Spleen Review

An asymptomatic patient presents to the ultrasound department with a history of hepatitis B. An incidental finding is identified in the superior portion of the spleen. This finding is most consistent with a

cyst

Metastasis to the spleen most commonly originates from which of the following malignancies

melanoma

You are performing an ultrasound study on a patient with malignant melanoma. Your ultrasound findings reveal multiple hyperechoic masses within the spleen. This most likely represents

metastasis

A congenital anomaly of the spleen associated with gastrointestinal, cardiovascular, and biliary anomalies is most consistent with

polysplenia syndrome

A hematoma located below the splenic capsule most commonly appears on ultrasound as a

crescent-shaped fluid collection inferior to the diaphragm

Which of the following would be most helpful in improving diagnostic confidence in the case of a wedge-shaped lesion?

evaluate the lesion with color Doppler

(You detect moderate splenomegaly and dilated, tortuous vessels at the splenic hilum). Considering the ultrasound findings, what additional information should you provide?

evaluate the liver and portal vein

Splenic infarction is most commonly associated with an embolism originating from which of the following structures?

heart

An afebrile 13 yr old female patient presents to the ultrasound department complaining of vague left upper quadrant pain. She admits to "wrestling" with her brother a week ago. She denies blunt force trauma. Lab tests are pending. Based on this clinical history, the sonographic findings are most suspicious for

hematoma

Which of the following structures carries carbon dioxide back to the lungs?

hemoglobin

Which of the following structures is recycled into iron by the spleen?

hemoglobin

A patient arrives at the ER following a motor vehicle accident. An abdominal ultrasound is MOST LIKELY ordered to evaluate for which of the following conditions?

hemoperitoneum

Enlargement of the spleen may be associated with all EXCEPT: cirrhosis hypotension diabetes mellitus portal hypertension congestive heart failure

hypotension

(A retroperitoneal ultrasound is ordered on an elderly patient with a history of elevated creatinine levels. Hyperechoic foci are identified in the splenic parenchyma). Based on the clinical history, these sonographic findings are most likely considered

incidental findings

Which of the following is NOT a feature you would detect in a splenic cyst? smooth border posterior acoustic enhancement anechoic increased attenuation rounded shape

increased attenuation

Which of the following conditions is most likely to demonstrate an elevated hematocrit?

infection

You have been asked to evaluate the tail of the pancreas. What is the relationship of the pancreatic tail to the spleen?

inferomedial

The location of the spleen is best described as

lateral to the stomach

You are performing an abdominal ultrasound and are having difficulty identifying the spleen. Which of the following structures is in contact with the spleen?

left hemidiaphragm stomach pancreas splenic flexure of the colon

In cases of portal hypertension, the splenic vein is most likely to shunt blood directly into the

left renal vein

Leukemia may be associated with all the following EXCEPT: splenomegaly joint pain leukopenia weakness lymphadenopathy

leukopenia

Hemangiosarcoma involving the spleen frequently metastasizes to which of the following organs?

liver

Which of the following conditions is most likely associated with a decrease in leukocytes?

lymphoma

Predisposing factors for developing an aneurysm of the splenic artery may include all of the following EXCEPT: trauma infection atherosclerosis male prevalence portal hypertension

male prevalence

You are imaging the spleen of a 27 yr old male with AIDS. What is the most common finding in the spleen in patients with AIDS?

moderate splenomegaly

You are performing an abdominal ultrasound on a patient with histoplasmosis. What findings of the spleen are commonly seen with this condition?

multiple focal, bright echogenic granulomatous lesions throughout the spleen

A patient with an accessory spleen will most likely present with which of the following symptoms?

no symptoms

During splenic sonography, you detect moderate splenomegaly and dilated, tortuous vessels at the splenic hilum. What condition do you suspect?

portal hypertension

You are scanning a patient with moderate splenomegaly. Which of the following is a cause of mild to moderate splenomegaly?

portal hypertension infection AIDS

The splenic vein drains into what vein?

portal vein

The splenic vein joins the superior mesenteric vein to form the

portal vein

An afebrile patient with a history of leukemia presents to the ultrasound department complaining of left upper quadrant pain. A sonogram of the spleen demonstrates hypoechoic nodules within the splenic parenchyma. These nodules most likely represent

primary malignant tumors

Hematocrit is defined as the percentage of

red blood cells in the blood

Which of the following is a pitfall you might encounter in ultrasound scanning of the spleen?

rib shadows hepatomegaly mistaken for spleen pancreatic tail mass mistaken for splenic mass accessory spleen mistaken for enlarged lymph node

A retroperitoneal ultrasound is ordered on an elderly patient with a history of elevated creatinine levels. Hyperechoic foci are identified in the splenic parenchyma. These foci are most suspicious for

splenic calcifications

The most common location of an accessory spleen is near the

splenic hilum

You are performing an abdominal ultrasound scan and detect a hypoechoic, wedge-shaped lesion within the spleen. This is the typical appearance of which of the following entities?

splenic infarction

Which structure will you detect at the splenic hilum?

splenic vein

A 50 yr old patient with a long history of alcohol abuse presents to the ultrasound department complaining of left upper quadrant pain. The sonogram of the left upper quadrant is most consistent with which of the following conditions? (19.41cm spleen)

splenomegaly

The normal adult spleen measures approximately

11 cm in length, 7 cm in width, and 4 cm in height

In a 40 yr old patient, splenomegaly is suggested once the length of the spleen exceeds

13 cm

Normal hemoglobin levels should not exceed

20 g/dL

An average sized male patient has been referred for ultrasound evaluation of splenomegaly. What transducer would provide the highest resolution images of the spleen?

5.0 MHz curved linear array

You are examining the spleen during routine sonography. What view provides the best long axis image of the spleen?

Intercostal coronal view with patient supine

Which of the following statements is NOT true regarding the spleen? The spleen is located in the left upper quadrant The spleen is a retroperitoneal structure The spleen lies between the fundus of the stomach and the diaphragm The average adult spleen measures 12 cm in length The normal spleen decreases in size and weight with advancing age

The spleen is a retroperitoneal structure

Leukocytosis is defined as a white blood cell count

above 20,000

Which of the following splenic abnormalities is most commonly linked to infective endocarditis?

abscess

A patient presents with a history of liver function tests showing elevated levels. The arrows in this sonogram (round structure near kidney and spleen) are most likely identifying a

accessory spleen

During routine sonographic evaluation of the spleen, you detect a small, rounded mass at the splenic hilum that is homogenous and isoechoic with the spleen. You have most likely detected

accessory spleen

The most common clinical finding associated with a hemangiosarcoma is

anemia

A patient presents with a history of increased abdominal girth and liver function tests showing elevated levels. Which of the following findings is most likely demonstrated in this sonogram of the left upper quadrant?

ascites

Leukopenia is defined as a white blood cell count

below 4,000

All of the following are considered functions of the spleen EXCEPT: reservoir for blood filters the blood recycles hemoglobin initiates production of antibodies breaks down old white blood cells

breaks down old white blood cells

Which of the following splenic pathologies is associated with granulomatosis

calcifications

You are performing an ultrasound study on a patient with a history of recent blunt left-sided trauma in a motor vehicle accident. Which finding is NOT associated with this history? splenic laceration subcapsular hematoma of the spleen free fluid perisplenic hematoma calcified splenic cyst

calcified splenic cyst

Multiple splenic infections is a predisposing factor of which of the following conditions?

candidiasis

Which of the following pathologies is associated with a "wheel within a wheel" appearance on ultrasound?

candidiasis

An asymptomatic middle-aged patient presents with a history of liver function tests showing elevated levels on an annual physical exam. An abdominal ultrasound is order to rule out liver disease. A sonogram of the left upper quadrant demonstrates a hyperechoic mass in the splenic parenchyma. Based on this history, the mass identified most likely represents a

cavernous hemangioma

The most common benign neoplasm of the spleen is a

cavernous hemangioma

The splenic artery is a branch of which of the following vascular structures?

celiac axis

Which of the following scanning planes is most likely demonstrated in this sonogram (sagittal)

coronal

Indications for an ultrasound of the spleen may include all the following EXCEPT: fatigue trauma abdominal mass elevated serum amylase leukocytosis

elevated serum amylase

A patient presents with a history of portal hypertension. The spleen is expected to demonstrate

enlargement

During abdominal sonography of a patient with portal hypertension and splenomegaly, you detect a calcified ring at the splenic hilum. What should you do?

evaluate the area with color Doppler

Which of the following benign neoplasms is composed of lymphoid tissue?

hamartoma

Which term can be used to describe the normal sonographic appearance of the splenic parenchyma?

homogenous with mid- to low-level echogenicity

When compared to the liver, the echogenicity of the normal splenic parenchyma is described as

hypoechoic or isoechoic

(A 50 yr old patient with a long history of alcohol abuse presents to the ultrasound department complaining of left upper quadrant pain - 19.41cm spleen.) Based on this history and sonogram, the sonographer should also evaluate for which of the following pathologies?

portal hypertension