CH 11 Pediatric Spleen

Question 1

Spleen

Answer 1

intraperitoneal organ located in the LUQ. part of the reticuloendothelial system (** responsible for phagocytosis = engulfing and destroying of damaged/old cells and their debris, foreign material and pathogens and taking them out of the circulating blood)

largest lymphoid organ (primarily lymph tissue)
not essential for life (you can live without)

Question 2

Spleen sono:

Answer 2

neonate- is iso- or hypoechoic relative to kidneys.

by end of first year of life, it becomes hyperechoic relative to the kidneys.

Question 3

Accessory Spleen

Answer 3

arises from failure of the individual clumps of mesenchyme to fuse during development. Usually single and found at the splenic hilum.

may be found attached to the left ovary or within the scrotum due to the relationship of splenic, mesonephric and left gonadal development.

can hypertrophy if spleen is removed

Question 4

Wandering spleen

Answer 4

spleen is highly mobile and on a long/absent pedicle.

common in “prune belly” syndrome.

Question 5

Splenic torsion

Answer 5

twisting may occur compromising the blood supply.

In acute torsion a large, hypoechoic spleen will be seen due to infarction and congestion.

In chronic torsion the spleen will be very small and difficult to image.

Question 6

Polysplenia (heterotaxy syndrome)

Answer 6

• Left isomerism, multiple splenules
  more common in females.
  present with midline liver, malrotated bowel, absent GB, bilateral BI-lobed lungs, interrupted intrahepatic IVC, with an azygous or hemiazygous continuation.

Question 7

Asplenia

Answer 7

*right isomerism, absence of spleen
more common in males
associated: complex cyantoic congenital heart disease, transposition of the great vessels, absent GB, bilateral TRI-lobed lungs and transverse liver.

Question 8

Situs Inversus

Answer 8

congenital condition where the major visceral organs are reversed or “mirrored”
Spleen on the Right, Liver on the Left.

Question 9

Splenomegaly causes:

Answer 9

Hepatomegaly- issue with splenic v or portal v
leukemia
ECMO
infiltrative storage disorders
mononucleosis
infections
focal lesions
portal HTN
heart failure
lymphoma
hemolytic anemias

Question 10

Small spleen causes:

Answer 10

Infarction due to wandering spleen/ sickle cell anemia
congenital absence or hypoplasia
partial splenectomy
celiac dz
fanconi anemia (rare, inherited disorder, common in Jewish descent and South Africans, leads to bone marrow failure.

Question 11

Splenic cysts

Answer 11

may be congenital (true epithelial or epidermoid) or aquired (false or pseudocysts- post traumatic)

they may rupture or become infected.

can not differentiate between congenital and aquired by ultrasound

Question 12

Congenital Splenic cysts

Answer 12

epithelial lining and imperceptible walls.

cysts secondary to a hematoma or infective process will have no epithelial lining. Post-traumatic cysts have thicker walls and may be calcified.

Question 13

Epidermoid splenic cysts

Answer 13

primary congenital cyst, well-defined cystic lesions which may have calcifications present in the cyst or wall. May be septated and have internal echoes due to hemorrhage.

Question 14

Hydatid cyst (spleen)

Answer 14

from ruptured liver cyst or systemic infection (due to parasites)

well-defined, may be single or multiple and have wall calcifications.

Question 15

Lymphangiomas of Spleen

Answer 15

rare multiple cystic spaces of variable thickness, filled with lymph, which have vascular spetations.

Question 16

Hemangiomas of Spleen

Answer 16

common benign neoplasms. similar in appearance to those in liver of adults.
associated with: beckwith-wiedemann syndrome, klippel-trenaunay-weber, turners syndrome, and Kasabach-Merrit syndrome (large hemangioma which causes platelet trapping and damage resulting in disseminated intravascular coagulation - may be fatal)

appearance varies due to size of vessels

Question 17

Abscesses in spleen

Answer 17

have thick walls and internal echoes and are usually > 1.5 cm. Form due to the spread of infection through the bloodstream.
Abscess is a collection of pus within the splenic parenchyma.
Children with splenic abscesses are usually immunocompromised.

spread due to appendicitis, empyema, osteromyelitis, bacterial endocarditis or ear infection.

Question 18

Fungal abscesses in liver

Answer 18

seen in cases of candida, aspergillus and cryptococcus.

“bull’s-eye” or “target” appearance and are usually small

Question 19

Candida abscesses (spleen)

Answer 19

occur in immunocompromised children

Question 20

Cat-scratch disease

Answer 20

can cause multiple splenic abscesses

Question 21

Splenic calcifications

Answer 21

may be due to histoplasmosis or TB

caves in midwest

Question 22

Neoplastic conditions of spleen

Answer 22

Lymphoma and leukemia are the most common.

The spleen may be involved in a focal or diffuse manner.

Question 23

Lymphoma

Answer 23

may cause enlargement of the spleen and focal hypoechoic lesions within the parenchyma (hypo- or hyperechoic appearance)

Question 24

Leukemia

Answer 24

hypo- or hyperechoic parenchyma with enlargement of the spleen. may see small focal lesions.
big spleen, usually no lesions seen

Question 25

*Langerhans cell histiocytosis

Answer 25

proliferation of the hisiocytes involving the skin, bone marrow, reticuloendothelial system and lungs.
Enlarged spleen with multiple focal hypoechoic nodules is seen.

Question 26

*Gaucher disease

Answer 26

congenital storage disorder where the enzyme glucocerebrosidase is lacking. This enzyme breaks down a fatty substance, glucocerbroside. Without enzyme glucocerebroside builds up to toxic levels and accumulates in the liver and spleen.

causes hyper- or hypoechoic nodules in the spleen.
Extramedullary hemopoiesis (failure of RBC development in the bone marrow) infarction and fibrosis of the spleen.

Question 27

Splenic infarction

Answer 27

Spleen in very vulnerable to infarction.
*sono infarcts appear wedge-shaped

conditions causing infarcts:
sickle cell
splenic torsion
cardiac emboli
vascular diseases
portal HTN (rarely)

following splenic infarct pseudocyst formation or rupture of the infection with abscess formation may occur.

Question 28

Splenic peliosis

Answer 28

rare condition associated with TB, steroid therapy, and hematologic malignancies, leishmaniasis (a rare tropical parasitic infection, middle east).

Blood-filled spaces are seen in the spleen with this condition.

Question 29

Splenic trauma

Answer 29

usually due to abdominal trauma. *Spleen is the most commonly injured solid organ in children.

abnormalities may include: lacerations, subcapsular hematoma, hematoma, fracture or rupture of the spleen.

Acute bleeding hyperechoic and may be difficult to distinguish from normal splenic tissue.

subcapsular fluid will present as a crescent-shaped collection seen just beneath the capsule.

Question 30

Splenic rupture

Answer 30

fluid in the flank or rest of the abdomen will be seen.

Question 31

*Splenosis

Answer 31

when the spleen is injured, splenic tissue scatters throughout peritoneal cavity.