211 - Ch 8 Workbook (Spleen)

A fibrous capsule surrounds the spleen and trabeculate project from the capsule into the organ, dividing the spleen into several compartments.

A fibrous capsule surrounds the spleen and __________ project from the capsule into the organ, dividing the spleen into several compartments.

bacterial infection

Leukocytosis is the typical response to which of the following conditons? a. lupus erythrematosus b. chemotherapy c. bacterial infection d. hemorrhage

granulomatous

Splenic calcifications usually result from which disease? a. splenomegaly b. lymphocytic c. angiosarcomas d. granulomatous

isoechoic to the liver

What is the normal echogenicity of the spleen? a. heterogenous b. isoechoic to the liver c. hyperechoic to the liver d. hypoechoic to the liver

The arrow is pointing to an accessory spleen, which is a normal variant and asymptomatic in most cases. In cases of splenectomy, the accessory spleen can enlarge and take over the function of the removed spleen. In cases of hematologic disorders, this may cause a relapse in symptoms.

What structure is the arrow pointing to in this image? What is the significance of this structure?

When imaging the spleen in the sagittal plane, views should always include the left diaphragm to evaluate for ascites or pleural fluid and the interface with the left kidney.

When imaging the spleen in the sagittal plane, views should always include the left __________ to evaluate for ascites or pleural fluid and the interface with the __________ __________.

splenomegaly

Which of the following is NOT included as a focal lesion of the spleen? a. cysts b. infarcts c. splenomegaly d. granulomas

falciform ligament

Which of the following ligaments does NOT help stabilize the spleen? a. falciform ligament b. lienorenal ligament c. gastrosplenic ligament d. phrenicocolic ligament

sickle cell anemia

Which of the following may cause a small, shrunken spleen? a. mononucleosis b. acquired immunodeficiency syndrome c. sickle cell anemia d. portal hypertension

the spleen is a retroperitoneal organ

Which of the following statements regarding the anatomy of the spleen is FALSE? a. the spleen is surrounded by a fibrous capsule b. the spleen is a retroperitoneal organ c. the spleen is located in the left hypochondrium d. the spleen lies posterior to the stomach

A well-defined, hypoechoic, wedge-shaped lesion is seen within the splenic parenchyma. Given the patient's history of sickle cell crisis, the most likely diagnosis is splenic infarct.

A 12-year-old patient with a history of sickle cell disease presents in a sickle cell crisis with severe left upper quadrant pain. Describe what is seen in this image of the spleen. What is the most likely diagnosis?

The spleen is enlarged. The spleen is considered enlarged when its length exceeds 13 cm. With cirrhosis, the liver becomes fibrotic and the resistance to incoming blood flow increases. The pressure in the portal vein increases and flow may even reverse. As pressure in the portal vein increases, so does pressure in the splenic vein, causing congestion in the spleen. The hilum of the spleen and surrounding area should be evaluated for collateral varices. Dilated tortuous vessels may be seen in the splenic hilum from splenorenal collaterals.

A 47-year-old man presents for an abdominal sonogram with a history of chronic alcohol abuse and cirrhosis. What pathology is seen in this image of the spleen? What is the normal measurement of the spleen? Why does the spleen enlarge in cases of liver cirrhosis? You are asked to evaluate the splenic hilum with color doppler. What are you looking for?

The spleen appears grossly enlarged and the left kidney appears flattened. Ascites is seen surrounding the spleen. A large irregular hypoechoic mass is seen within the spleen. In cases of lymphoma, the spleen may appear normal sonographically or it may be diffusely enlarged. A focal mass may be seen and may appear hypoechoic or hyperechoic. Multiple nodules may also be seen.

A 54-year-old patient presents with a history of lymphoma. Describe what is seen in this image of the spleen. What is the typical appearance of the spleen in a patient with lymphoma?

Multiple hypoechoic lesions are seen throughout the spleen. Some of the lesions have a target appearance with a hyperechoic center. Given the patient's history of cancer, metastatic disease is the most likely diagnosis. Fungal or microbacterial abscesses can occur in patients with immunocompromise. These lesions may appear as multiple hypoechoic or target lesions seen within the splenic parenchyma.

A 56-year-old woman presents with a history of pancreatic cancer. Describe what is seen in this image of the spleen. What is the most likely diagnosis? What other pathology may cause multiple target or hypoechoic lesions in the spleen?

A large simple cyst is seen in the anterior portion of the spleen. Cysts of the spleen can either be primary or secondary. Secondary cysts include resolving hematoma or abscess. Parasitic cysts are also common in other parts of the world. Pseudocysts are also common.

Describe what is seen in this image of the spleen. List 3 of the most common causes of this splenic pathology.

Following a splenectomy, an accessory spleen may enlarge and assume the functions of the removed spleen.

Following a splenectomy, an __________ __________ may enlarge and assume the functions of the removed spleen.

In patients with both Hodgkin disease and non-Hodgkin lymphoma, the spleen may contain focal hypoechoic or hyperechoic masses, may exhibit diffuse splenomegaly, or may appear sonographically normal.

In patients with both Hodgkin disease and non-Hodgkin lymphoma, the spleen may contain focal __________ or __________ masses, may exhibit diffuse __________, or may appear sonographically __________.

Patients with splenic infarcts are at risk for splenic rupture. Signs to watch out for include increasing subcapsular hemorrhage, free peritoneal blood, and expanding liquefaction area within the infarct.

Patients with splenic infarcts are at risk for splenic __________. Signs to watch out for include increasing __________ hemorrhage, free __________ blood, and expanding __________ area within the infarct.

could be hyperechoic or hypoechoic but does not correlate with the cause of the enlargement

Sonographically what is the splenic echogenicity when splenomegaly occurs? a. does not change b. always becomes more hypoechoic c. always becomes more hyperechoic d. could be hyperechoic or hypoechoic but does not correlate with the cause of the enlargement

The average spleen measures 12 cm in length, 7 cm in width, and 3-4 cm in thickness.

The average spleen measures __________ cm in length, __________ cm in width, and __________ cm in thickness.

The most common malignant disease that affects the spleen is lymphoma. Sonographically, splenomegaly may be present if the spleen is diffusely infiltrated.

The most common malignant disease that affects the spleen is __________. Sonographically, __________ may be present if the spleen is diffusely infiltrated.

The most common varice to occur in cases of portal hypertension is the splenorenal collateral, which diverts blood from the splenic vein to the left renal vein and finally into the IVC.

The most common varice to occur in cases of portal hypertension is the __________ collateral, which diverts blood from the splenic vein to the __________ __________ vein and finally into the __________.

The red pulp is responsible for filtering the peripheral blood. It removes macrophages of ruptured, worn-out, or defective red blood cells; stores platelets and during fetal life produces red blood cells. The red pulp also removes sickle and thalassemic cells from circulation. If chronic anemia develops, the spleen can regain its hematopoietic function. The red pulp stores blood and can release this stored blood in cases of hemorrhage. The white pulp is part of the immune system and is a site of residence, proliferation, and differentiation of lymphocytes and mononuclear phagocytes. Bacteria are phagocytized in the white pulp.

The red pulp and white pulp that make up the spleen each have different functions. Describe the function of each and how they can be affected by pathological processes.

The red pulp is responsible for filtering the peripheral blood. These functions include removal of worn out or defective blood cells and the storage of platelets.

The red pulp is responsible for __________ the peripheral blood. These functions include removal of __________ __________ or __________ blood cells and the storage of __________.

The removal of defective and worn-out red blood cells occurs in the cords of Billroth.

The removal of defective and worn-out red blood cells occurs in the cords of __________.

In patients with sickle cell disease, the spleen may have a variety of appearances. The spleen may appear normal. In children with acute splenic sequestration crisis, a large amount of blood pools within the spleen and the spleen may enlarge quickly. Splenomegaly may be present and hypoechoic areas may be seen within the parenchyma due to hemorrhage. With repeated crisis, splenic infarcts may occur and over time the spleen becomes shrunken.

The spleen is commonly affected in patients with sickle cell anemia. Describe the variation in sonographic appearance that can occur with this disease.

13 cm

The spleen is considered enlarged when its length is greater than what measurement? a. 9 cm b. 11 cm c. 13 cm d. 15 cm

The spleen is located in the peritoneal cavity and is covered by the peritoneum except at the splenic hilum.

The spleen is located in the __________ cavity and is covered by the peritoneum except at the splenic __________.

The spleen is located posterior to the stomach, lateral to the left kidney, splenic flexure of the colon, and pancreatic tail, and anterior to the diaphragm.

The spleen is located posterior to the __________, lateral to the __________ __________, __________ __________ of the colon, and __________ tail, and anterior to the __________.

The spleen is made up of red and white pulp. The white pulp is composed of lymphatic tissue and the red pulp is composed of venous sinuses capable of storing more than 300 mL of blood.

The spleen is made up of __________ and __________ pulp. The __________ pulp is composed of lymphatic tissue and the __________ pulp is composed of venous sinuses capable of storing more than 300 mL of blood.

The spleen is one of the most frequently injured abdominal organs in cases of blunt abdominal trauma due to its vulnerable location in the left upper quadrant. The spleen also holds a reservoir of blood, so damage to the spleen can cause significant hemorrhage. The tissue of the spleen is like a sponge and is easily damaged in cases of trauma. In a trauma situation, the spleen may shatter or fragment, hilar vessels may be disrupted, the parenchyma may be lacerated, or the capsule may tear. Sonographically, an evaluation for free fluid should be performed looking at the pelvis, both flanks, and posterior right subhepatic space (aka hepatorenal fossa, Morrison pouch). The spleen may appear normal or, if there is a parenchymal hematoma, a mass may be visualized. Depending on the age of the bleed, the hematoma may be heterogeneous, isoechoic, anechoic, or hyperechoic. A hematoma may develop between the spleen and capsule, a subcapsular hematoma. If this occurs, a double contour can be seen. The hematoma may be isoechoic to the spleen and therefore difficult to visualize. An enlarging or heterogeneous spleen suggests rupture.

The spleen is the most frequently damaged organ in blunt abdominal trauma. Why is the spleen so commonly injured? Describe the appearance of spleen in a trauma situation.

celiac axis

The splenic artery branches off which artery to supply blood to the spleen? a. aorta b. superior mesenteric c. pancreatic d. celiac axis

The white pulp is part of the immune system as it is a source of lymphocytes, macrophages, and antibodies. In addition, the white pulp can phagocytose bacteria that have bypassed the lymph nodes.

The white pulp is part of the __________ system as it is a source of lymphocytes, macrophages, and antibodies. In addition, the white pulp can __________ bacteria that have bypassed the lymph nodes.

Three ligaments help hold the spleen in its position in the left upper quadrant. The lienorenal ligament attaches the spleen to the left kidney. The gastrosplenic ligament attaches the spleen to the stomach and the phrenicolic ligament, although not directly attached to the spleen, helps support its inferior end.

Three ligaments help hold the spleen in its position in the left upper quadrant. The __________ ligament attaches the spleen to the left kidney. The __________ ligament attaches the spleen to the stomach and the __________ ligament, although not directly attached to the spleen, helps support its inferior end.

frequently a side effect of chemotherapy

What is leukopenia? a. a normal finding b. the result of severe inflammation c. frequently a side effect of chemotherapy d. an increase in the number of white blood cells in circulation

portal hypertension

What is the most common cause of splenomegaly? a. mononucleosis b. lymphoma c. sickle cell anemia d. portal hypertension

splenomegaly

What is the most common sonographically visualized abnormality of the spleen? a. splenic rupture b. splenic abscess c. splenomegaly d. lymphoma

wandering spleen

While performing an abdominal sonography, you are having difficulty locating the spleen in its normal location in the left upper quadrant. As you scan the entire left side, you locate what appears to be the spleen in the left lower quadrant. What is the most likely explanation for this finding? a. asplenia b. accessory spleen c. situs inversus d. wandering spleen

accessory spleen

While scanning the spleen, you notice a small round mass that appears to be separate from the spleen in the region of the splenic hilum. The echotexture of the mass is similar to that of the spleen. What is the most likely diagnosis? a. splenic metastases b. accessory spleen c. splenic hemangioma d. ruptured spleen

portal hypertension with collateral varices

While scanning the spleen, you notice multiple enlarged tortuous vessels in the splenic hilum. Color doppler confirms that they are vascular in nature. Dilated vessels are also noted within the splenic parenchyma. What is the most likely cause of these findings? a. portal hypertension with collateral varices b. lymphoma with metastases c. splenic rupture with bleeding outside the capsule d. accessory spleen near the splenic hilum

Splenomegaly has many causes; the single most common cause is portal hypertension. Splenomegaly can be caused by infectious or inflammatory causes such as mononucleosis or endocarditis; congestive pathologies such as portal hypertension; infiltrative diseases such as in lymphoma; or hematologic, metabolic, and traumatic causes. The spleen is loosely held in place by three ligaments but does not have fixed peritoneal attachments. These loosely held ligaments allow the spleen to increase up to 10 times its normal size.

You are asked to perform an abdominal sonogram to rule out splenomegaly. What are the most common causes of splenomegaly and how does the anatomy of the spleen allow for such an increase in size?

Most splenic abscesses are multiple and complex in appearance with mixed echogenic properties. Gas is frequently present in abscesses and will appear as a highly echogenic area with ring-down artifact or dirty shadowing. An air-fluid level may also be observed.

Your patient presents with a history of bacterial endocarditis now complaining of left upper quadrant pain, fever, and leukocytosis. Splenic abscess is suspected. Describe the sonographic appearance of splenic abscess. What characteristics can help confirm the diagnosis?

Asplenia is a very rare condition that leads to a congenital absence of the spleen.

__________ is a very rare condition that leads to a congenital absence of the spleen.

hematocrit

laboratory value of the percentage of blood volume made up of red blood cells

erythropoiesis

process of red blood cell production

phagocytosis

process used by the red pulp to destroy old red blood cells

erythrocyte

red blood cell; contains hemoglobin

An irregular, hypoechoic collection is seen near the hilum of the spleen. Given the patient's history of abdominal trauma, a hematoma is the most likely diagnosis. The remainder of the spleen should be evaluated as well as the splenic capsule to look for a subcapsular hematoma. The pelvis, the paracolic gutters, and posterior right subhepatic space should be evaluated for free fluid. The hematocrit may be decreased in cases of hemorrhage.

A 10-year-old girl presents for a sonogram of the spleen following a bicycle accident. Describe what is seen in this sagittal image of the spleen. What is the most likely diagnosis? What other areas in the abdomen will you evaluate based on these findings? Which lab value may be associated with this finding?

varices in the splenic hilum

A 10-year-old patient presents for an abdominal sonogram following blunt abdominal trauma that occurred during a bicycle accident. Which of the following would be an unusual finding in this patient? a. subcapsular hematoma b. free fluid in the peritoneum c. hematoma within the splenic parenchyma d. varices in the splenic hilum

splenic infarct

A patient with sickle cell disease presents for an abdominal sonogram complaining of recent left upper quadrant pain. A hypoechoic wedge shaped lesion is seen in the spleen. What is this typical of? a. lymphoma b. splenic rupture c. splenomegaly d. splenic infarct

torsion and infarction

A wandering spleen is at increased risk of acquiring which of the following conditions? a. splenic rupture b. torsion and infarction c. splenomegaly d. leukemia and lymphoma

Acquired splenic cysts are postinflammatory, traumatic, or parasitic in origin.

Acquired splenic cysts are __________, __________, or __________ in origin.

Patients who are immunocompromised are more susceptible to fungal and bacterial abscesses of the spleen.

Patients who are __________ are more susceptible to fungal and bacterial abscesses of the spleen.

The most common benign vascular lesion of the spleen is the hemangioma.

The most common benign vascular lesion of the spleen is the __________.

The splenic vein joins with the inferior mesenteric vein and can be seen posterior to the tail and body of the pancreas. Posterior to the neck of the pancreas, the splenic vein joins with the superior mesenteric vein to form the main portal vein.

The splenic vein joins with the __________ __________ __________ and can be seen posterior to the tail and body of the pancreas. Posterior to the __________ of the pancreas, the splenic vein joins with the __________ __________ __________ to form the main portal vein.

the red pulp is responsible for erythropoiesis throughout our lives

Which of the following statements regarding the function of the red pulp is FALSE? a. the red pulp is responsible for erythropoiesis throughout our lives b. in cases of severe hemorrhage, the red pulp may release its reservoir into the bloodstream c. red pulp is responsible for the removal of worn-out red blood cells d. the red pulp removes defective cells such as sickle and thalassemic cells from circulation

leukopenia

decreased white blood cell, count, possibly the result of viral infection or leukemia

leukocytosis

elevated white blood cell count, usually due to infection

splenomegaly

enlarged spleen

infarct

tissue death caused by an interruption of the blood supply

leukocyte

white blood cell; protects and fights against infection in the body