ch 11 spleen

In a 40-year-old patient, splenomegaly is suggested after the length of the spleen exceeds

13 cm In adults, splenomegaly is sug-gested after the length of the spleen exceeds 13 cm. The normal spleen measures approximately 10 to 12 cm in length, 7 cm in width, and 4 cm in height.

Normal hemoglobin levels should not exceed

20 g/dL Normal hemoglobin levels vary between males and females but should not exceed 20 g/dl. Hemo-globin is developed in the bone marrow and is the oxygen-carrying pigment in the blood.

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

abscess Formation of a splenic abscess is most commonly associated with in-fective endocarditis. Infarction of the spleen may be caused by emboli from the heart, subacute bacterial endocarditis, leukemia, sickle cell anemia, metastasis, or pancreatitis. Hematomas are generally associ-ated with trauma. Hamartomas are composed of lymphatic tissue.

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 quadran

ascites Anechoic free fluid is identified inferior to the diaphragm and supe-rior to the spleen as well as inferior to the spleen. These sonographic findings are most suspicious for ascites.

The location of the spleen is best described as:

ateral to the stomach The spleen is an intraperitoneal structure located lateral to the pan-creas, anterior to the left kidney, inferior to the left hemidiaphragm, and lateral to the stomach and left adrenal gland.

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

candidiasis Patients with a history of multi-ple splenic infections are at an increased risk for developing can-didiasis. This condition is most commonly found in autoimmune-compromised patients. An embo-lism originating from the heart is the most common cause of splenic infarction. Calcifications in the spleen are more commonly caused by granulomatosis or infarction

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

candidiasis . Splenic candidiasis and meta-static lesions most commonly dem-onstrate a "wheel within a wheel" or target pattern on ultrasound. A hem-angiosarcoma generally appears on with two right lungs, gastrointesti-nal and urinary anomalies, and a midline placement of the liver. Ac-cessory spleen and wandering spleen are not associated with ad-ditional anomalies.

An asymptomatic middle-aged patient presents with a history of liver function tests showing elevated levels on an annual physical examina-tion. An abdominal ultrasound is ordered 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(n)

cavernous hemangioma Cavernous hemangiomas are common benign masses that may develop in the splenic parenchyma. Hemangiomas are the most com-mon benign solid mass, and they are the most likely diagnosis of this hyperechoic intraparenchymal mass. Lipoma is a differential con-sideration but not a common find-ing within the splenic parenchyma. Primary malignancy of the spleen and abscess formation are unlikely considerations in an asymptomatic patient.

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

celiac axis The celiac axis (trunk) is the first branch of the abdominal aorta. The celiac axis trifurcates into the splenic, left gastric, and common hepatic arteries. Branches of the su-perior mesenteric artery supply the head of the pancreas and portions of the small and large intestine.

Which of the following scanning planes is most likely demonstrated in this sonogram?

coronal The sonogram demonstrates the length of the left kidney. The spleen and kidney lie closest to the trans-ducer footprint, and the spinous processes lie furthest from the transducer footprint. These find-ings are most consistent with a cor-onal plane. There are three basic scanning planes: sagittal, transverse, and coronal.

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

crescent-shaped fluid collection inferior to the diaphragm A subcapsular hematoma is lo-cated between the splenic capsule and parenchyma. It most com-monly appears on ultrasound as a crescent-shaped fluid collection inferior to the diaphragm.

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

cyst Smooth, thin wall margins are identified along with posterior acoustic enhancement. This is most consistent with a splenic cyst. He-matoma or abscess formation is an unlikely consideration for an inci-dental finding in an asymptomatic patient. Cystic lymphangioma dem-onstrates a multilocular cystic mass appearance.

The spleen is predominantly located in which of the following quadrants

epigastrium The spleen is an intraperitoneal organ predominantly located in the left hypochondriac region with the superior aspect extending into the epigastric region.

Which of the following is an indication for an ultrasound of the spleen

fatigue Indications for an ultrasound of the spleen may include: chronic liver disease, infection, leukocyto-sis, leukopenia, abdominal or left upper quadrant mass, fatigue, leu-kemia, lymphoma, or trauma.

Which of the following benign neoplasms is composed of lymphoid tissue

hamartoma A hamartoma is a benign neo-plasm composed of lymphoid tis-sue. A lipoma is composed of fatty tissue. An adenoma is an epithelial neoplasm. A cavernous hemangi-oma is a benign tumor consisting of a mass of blood vessels

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

heart An embolism originating in the heart is the most common source of a splenic infarction.

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 earlier. She denies blunt force trauma. Laboratory tests are pending. Based on this clinical history, the sonographic findings are most suspicious for which of the following conditions?

hematoma A cystic mass in a patient with a history of abdominal trauma most likely represents an intraparen-chymal hematoma. Pseudocyst formation is a complication of acute pancreatitis. A loculated ab-scess is an unlikely diagnosis in an afebrile patient. Polycystic disease is unlikely in a 13-year-old patient.

Which of the following structures carries carbon dioxide back to the lung

hemoglobin Hemoglobin carries carbon diox-ide from the cells back to the lungs. Platelets are essential for the coagu-lation of blood and the maintenance of hemostasis. Hematocrit is the percentage of red blood cells in the blood. Lymphocytes and leuko-cytes are associated with infection.

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

hemoglobin The spleen is a major destruction site of old red blood cells. The Red blood cells are removed, and the hemoglobin is recycled into iron

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?

hemoperitoneum The possibility of internal hem-orrhage is a concern for the emer-gency department physician in cases involving trauma. Ultrasound is a portable imaging tool used to evaluate quickly the abdominal and pelvic cavity for hemoperitoneum.

A hemanigosarcoma located in the spleen on ultrasound would appear as a(n)

hyperechoic or complex mass A hemangiosarcoma located in the spleen appears on ultrasound as a hyperechoic or complex mass. Frequently metastatic lesions are discovered in the liver.

Based on the clinical history, these sonographic findings are most likely considered

incidental findings Splenic calcifications are gener-ally an incidental finding. Follow-up is typically recommended only if clinically indicated. Splenic calci-fications are most commonly asso-ciated with granulomatosis or in response to infection.

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

infection. Elevation in hematocrit may be related to infection, dehydration, shock, and polycythemia vera. De-creases are associated with hemor-rhage, anemia, and leukemia.

Which of the following splenic regions is identi-fied by arrow C

inferior portion Arrow C identifies the inferior lateral portion of the spleen.

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

left renal vein To decrease venous pressure in portal hypertension, the splenic vein will most likely shunt blood directly into the left renal vein. The gastric vein is also considered a portosplenic collateral but is not the most likely bypass for an engorged splenic vein.

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

liver Hemangiosarcoma is a rare pri-mary malignant neoplasm of the spleen that frequently metastasizes to the liver

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

lymphoma A decrease in leukocytes may be associated with lymphoma, viral infections, and diabetes mellitus. Leukemia is usually related to a proliferation in white blood cells. Anemia is defined as a decrease in hemoglobin levels.

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

melanoma Metastasis to the spleen is rare. Metastatic disease involving the spleen most commonly originates from melanoma. Other primary neoplasms metastasizing to the spleen may arise from the breast, lung, ovary, stomach, colon, kidney, and prostate.

A clinical finding associated with splenic infarction may include

no symptoms The majority of patients with a history of splenic infarction are as-ymptomatic but may demonstrate left upper quadrant (LUQ) pain.

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

no symptoms Accessory spleens are rarely a source of a patient's clinical symp-toms. They are considered an inci-dental finding.

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

polysplenia syndrome Polysplenia is associated with multiple small spleens, two left lungs, and congenital anomalies of the gastrointestinal tract, cardiovas-cular system, and biliary system. Asplenia syndrome is associated with two right lungs, gastrointesti-nal and urinary anomalies, and a midline placement of the liver. Ac-cessory spleen and wandering spleen are not associated with ad-ditional anomalies

Based on this history and sonogram, the sonogra-pher should also evaluate for which of the following pathologies?

portal hypertension Splenomegaly in a patient with a long history of alcohol abuse should be evaluated for liver disease.

The splenic vein joins the superior mesenteric vein to form the

portal vein The main portal vein is formed at the junction of the splenic and superior mesenteric veins.

An afebrile patient with a history of leukemia presents to the ultrasound department complain-ing 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 In a patient with a history of leu-kemia, the parenchymal nodules most likely represent primary

Hematocrit is defined as the percentage of

red blood cells in the blood Hematocrit is the percentage of red blood cells in the blood. Hemo-globin is the oxygen-carrying pig-ment of the red blood cell. Platelets are formed in the bone marrow, and some are stored in the spleen.

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

splenic calcifications Hyperechoic foci within the pa-renchyma are most suspicious for splenic calcifications. Calcifications are generally an incidental finding commonly associated with granu-lomatosis. Other etiologies may in-clude splenic infarction, calcified cyst, or abscesses. Pneumobilia is associated with air in the biliary tree.

The most common location of an accessory spleen is near the

splenic hilum Accessory spleens are commonly located medial to the splenic hilum. The tail of the pancreas may extend toward the splenic or left renal hilum

Which of the following splenic regions is identi-fied by arrow

splenic hilum. Arrow B identifies the midpor-tion of the spleen known as the splenic hilum.

A 50-year-old patient with a long history of alco-hol abuse presents to the ultrasound department complaining of left upper quadrant pain. This sonogram of the left upper quadrant is most con-sistent with which of the following conditions?

splenomegaly Alcohol abuse is associated with cirrhosis. Chronic insult to the liver cells leads to a decrease in liver function leading to splenomegaly. This sonogram demonstrates an enlarged spleen measuring 19.4 cm in length (normal 13 cm in length). Lymphoma may demonstrate sple-nomegaly but is not the most likely differential in this case.

Which of the following splenic regions is identi-fied by arrow A ?

superior portion Arrow A identifies the superior medial portion of the spleen.

The most common benign neoplasm of the spleen

. cavernous hemangioma The cavernous hemangioma is the most common benign neoplasm of the spleen. Cysts and cystadeno-mas involving the spleen are un-common findings. An accessory spleen is considered a congenital anomaly. .

The normal adult spleen measures approximately

11 cm in length, 7 cm in width, and 4 cm in thickness The normal adult spleen mea-sures approximately 10 to 12 cm in length; 7 cm in width; 3 to 4 cm in thickness.

Leukocytosis is defined as a white blood cell count

above 20,000 . Leukocytosis is defined as a white blood count above 20,000. Normal serum levels range be-tween 4500 and 11,000 mm 3

The most common clinical finding associated with a hemangiosarcoma is:

anemia Anemia is the most common clin-ical finding associated with a hem-angiosarcoma involving the spleen. Other symptoms may include: left upper quadrant pain, weight loss, and leukocystosis.

Patients with a history of portal hypertension have an increased risk of developing a splenic

artery aneurysm Factors associated with an increase risk for developing an aneurysm of the splenic artery include: female prevalence, trauma, atherosclerosis, infection, and por-tal hypertension.

Leukopenia is defined as a white blood cell count

below 4000 Leukopenia is defined as a white blood count below 4000 mm 3 . Nor-mal serum levels range between 4500 and 11,000 mm3.

Which of the following splenic pathologies is associated with granulomatosis

calcifications Granulomatosis is defined as an abnormal increase in the total num- ber of granulocytes in the blood. Granulomatosis occurs in response to infection. Calcifications within the splenic parenchyma are associ-ated with granulomatosis.

A patient presents with a history of liver func-tion tests showing elevated levels. Based on this clinical history, the sonogram is most likely demonstrating a(n)

enlarged lymph node A smooth, solid mass is identi-fied in medial to inferior portion of the spleen and left kidney. This mass demonstrates an echo pattern similar to the spleen (isoechoic). These sonographic findings are most consistent with an accessory spleen. An adrenal adenoma is a possibility, but the mass is isoechoic to the spleen and the sonogram ap-pears to be at level to inferior for the adrenal gland. An enlarged lymph node appears as an oval-shaped hypoechoic mass with a prominent hyperechoic fatty center.

A patient presents with a history of portal hyper-tension. The spleen is expected to demonstrate:

enlargement Splenomegaly is the most com-mon sonographic finding associ-ated with portal hypertension. Other findings may include hepato-megaly, diameter enlargement of the main portal, splenic, and/or su-perior mesenteric veins, develop-ment of portosplenic collaterals, and changes in the flow or direction pattern of the portal circulation.

Gain settings should be placed to demonstrate the normal spleen as:

isoechoic to the normal liver The normal spleen is isoechoic to slightly hypoechoic when com-pared to the normal liver. The nor-mal renal cortex is hypoechoic to the liver and spleen.