Spleen Review

An afebrile 13-year-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 the clinical history, the most likely diagnosis is: a. lymphoma b. hematoma c. polycystic disease d. loculated abscess e. pseudocyst

b. hematoma

What systemic disease results in the development of granulomas within the spleen and throughout the body? a. granulomatosis b. sarcoidosis c. sickle cell anemia d. histoplasmosis

b. sarcoidosis

The splenic vein joins with what structure posterior to the pancreatic neck to form the portal vein? a. inferior mesenteric artery b. superior mesenteric vein c. inferior mesenteric artery d. main hepatic vein

b. superior mesenteric vein

The normal adult spleen measures approximately: a. 9 cm in length, 2 cm in width, and 5 cm in height b. 13 cm in length, 4 cm in width, and 6 cm in height c. 11 cm in length, 7 cm in width, and 4 cm in height d. 17 cm in length, 4 cm in width, and 7 cm in height e. 15 cm in length, 5 cm in width, and 7 cm in height

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

Normal hemoglobin levels should not exceed: a. 5 g/dL b. 10 g/dL c. 20 g/dL d. 50 g/dL e. 75 g/dL

c. 20 g/dL

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: a. histoplasmosis b. tuberculosis c. pseudocyst d. metastasis e. infarction

d. metastasis

Leukocytosis is defined as a white blood cell count: a. below 4,000 b. below 11,000 c. above 4,000 d. above 12,000 e. above 20,000

e. above 20,000

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

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

a. red pulp

The splenic artery is a branch of which of the following vascular structures? a. abdominal aorta b. celiac axis c. gastric artery d. thoracic aorta e. superior mesenteric artery

b. celiac axis

In a patient with suspected lymphoma, the presence of Reed-Sternberg cells indicates: a. Hodgkin lymphoma b. non-hodgkin lymphoma c. metastatic liver disease d. splenic infarction

a. Hodgkin lymphoma

Epstein-Barr infection is best described as: a. a herpesvirus that can lead to infectious mononucleosis in children 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 following blunt trauma

a. a herpesvirus that can lead to infectious mononucleosis in children

The most common clinical finding associated with a hemangiosarcoma is: a. anemia b. weight c. leukopenia d. abdominal pain e. lymphadenopathy

a. anemia

44. Leukopenia is defined as a white blood cell count: a. below 4,000 b. below 11,000 c. above 4,000 d. above 12,000 e. above 20,000

a. below 4,000

Which of the following pathologies is associated with a "wheel within a wheel" appearance on ultrasound? a. candidiasis b. infarction c. hemangiosarcoma d. cavernous hemangioma e. cystic lymphangiomatosis

a. candidiasis

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 is most consistent with a(n): a. cyst b. hematoma c. abscess d. cystic lymphangioma e. cavernous hemangioma

a. cyst

What is the most common sonographic appearance of splenic hemangioma? a. echogenic b. hypoechoic c. anechoic d. complex

a. echogenic

The process of making red blood cells is termed: a. erythropoiesis b. leukopoiesis c. histopoiesis d. anemia

a. erythropoiesis

During abdominal sonography 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 2 oz. of water and rescan e. nothing as this is not a significant finding

a. evaluate the area with color Doppler

A patient is diagnosed with splenomegaly, and dilated, tortuous vessels at the splenic hilum. What additional information should you provide? a. evaluate the liver and portal vein b. look for signs of pancreatitis c. check for evidence of hematoma surrounding the spleen d. evaluate the periaortic area for lymphadenopathy e. check for an ipsilateral pleural effusion

a. evaluate the liver and portal vein

Splenic infarction is most commonly associated with an embolism originating from which of the following structures? a. heart b. liver c. spleen d. pancreas e. lower extremity

a. heart

The spleen is a/n: a. intraperitoneal organ b. retroperitoneal organ

a. intraperitoneal organ

Hemangiosarcoma involving the spleen frequently metastasizes to which of the following organs? a. liver b. colon c. lung d. kidney e. pancreas

a. liver

During splenic sonography, 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

A 8-year-old male patient with a history of severe, sudden onset of left upper quadrant pain without trauma presents to the ultrasound department for a sonogram of the spleen. You visualize a wedge-shaped, hypoechoic area within the spleen. This most likely represents: a. splenic infarct b. splenic hematoma c. splenic hemangioma d. splenic metastasis

a. splenic infarct

Diffuse involvement of lymphoma or leukemia of the spleen with often lead to: a. splenomegaly b. splenic atrophy c. Epstein-Barr infection d. splenic torsion

a. splenomegaly

Which of the following splenic abnormalities is most commonly linked to infective endocarditis? a. hematoma b. abscess c. infarction d. calcifications e. hamartoma

b. abscess

During routine sonographic 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 metastasis e. splenic hemangioma

b. accessory spleen

A rare malignant tumor of the spleen that consists of blood vessels is a/n: a. lymphoma b. angiosarcoma c. hemangioma d. granuloma

b. angiosarcoma

Which of the following splenic pathologies is associated with granulomatosis? a. cyst b. calcifications c. cavernous hemangioma d. cystadenoma d. cavernous lymphangioma

b. calcifications

Multiple splenic infections is a predisposing factor of which of the following conditions? a. infarction b. candidiasis c. arterial calcification d. cavernous hemangioma e. arterial aneurysm

b. candidiasis

The spleen removes irregular cells from the blood stream and retains them through a process called: a. pitting b. culling c. crimping d. amassing

b. culling

Which term can be used to describe the normal sonographic appearance of the splenic parenchyma? a. heterogeneous with mid- to low-level echogenicity b. homogeneous with mid- to low-level echogenicity c. homogeneous with echogenicity exceeding that of the liver d. heterogeneous with mixed echogenicity e. the normal spleen has a varied appearance on ultrasound?

b. homogeneous with mid- to low-level echogenicity

Enlargement of the spleen may be associated with all of the following conditions except: a. cirrhosis b. hypotension c. diabetes mellitus d. portal hypertension e. congestive heart failure

b. hypotension

Which of the following conditions is most likely to demonstrate an elevated hematocrit? a. overhydration b. infection c. leukemia d. hemorrhage e. splenomegaly

b. infection

You are examining the spleen during routine sonography. What view provides the best long axis image of the spleen? a. sagittal view from the anterior position with patient supine b. intercostal coronal view with patient supine c. corconal view with patient in left lateral decubitus position d. anterior sagittal view with patient in the left lateral decubitus position e. posterior sagittal view with patient in a prone position

b. intercostal coronal view with patient supine

In cases of portal hypertension, the splenic vein is most likely to shunt blood directly into the: a. gastric vein b. left renal vein c. middle hepatic vein d. IVC e. inferior mesenteric vein

b. left renal vein

Which of the following conditions is most likely associated with a decrease in leukocytes? a. anemia b. lymphoma c. leukemia d. malignancy e. cirrhosis

b. lymphoma

A patient with an accessory spleen will most likely present with which of the following symptoms? a. dysplenia b. no symptoms c. left upper quadrant pain d. palpable abdominal mass e. elevated white blood cell count

b. no symptoms

A patient presents with a long history of alcohol abuse and complains of left upper quadrant pain. During sonographic evaluation, the spleen is positive for splenomegaly. Based on the history and the sonogram, the sonographer should also evaluate for which of the following pathologies? a. pancreatitis b. portal hypertension c. lymphadenopathy d. renal obstruction e. abdominal aortic aneurysm

b. portal hypertension

The most common cause of splenomegaly is: a. hepatitis b. portal hypertension c. lymphoma d. trauma

b. portal hypertension

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: a. splenic hemangioma b. splenic infarction c. splenic metastasis d. granulomatous disease of the spleen e. splenic abscess

b. splenic infarction

Which structure will you detect at the splenic hilum? a. diaphragm b. splenic vein c. left kidney d. duodenum e. left lobe of the liver

b. splenic vein

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

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

b. the spleen is a retroperitoneal structure

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

In a 40-year-old patient, splenomegaly is suggested once the length of the spleen exceeds: a. 7 cm b. 11 cm c. 13 cm d. 18 cm e. 20 cm

c. 13 cm

An average sized male patient has been referred for ultrasound evaluation of splenomegaly. What transducer would provide the highest resolution images of the spleen? a. 2.25 MHz linear b. 3.5 MHz phased array c. 5.0 MHz curved linear array d. 3. MHz curved linear array e. 2.25 MHz phased array

c. 5.0 MHz curved linear array

A 25-year old female patient presents to the ultrasound 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 represents? a. pancreatic cystadenocarcinoma b. splenic hemangioma c. accessory spleen d. neuroblastoma

c. accessory spleen

The splenic artery originates at the: a. superior mesenteric artery b. inferior phrenic artery c. celiac trunk d. gastroduodenal artery

c. celiac trunk

A patient presents with a history of portal hypertension. The spleen is expected to demonstrate: a. atrophy b. fatty infiltration c. enlargement d. intraparenchymal caclifications e. reversal of flow in the splenic vein

c. enlargement

Which of the following would be most helpful in improving diagnostic confidence in splenic infarct? a. have the patient perform a valsalva maneuever b. evaluate the lesion in both inspiration and expiration c. evaluate the lesion with color Doppler d. have the patient drink 8 oz. of water and rescan e. rescan the patient in an upright position

c. evaluate the lesion with color Doppler

A complex cyst that results from the parasitic infection of the spleen by a tapeworm is the: a. bacterial endocarditis cyst b. choledochal cyst c. hydatid cyst d. candidasis

c. hydatid cyst

Leukemia may be associated with all of the following except: a. splenomegaly b. joint pain c. leukopenia d. weakness e. lymphadenopathy

c. leukopenia

Metastasis to the spleen most commonly originates from which of the following malignancies? a. renal cell carcinoma b. hepatoma c. melanoma d. nephroblastoma e. adrenocortical carcinoma

c. melanoma

Small echogenic foci scattered throughout the spleen most likely represents: a. multiple hemangioma b. multiple benign hematomas c. multiple benign granulomas d. malignant lymphoma

c. multiple benign granulomas

The splenic vein drains into what vein? a. inferior mesenteric vein b. superior mesenteric vein c. portal vein d. left renal vein e. IVC

c. 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: a. candidiasis b. lymphadenopathy c. primary malignant tumors d. multiple splenic abscesses e. metastatic disease

c. primary malignant tumors

Hematocrit is defined as the percentage of: a. platelets in the red blood cells b. oxygen in the red blood cells c. red blood cells in the blood d. platelets in the blood e. oxygen in the blood

c. red blood cells in the blood

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: a. candidiasis b. pneumobilia c. splenic calcifications d. multiple small hemangiomas e. multiple splenic abscesses

c. splenic calcifications

A 14-year-old male patient presents to the ultrasound 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

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

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

a 32-year-old female patient presents to the ultrasound 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

c. splenic metastasis

Sickle cell disease will often lead to: a. splenic metastasis b. sarcoidosis c. splenomegaly d. wandering spleen

c. splenomegaly

All of the following are true of the spleen except: a. it is the largest structure of the reticuloendothelial system b. the primary objective of the spleen is to filter the peripheral blood c. the spleen has a convex inferior margin and a concave superior border d. the spleen is considered the largest lymphatic organ

c. the spleen has a convex inferior margin and a concave superior border

The most common benign neoplasm of the spleen is a(n): a. cyst b. accessory spleen c. hematoma d. cavernous hemangioma e. cystadenoma

d. cavernous hemangioma

A hematoma located below the splenic capsule most commonly appears on ultrasound as a: a. left pleural effusion b. lateral anechoic mass c. hypoechoic parenchymal mass d. crescent-shaped fluid collection inferior to the diaphragm e. loculated mass anterior to the left kidney

d. crescent-shaped fluid collection inferior to the diaphragm

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

Indications for an ultrasound of the spleen may include all of the following except: a. fatigue b. trauma c. abdominal mass d. elevated serum amylase e. leukocytosis

d. elevated serum amylase

Which of the following benign neoplasms is composed of lymphoid tissue? a. lipoma b. adenoma c. seroma d. hamartoma e. cavernous hemangioma

d. hamartoma

Which of the following structures carries carbon dioxide back to the lungs? a. platelet b. lymphocyte c. hematocrit d. hemoglobin e. leukocyte

d. hemoglobin

Which of the following structures is recycled into iron by the spleen? a. erythrocytes b. platelets c. leukocytes d. hemoglobin e. monocytes

d. hemoglobin

A patient arrives at the emergency department following a motor vehicle accident. An abdominal ultrasound is most likely ordered to evaluate for which of the following conditions? a. pancreatitis b. biliary obstruction c. urinary obstruction d. hemoperitoneum e. abdominal aortic aneurysm

d. hemoperitoneum

When compared to the liver, the echogenicity of the normal splenic parenchyma is described as: a. hypoechoic b. hyperechoic c. isoechoic d. hypoechoic to isoechoic e. hyperechoic to isoechoic

d. hypoechoic to isoechoic

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

You have been asked to evaluate the tail of the pancreas. What is the relationship of the pancreatic tail to the spleen? a. superior and lateral b. superior medial c. anterior d. inferomedial e. posterior

d. inferomedial

The location of the spleen is best described as: a. anterior to the stomach b. superior to the diaphragm c. posterior to the left kidney d. lateral to the stomach e. medial to the left adrenal gland

d. lateral to the stomach

Predisposing factors for developing an aneurysm of the splenic artery may include all of the following except: a. trauma b. infection c. atherosclereosis d. male prevalence e. portal hypertension

d. male prevalence

You are imaging the spleen of a 27-year-old male with AIDS;. What is the most common finding in the spleen in patients with AIDS? a. abscess b. metastasis c. accessory spleen d. moderate splenomegaly e. lymphoma

d. moderate splenomegaly

You are performing an abdominal ultrasound on a patient with histoplasmosis. 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. multiple focal, bright echogenic granulomatous lesions throughout the spleen e. solitary cyst with calcified walls

d. multiple focal, bright echogenic granulomatous lesions throughout the spleen

A 35-year-old male patient presents to the ultrasound 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

From the list below, what is the most likely clinical finding of a patient who has a splenic hemangioma? a. fever b. decreased hematocrit c. elevated white blood cell count d. none

d. none

All of the following can be associated with splenomegaly except: a. trauma b. hemolytic abnormalities c. mononucleosis d. pancreatitis

d. pancreatitis

A congenital anomaly of the spleen associated with gastrointestinal, cardiovascular, and biliary anomalies is most consistent with: a. aplasia b. asplenia syndrome c. wandering spleen d. polysplenia syndrome e. accessory spleen

d. polysplenia syndrome

The splenic vein joins the superior mesenteric vein to form the: a. coronary vein b. hepatic vein c. inferior mesenteric vein d. portal vein e. gastric vein

d. portal vein

The most common location of an accessory spleen is near the: a. left renal hilum b. body of the pancreas c. left adrenal gland d. splenic hilum e. lesser curvature of the stomach

d. splenic hilum

You are scanning a patient with moderate splenomegaly. Which of the following is a cause of mild to moderate splenomegaly? a. portal hypertension b. infection c. AIDS d. lymphoma e. a, b, and c only

e. a, b, and c only

Which of the following is a pitfall you might encounter in ultrasound scanning of the spleen? a. intercostal scanning may produce rib shadows obscuring the splenic parenchyma b. in hepatomegaly, the left lobe of the liver may be mistaken for the spleen c. a mass in the tail of the pancreas may be confused with a splenic mass d. an accessory spleen may be confused with an enlarged lymph node e. all of the above

e. all of the above

You are performing an abdominal ultrasound and are having difficulty identifying the spleen. Which of the following structures is in contact with the spleen? a. left hemidiaphragm b. stomach c. pancreas d. splenic flexure of the colon e. all of the above

e. all of the above

All of the following are considered functions of the spleen except: a. reservoir for blood b. filters the blood c. recycles hemoglobin d. irritates production of antibodies e. breaks down old white blood cells

e. breaks down old white blood cells

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 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