portal vein?

Superior mesenteric vein

What is the most common mass of the spleen?

The benign hemangioma

Pitting

The process in which the spleen cleans red blood cells of unwanted material.

Culling

The process when the spleen removes irregular red blood cells from the bloodstream.

Measurements of the spleen

The spleen should never measure more than 12-13 cm in length and 6 cm in thickness

The type of tissue within the spleen that is responsible for its lymphatic function is...

The white pulp

Other causes of splenomegaly

Trauma, leukemia, lymphoma, a pediatric sickle cell anemia crisis, granulomatous disease (inherited disease that disrupts immune system) and infections such as endocarditis, AIDS, and hepatitis. Epstein Barr infection.

Splenic torsion

Vessels of the spleen may twist secondary to the hypermobility of the organ.

Autosplenectomy

With time and with recurrent sickle cell crises, the spleen will eventually become fibrotic and atrophy. Wasting away of the spleen caused by multiple infarctions.

Splenic cleft

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

Heterotaxia syndromes

a situation in which the organs of the chest and abdomen are abnormally arranged

Splenic infarct

an area within the spleen that has become necrotic because of a lack of oxygen. Can be caused by sickle cell disease , bacterial endocarditis, tumor embolization, vasculitis and lymphoma.