Spleen Pathology

True cyst

-uncommon -epithelial-lined cysts -congenital -present in young adults with LUQ pain -adult polycystic disease

Cystic lymphangioma

2nd most common benign tumor ultrasound findings: multiple cystic spaces that vary in size, solid lesion when smaller and more anechoic when larger

False Cysts: ---- % of non-parasitic, usually results from trauma (hematoma) ---- of true epithelial wall may have wall -------

80 lack calcifications

Sickle cell anemia

Early stage: spleen is enlarged w/ congestion of red pulp infarction of spleen & fibrosis occurs, decreasing size until small mass of fibrous tissue may be found (known as autosplenectomy) changes result from sickle cell plugs vasculature of splenic substance producing ischemic destruction of the spleen

Hematoma rupture clinical findings:

LUQ pain, left shoulder pain, left flank pain, hypotension, decreased hematocrit, ultrasound is uses to help find treatment/follow up on splenic injuries

Splenic abscess clinical findings:

LUQ tenderness, fever, left shoulder and flank pain

Splenic Abscess

Not common echinocactus in origin, not as common in united states infections spread from adjacent infected organs

Splenic abscess sonographic appearance:

complex cystic mass, solid lesion, (ring down artifact if air is present).

Subcapsular hematoma ultrasound appearance:

conforms to shape of spleen, echo pattern varies with age use color doppler to rule out psuedoaneurysms

Granulomatous Disease ultrasound findings:

diffuse, multiple small echogenic calcifications seen within the spleen may or may not have acoustic shadowing

Sarcoidosis

form of granulomatous disease cause is unknown clumps of granulomas (clusters of immune cells)

Parasitic infections differential considerations:

hematoma, neoplasm, infarct (clinical findings are used to help with diagnosis)

Rare malignant neoplasms:

kaposi's sarcoma, hemangiosarcoma, leimyosarcoma, malignant fibrous histiocytoma, cystdenocarcinoma, and teratoma

Acute myelogenous leukemia

large mass within the splenic parenchyma and enlarged nodes in the hilum

Splenic Location: ---- hypochondrium ----- organ ----- upper quadrant

left intraperitoneal left

Splenic infarction ultrasound findings:

localized hypo echoic areas (acute stage) chronic (hemorrhage is more echogenic) wedge shape lesions w/ base towards the sub capsular surface of the spleen along peripheral margins of spleen

Capsular hematoma

look for fluid in the peritoneal cavity w/ splenic capsular rupture CT is the imaging modality of choice with blunt trauma

Malignant neoplasms: 1. 2. 3. 4. 5.

lymphoma leukemia angiosarcoma metastasis (10th most common site) rare

Splenomegaly clinical findings:

palpable spleen, discomfort after eating due to pressure on the stomach

Cavernous hemangioma ultrasound findings:

similar to hemangioma in liver echogenic mass, well-defined, homogenous, may appear complex/contain calcifications

Vascular Supplies: ----- ----- supplies blood to the spleen ----- ----- drains blood to the portal vein the ---- ---- and ---- ----- enter and exit through the splenic hilum ---- vessels follow the path of the splenic artery and drain into celiac nodes

splenic artery splenic vein splenic artery, splenic vein lymph vessels

Accessory Spleen: a common congenital anomaly that usually projects from the ---- ------ can be seen anywhere within the ----- can be mistaken for pancreatic ----, kidney ----, or ------ tumor

splenic hilum abdomen mass, mass, retroperitoneal

Normal sonographic appearances: ----- ----- are seen at the splenic hilum appear anechoic and can be better seen with the use of color doppler. ----- or ------ ------ superior ------ inferior

splenic vessels ovoid, smooth convex concave

Splenic infarction causes and clinical findings:

sub-acute bacterial endocarditis, sickle cell anemia, neoplasm, infections, hypotension, and pancreatitis LUQ pain

splenic landmarks: diaphragm: ------ border of spleen the spleen lies between the ----- and ------ posterior to the spleen is the ---- , ----- 10th and 11th and ---- lung medial surface: ------, ---- of pancreas, ---- kidney, and ------ ---- of colon

superolateral stomach hemi-diaphragm diaphragm, ribs, left stomach, tail, left, splenic flexure

Splenic Cysts 2 categories: ------- (primary) ----- (secondary)

true false

Metastasis

uncommon, arises from melanoma (most common), breast, lung, ovary, uterus, stomach, & prostate

Splenic infarction

uncommon, more common cause of focal splenic lesions splenic artery occlusion emboli usually from the heart

Parasitic infections ultrasound findings:

variable, internal separations, single or multiple, irregular ill defined borders, internal echoes, gas with dirty shadowing, calcifications within the walls

Normal Splenic Size: ----- in size and shape -----cm in length -----cm AP ---- < ---- cm in thickness spleen ------ in size with age

varies 8-13 7-8 6 decreases

Sickle cell anemia sonographic appearances:

varies depending on disease state acute: children with homozygous SCD with splenomegaly and sudden decrease in hematocrit these patients may develop subacute hemorrhage that appears as hypo echoic area in the periphery of spleen

Candida sonographic appearances:

"wheel within a wheel" with healing the candid micro abscesses become hyperechoic

AIDS ultrasound findings:

Splenomegaly (most common) fungal infections focal splenic lesions (micro abscesses) may occur secondary to pneumocytosis most common organism is candida

Hematoma ultrasound appearances:

echo pattern varies w/ age usually complex, hypoechic in acute stage, clot formation becomes more echogenic and with time becomes more hypo echoic to anechoic

Angiosarcoma symptoms and ultrasound findings:

fever, weight loss, malaise, LUQ pain, splenic rupture can occur causing death. ultrasound findings: inhomogeneous spleen, multiple hypoechoic lesions

Splenic infarction differentials:

hemorrhage, infection, neoplasm

Normal Sonographic Appearances: ------- pattern equal or slightly ----- in echogenictiy when compared to the liver the spleen is more ---- than the left renal cortex ----- and ----- --- interfere with image of the spleen

homogenous increased echogenic ribs, bowel gas

Hamartoma ultrasound findings:

homogenous solid lesion, variable in echogenicity, can be complex, contain calcifications, and hypervascularity

False Cysts Sonographic Appearances:

hypoechoic or anechoic, internal echoes may be seen representing clotting blood, well defined walls and increased transmission

Causes of splenomegaly:

infections, congestive states (portal hypertension, heart failure, portal/splenic thrombosis) blood disorders (hemolytic anemias) lupus storage disease (gauchers disease) neoplasm (leukemia) hepatitis mononucleosis sickle cell anemia

Sickle cell anemia

inherited autosomal recessive trait that causes abnormality of the global genes in hemoglobin splenomegaly subacute hemorrhage may develop & appears hypo echoic along the periphery of the spleen

Angiosarcoma (hemangiosarcoma)

primary neoplasm usually metastasizes to the liver arises from the capsul highly aggressive tumor, usually fatal

Chronic lymphocytic leukemia

produces less severe splenomegaly

Lymphoma ultrasound findings:

solitary, multiple or diffuse masses of varying size may occur in the spleen diffuse lymphoma can be hard to detect focal lesions are almost always hypo echoic

Benign Splenic Neoplasms: 1. 2. 3. 4. 5. 6. 7. 8.

Cysts splenic infections granulomatous disease splenic infarct cavernous hemangioma cystic lymphangioma hamartoma (fibromas, osteomas, chondromas)

Parasitic Infections

Echinococcal disease, that is usually caused by tape worm

Splenic Infections: 1. 2. 3. 4. 5.

abscess parasitic (hyatid disease) aids/fungal infection granulomatous disease sarcoidosis

Congenital Anomalies: ------- spleen ------ ------- ------- (floating) spleen

accessory asplenia polysplenia wandering

True Cyst ultrasound appearances:

anechoic, well-defined walls and increased through transmission

Granulomatous Disease clinical symptoms:

asymptomatic, calcified areas from old tuberculosis or histoplasmosis

Splenic Abscess causes:

bacterial endocarditis, septicemia, immunologic deficiencies, IV drug abuse

Hamartoma

benign rare tumor, asymptomatic, solid lesions, can get very large, can spontaneously rupture causing acute LUQ pain

Lymphadenopathy

can occur w/ infections & malignancy ultrasound findings: sandwich sign, hypo echoic nodules along the aorta, IVC, mesenteric vessels normal lymph node size if <1 cm in size

Chronic myelogenous leukemia

may be responsible for more extreme splenomegaly than any other disease

Granulomatous Disease:

may be secondary to acute or chronic inflammation

Cavernous hemangioma

most common primary benign neoplasm rare, insignificant, at risk for rupture associated with klippel-trenaunay-weber syndrome

Splenomegaly

most common spleen abnormality >13 cm in length >6 cm in thickness >200 grams

Lymphoma

most common splenic malignancy hodgkin's & non-hodgkin's splenomegaly may occur

Splenic trauma/rupture of spleen

most involved organ in upper abdominal trauma blunt trauma can cause hematoma, sub capsular hematoma w/ or without rupture of splenic capsule spontaneous rupture can occur in certain disease states when spleen is enlarged/fragile

Metastasis ultrasound findings:

most lesions appear hypo echoic, can appear complex or hyperechoic

Non-Hodgkin's Lymphoma

most lymphomas w/ a higher incidence w/ increasing age high evidence of mesenteric and paraaortic nodal involvement is seen

Sarcoidosis sonographic appearances:

multifocal hypo echoic masses and often with splenomegaly.

3 main types of splenic ruptures:

sub capsular, intraparenchymal, capsular