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KEVIN BURANT IV > Chapter 27 - Pancreas and Spleen (CHERI NOTES) > Flashcards

Chapter 27 - Pancreas and Spleen (CHERI NOTES) Flashcards

1
Q

_____ (___ test)increases pancreatic secretions and improves visualization of the pancreatic duct.(p.720)

A

SECRETIN administration during MRCP (Secretin test)

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2
Q

_____ provides excellent visualization of the lumen of the pancreatic duct; which is usually affected by any mass lesion of the pancreas (p.720)

A

Endoscopic retrograde cholangiopancreatography (ERCP)

  • This procedure is performed by endoscopic cannulation of the bile and the pancreatic ducts followed by injection of a contrast agent and radiography.
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3
Q

TRUE OR FALSE.

Acute pancreatitis is generally diagnosed clinically. (p.720)

A

TRUE

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4
Q

Because the pancreas lacks a ____; the pancreatic juices

have ready access to the surrounding tissues. (p.720-721)

A

CAPSULE

  • pancreatic enzymes digest fascial layers; spreading the inflammatory process to multiple anatomic compartments.
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5
Q

Three imaging abnormalities that may that may be seen in the pancreas (p.721)

A
  1. Focal or diffuse parenchymal enlargement
  2. changes in density due to edema
  3. indistinctness of the margins of the gland due to inflammation.
  • abnormalities in the peripancreatic tissues include stranding densities in the fat with indisctinctness of the fat planes and thickening of affected
    fascial planes.
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6
Q

_____ is a common congenital variant of pancreatic anatomy
that serves as a predisposition to pancreatitis. (p.721)

  • the ventral and dorsal ductal systems of the pancreas fail to fuse.
  • major portion of the pancreatic secretions from the body and tail drain through the dorsal pancreatic duct (Santorini) into the minor papilla;
  • minor portion of pancreatic secretions from the head and uncinate process (ventral duct of Wirsung) drain into the duodenum through the major papilla in association with the common bile duct. (p.722)
A

PANCREAS DIVISUM

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7
Q

TRUE OR FALSE.
Relative obstruction at the minor papilla results in pancreatitis in 5% to 15% of patients with pancreas divisum. (p.722)

A

TRUE

  • PANCREAS DIVISUM is found in 6% of the general population
  • in 10% to 20% of patients with a history of acute recurrent pancreatitis.
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8
Q

_____ is caused by recurrent and prolonged bouts of acute pancreatitis that cause parenchymal atrophy and progressive fibrosis. (p.723)

A

CHRONIC PANCREATITIS

  • both the exocrine and the endocrine functions of the pancreas may be impaired.
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9
Q 
The most common causes of chronic pancreatitis
are \_\_\_\_ (70%) and (20%). (p.723)
A

ALCOHOL ABUSE (70%) and BILIARY STONE DISEASE (20%).

  • many of the remaining patients may have autoimmune pancreatitis
    that responds to steroid therapy.
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10
Q

7 morphologic changes of chronic pancreatitis. (p.723)

A
  1. Dilation of the pancreatic duct (70% to 90% of cases); usually in a beaded pattern
  2. decrease in visible pancreatic tissue because of atrophy
  3. calcifications (40% to 50% of cases)in the pancreatic parenchyma.
  4. fluid collections that are both intrapancreatic and extrapancreatic
  5. focal mass-like enlargement of the pancreas owing to benign inflammation and fibrosis
  6. stricture of the biliary duct because of fibrosis or mass in the pancreatic head resulting in proximal bile duct dilatation
  7. fascial thickening and chronic inflammatory changes in the surrounding tissues.
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11
Q

____ is a unique form of chronic pancreatitis caused by autoimmune system disease that involves the pancreas; kidneys; bile ducts and retroperitoneum (p.723)

A

AUTOIMMUNE PANCREATITIS
(Lymphoplasmacytic Sclerosing Pancreatitis)

  • periductal infiltration by lymphocytes and plasma cells results in
    mass-like enlargement of the pancreas closely simulating adenocarcinoma
  • differentiation is important because autoimmune pancreatitis is effectively treated with oral steroids (p.723)
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12
Q

DIAGNOSIS ?
Imaging findings include:
1. Diffuse or focal swelling of the pancreas with
characteristic tight halo of edema
2. extensive peripancreatic stranding and edema are absent
3. diffuse or segmental narrowing of the pancreatic duct or the common bile duct
4. absence of dilatation of the pancreatic duct and absence of parenchymal atrophy proximal to the pancreatic mass (typically present with adenoCA)
5. pseudocysts and parenchymal calcifications are typically absent
6. peripancreatic blood vessels are usually not involved
7. the kidneys are involved in one-third cases of cases
8. serum IgG4 is often elevated
(p.724)

A

AUTOIMMUNE PANCREATITIS
(Lymphoplasmacytic Sclerosing Pancreatitis)

  • imaging findings normalize following steroid treatment
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13
Q

____ is an uncommon form of chronic pancreatitis that may also mimic adenoCA

  • fibrosis in the groove between the head of the pancreas; the descending duodenum; and the common bile duct produces an inflammatory mass that obstructs the common bile duct. (p.724)
A

GROOVE PANCREATITIS

  1. sheet-like mass in the pancreaticoduodenal groove
  2. atrophy and fibrotic changes in the pancreatic head
  3. small cysts along the wall of the duodenum
  4. duodenal wall thickening and luminal narrowing
  5. tapering stenosis of the common bile duct and pancreatic ducts
  6. widening of the space between the distal ducts and the wall of the duodenum
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14
Q

DIAGNOSIS ? It accounts for 3% of all cancers and second only to colorectal cancer as the most common digestive tract malignancy.

  • the average survival time of a patient with this disease is only 5 to 8 months (p. 724)
A

PANCREATIC ADENOCARCINOMA (DUCTAL CARCINOMA)

  • AdenoCA appears as a hypodense mass distorting the contour of the gland
  • associated findings include obstruction of the common bile duct and the pancreatic duct and atrophy of pancreatic tissue beyond the tumor
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15
Q

Pancreatic AdenoCA METASTASES commonly goes to___ nodes; ___ and the _____ cavity. (p.724)

A
  1. REGIONAL nodes
  2. LIVER
  3. PERITONEAL cavity
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16
Q

3 signs of RESECTABILITY of Pancreatic AdenoCA.(p.724)

A
  1. Isolated pancreatic mass with or without dilatation
    of the bile or pancreatic ducts
  2. no extrapancreatic disease
  3. no encasement of celiac axis or superior mesenteric artery
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17
Q

3 signs of POTENTIAL resectability of Pancreatic AdenoCA

p. 724

A
  1. Absence of involvement of the celiac axis or the
    superior mesenteric artery
  2. regional nodes may be involved
  3. limited peripancreatic extension of tumor may be present
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18
Q

3 signs of UNRESECTABILITY of Pancreatic AdenoCA

p.724-725

A
  1. Encasement of the celiac axis or the SMA
  2. Occlusion of the superior mesenteric or portal vein
    without a technical option for reconstruction
  3. Liver; peritoneal; lung;or any other distant metastases.
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19
Q

3 evidence of ARTERIAL ENCASEMENT that indicate

unresectability in PANCREATIC ADENOCA (p.725)

A
  1. Tumor abutting greater than 180 degree of the circumference of the artery
  2. Tumor abutment focally narrowing the artery
  3. Occlusion of the artery by tumor
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20
Q

Tumor reccurence ff the Whipple procedure is best detected with ____ . (p.725)

A

MULTIDETECTOR CT

  • MRCP defines ductal anatomy with dilatation proximal to the
    stricturing tumor
  • MRA and MRV are excellent in identifying vascular involvement
    by tumor
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21
Q

_____ pancreatitis may produce a mass that mimics pancreas carcinoma. (p.725)

A

CHRONIC PANCREATITIS

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22
Q

Beaded dilatation of the pancreatic duct is characteristic of _____ whereas smooth ductal dilatation is most frequent with ___.(p.725)

A

CHRONIC PANCREATITIS; CARCINOMA

  • calcifications within the mass are common with
    CHRONIC PANCREATITIS and are very rare with ADENOCARCINOMA
  • islet cell tumors more commonly contain calcifications
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23
Q

___ tumors may be functioning producing hormones resulting in
distinct clinical syndromes or may be nonfunctional and grow to large size before presenting cinically. (p.725)

A

NEUROENDOCRINE (ISLET CELL) tumors

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24
Q

Neuroendocrine tumor where patients present with episodic hypoglycemia (p.725)

A

INSULINOMAs

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25
Q

Neuroendocrine tumor where patients present with peptic ulcers; diarrhea caused by gastric hypersecretion;or Zollinger-Ellison syndrome.(p.725)

A

GASTRINOMAs

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26
Q

Islet cell tumor which present with diabetes mellitus and painful
glossitis (p.725)

A

GLUCAGONOMA

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27
Q

Islet cell tumor which present with diabetes and steatorrhea
(p.725)

A

SOMASTATINOMA

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28
Q

Islet cell tumor which present with massive watery diarrhea.
(p.725)

A

VIPoma

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29
Q

Arrange these islet tumors according to their malignant
potential from lowest to highest. (p.725)

GASTRINOMA; INSULINOMA; GLUCAGONOMA

A

INSULINOMA< GASTRINOMA

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30
Q

Functionally islet cell tumors are usually ____ cm in size and require strict attention to technique for accurate preoperative identification.(p.725)

A

less than 3 cm in size

  • most small neudoendocrine tumors cannot be
    identified on precontrast CT
  • because the lesions tend to be hypervascular; bolus contrast administration during rapid; thin-slice; MDCT scanning through the
    pancreatic bed offers the best chance of lesion visualization.
  • the tumor stands out as an enhancing nodule
    within the pancreas
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31
Q

Imaging appearance of ISLET CELL tumors in MR? and US?

p.725

A

MR:

  • T1WI: low signal
  • T2WI: high signal
  • Postcontrast: homogeneously hyperintense

ULTRASOUND:
- hypoechoic masses within the pancreas

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32
Q

TRUE OR FALSE.

Up to 80% of pancreatic nonfunctioning tumors are malignant. (p.725)

A

TRUE

  • non-functioning islet cell tumors tend to be much larger;
    6 to 20 cm in diameter
  • imaging findings include coarse calcifications; cystic degeneration;
    necrosis; local and vascular invasion and metastases
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33
Q

MR findings in pancreatic non-functioning tumors
(p.725)

T1W? T2W? And DYNAMIC
POST-CONTRAST IMAGES ?

A

HETEROGENEOUS MASSES
are generally:
T1WI: generally low signal
T2WI: heterogeneous high signal in cystic and necrotic areas
Dynamic Postcontrast images: heterogeneously hyperenhancing

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34
Q

Metastases to the pancreas are most frequent with

____ carcinoma and _____ carcinoma. (p.725)

A

RENAL CELL Carcinoma; BRONCHOGENIC Carcinoma

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35
Q

Three possible imaging appearances of pancreatic metastases

p.725-726

A
  1. Solitary; well-defined; heterogeneously-enhancing mass
  2. Diffuse heterogeneous enlargement of the pancreas
  3. Multiple nodules
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36
Q

TRUE OR FALSE.

Metastases to the pancreas have no predilection for any particular portion of the pancreas. (p.726)

A

TRUE

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37
Q

MR imaging appearance of metastases to the pancreas;including melanoma mets. (p.726)

T1WI? T2WI? (mets to the pancreas)
T1WI? (Melanoma mets)

A

METS TO THE PANCREAS
T1W: low signal
T2W: high signal

MELANOMA METS
T1W: hyperintense; because of the paramagnetic properties of melanin

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38
Q

____ may involve the pancreas as a primary site (rare) or by direct extension from disease in the retroperitoneum. (p.726)

A

LYMPHOMA

  • on CT: most lesions are homogeneous; of lower attenuation than muscle; and show limited enhancement.
  • lesions can be a localized; well-defined mass or infiltrating diffusely enlarging or replacing the gland.
  • attenuation may be so low as to appear cystic
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39
Q

Fatty lesions of the pancreas include __; ___; ____; and ____.
(p.726)

A
  1. DIFFUSE FATTY INFILTRATION
  2. FOCAL FATTY INFILTRATION
  3. FOCAL FATTY SPARING
  4. LIPOMA
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40
Q

DIAGNOSIS?
Fat infiltrates between the lobules of pancreatic parenchyma.

  • associated with aging and obesity and is seen with pancreatic atrophy. (p.726)
A

DIFFUSE FATTY INFILTRATION OF THE PANCREAS

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41
Q 
TRUE OR FALSE.
Focal fatty sparing in
diffuse infiltration may simulate a pancreatic mass;
especially when it involves
the head or uncinate 
process. (p.726)
A

TRUE

  • focal fatty infiltration may
    involve any portion of the
    pancreas. (p.726)
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42
Q

___ are rare; usually solitary; fat-density
pancreatic masses that are
usually incidental findings but may occasionally
obstruct the pancreatic
or the bile ducts. (p.726)

A

LIPOMAS

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43
Q 
DIAGNOSIS? 
The pancreas in teenage
and adult patients is 
commonly entirely 
replaced by fat in 
association with exocrine insufficiency.
  • now commonly seen in adults as treatment
    has continued to improve.
    (p.726)
A

CYSTIC FIBROSIS

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44
Q 
\_\_\_\_ refers to the 
unsual occurrence of 
macrocysts of varying size 
distributed througout the 
pancreas in patients with 
 cystic fibrosis. (p.726)
A

PANCREATIC CYSTOSIS

- the cysts are true cysts 
developing from functional 
remnants of pancreatic ducts.
- additional findings:
acute pancreatitis and calcifications
in the pancreas
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45
Q

____ include primary cystic tumors
(5% to 10% of cystic lesions) and
cystic degeneration of solid tumors
(p.726)

A

CYSTIC NEOPLASMS

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46
Q

____ rarely arise in the pancreas
and usually have characteristic hair;
fat; calcifications and cystic and
solid components. (p. 726)

A

CYSTIC TERATOMAS

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47
Q

___ is the optimal modality for
imaging characterizations of cystic
lesions. (p. 726)

A

MR

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48
Q

______ resulting from pancreatitis are
the most common pancreatic cystic
lesions representing up to 85% to
90% of cystic lesions. (p.726)

  • most of them are unilocular fluid
    collections confined by a fibrous
    wall that does not contain epithelium
    (p.726)
A

PSEUDOCYSTS

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49
Q 
DIAGNOSIS/
Imaging findings include:
1. fluid density unilocular cyst 
associated with findings of acute
or chronic pancreatitis
2. complex cystic mass with internal
hemorrhage; infection or gas
3. most are round or oval with a thin
or thick wall that may enhance; 
however; cyst contents do not 
enhance
4. septations and lobulated contours
are unusual and more often 
associated with serous cystadenoma
5.  serial imaging usually shows
involution of the lesion. (p.726)
A

PSEUDOCYSTS

50
Q

___ must be considered in any
patient with cystic pancreatic lesion
andd fever. (p.726)

A

ABSCESS

  • most abscesses have indistinct
    walls and contain fluid and debris
51
Q

The presence of ____ within the
cystic mass is a strong evidence
for abscess. (p. 726)

A

GAS BUBBLES

52
Q

___ cystadenomas are benign tumors
that do not require treatment. (p.726)

- tumors occur most commonly in 
women(esp . >60 yrs) and are 
distributed uniformly throughout the 
head; body and tail of the pancreas. 
(p.726)
A

SEROUS cystadenomas

  • these lesions are associated
    with von Hippel-Lindau syndrome
53
Q

Give 3 major imaging appearances of

SEROUS CYSTADENOMAS. (p.726-727)

A 
1. the most common is the 
honeycomb microcysts 
(microcyst adenoma) with 
innumberable small cysts
1 mm to to 2 cm in size
2. a macrocystic form with larger
cysts is seen in 10% overlapping
the appearance of mucinous
cystadenoma
3. innumerable tiny cysts may
make the lesion appear solid.
54
Q

TRUE OR FALSE.
A central stellate scar that may
calcify is a highly diagnostic feature
of SEROUS CYSTADENOMA. (p.727)

A

TRUE

- SEROUS CYSTADENOMA do not
communicate with the pancreatic 
duct
- diagnosis is confirmed by aspiration
of clear fluid without mucin
55
Q

____ neoplasm occurs most
commonly in the tail and
usually in women. (p.727)

  • lesions show pathologic progression
    from benign adenoma to low-grade
    malignancy to invasive carcinoma
A

MUCINOUS CYSTIC NEOPLASM

- lesions hows pathologic 
progression from benign 
adenoma to low-grade 
malignancy to invasive carcinoma.
- imaging shows a macrocystic 
lesion (>2cm) in the pancreatic 
tail that is unilocular or multilocular with 
few compartments.
- metastases to the liver tend to be cystic
56
Q 
TRUE OR FALSE.
Peripheral eggshell calcification
is uncommon but highly specific
finding in SEROUS CYSTADENOMA.
(p.727)
A

TRUE

57
Q

_____ neoplasms are mucinous
tumors with malignant potential
deserving surgical resection. (p.727)

A 
INTRADUCTAL PAPILLARY
MUCINOUS NEOPLASMS (IPMN)
58
Q 
The lesion may affect the main 
pancreatic duct (\_\_\_\_\_ IPMN) 
resulting in marked dilatation 
resulting from continuing mucin 
production and progressive atrophy 
of the pancreatic parenchyma 
resulting from obstruction. (p.727)
A

MAIN DUCT IPMN

- papillary solid tumor 
excrescences may be seen
within the dilated duct. 
- only a thin rim of atrophic 
pancreatic parenchyma may be 
present
59
Q 
Alternatively one or more branch
ducts may be affected (\_\_\_\_ IPMN).
-  a focal group of small cysts 
(1 to 2 cm diameter) that 
intercommunicate through dilated 
branch ducts. (p.727)
A

BRANCH DUCT IPMN

60
Q

BRANCH DUCT IPMN are most

common in the ____. (p.727)

A

UNCINATE PROCESS

61
Q

____ IPMN carry a higher risk of

carcinoma. (p.727)

A

MAIN DUCT IPMN

62
Q

6 features that suggest the presence

of carcinoma in IPMN: (p. 727)

A 
1. Dilatation of the main pancreatic
duct greater than 7 to 15 mm 
2. multiple mural nodules 
greater than 3 to 10 mm in size
3. tumor greater than 2 to 6 cm 
4. calcified intraluminal contents
5. associated dilatation of the 
common bile duct
6. peripancreatic lymph node enlargement
63
Q 
\_\_\_\_\_ tumor of the pancreas
is a rare; usually benign; neoplasm
presents as a large encapsulated
mass with a mixture of cystic;
hemorrhagic; and solid components.
(p.727)
A

SOLID PSEUDOPAPILLARY TUMOR

- it occurs most frequently in 
young women
- approx. 15% demonstrate low-grade
malignant elements.
- patients are often asymptomatic
even though the lesions may exceed 
20 cm in size. 
- these lesions most closely resemble
neuroendocrine tumors
64
Q 
TRUE OF FALSE.
Cystic change in adenoCA is 
usually the result of necrosis;
hemorrhage ; or formation of 
pseudocysts adjacent to the 
neoplasm. (p.728)
A

TRUE

65
Q

___ diverticula filled with
fluid may mimic a cystic
pancreatictumor or an
abscess. (p.728)

A

DUODENAL diverticula

66
Q

____ are common incidental
findings in the pancreas
demonstrated with high
sensitivity by MR. (p.728)

A

TINY SIMPLE CYSTS

67
Q 
\_\_ and \_\_ remain the major
techniques used to image
the splenic parenchyma
although with new techniques
MR plays an increasing role.
(p.728)
A

CT and US

  • Gadolinium enhancement
    improves the specificity of spleen
    MR
68
Q 
\_\_\_\_\_ scanning images both 
the liver and the spleen and 
can be used to confirm the
presence of functioning
splenic tissue; which is
important in the diagnosis
of splenosis. (p.728)
A

TECHNETIUM SULFUR COLLOID

RADIONUCLIDE scanning images

69
Q

Body’s largest lymphoid

organ. (p.728)

A

SPLEEN

  • site of blood formation in the fetus
  • no hematopoietic activity
    in the normal adult spleen
  • sequesters abnormal and aged
    red and white blood cells and
    platelets and serves as reservoir
    for red blood cells.
70
Q

Location of the spleen

p.728

A

left upper quadrant of the
abdomen just below the
diaphragm; posterior and lateral
to the stomach.

71
Q

Spleen size varies with __;

___ and ___. (p.728)

A

AGE; NUTRITION AND HYDRATION

72
Q

TRUE OF FALSE.
The spleen is relatively large
in children; reaching adult
size by 15 years. (p.728)

A

TRUE

73
Q 
The average spleen 
dimensions in adults are
\_\_ cm in length; \_\_ cm in 
width; and \_\_\_ in thickness. 
(p.728)
A

12 cm in length; 7 cm in width;
3 to 4 cm in thickness

  • in older adults; the spleen
    progressively decreases in size
    with age.
74
Q 
TRUE OR FALSE.
Splenic arteries are end 
arteries without anastomoses
or collateral supply.
(p.728)
A

TRUE

  • occlusion of the splenic artery
    or its branches produces
    infarction
75
Q

SPLEEN
On US? On Noncontrast CT?
On MR?

A 
On US: demonstrates a midlevel
homogeneous echo pattern for the 
splenic parenchyma
on NON-CONTRAST CT: the normal
spleen density is less than or equal
to the density of the normal liver.
On MR: the spleen signal intensity
is lower than hepatic parenchyma
on T1WI and higher than liver 
parenchyma on T2WI
76
Q 
Following IV contrast 
injection; the enhancement 
pattern of the spleen reflects 
the normal rapid direct circulation of the
\_\_\_\_; which functions to clear
aging and damaged blood 
cells. (p.728)
A

RED PULP

77
Q 
During arterial phase; splenic
contrast enhancement 
appears alternating bands of 
high and low density; the \_\_ 
enhancement pattern. (p.728)
A

ARCIFORM enhancement
pattern

  • delayed post-contrast images
    show homogeneous enhancement
    of the splenic parenchyma
78
Q

Transient pseudomasses
of the spleen may be formed
during the ___ phase on
postcontrast CT and MR. (p.728)

A

ARCIFORM enhancement
pattern

  • diffuse liver disease is associated
    with more prominent splenic
    pseudomasses during early enhancement.
79
Q 
TRUE OR FALSE.
Lobulations or clefts in 
the splenic contour are common and must not be 
mistaken for masses or 
splenic fractures. (p.728)
A

TRUE

80
Q 
\_\_\_\_ are found in 10% to 16% 
of normal individuals. These
appear as round masses; 1 to 3 cm in size and of the same 
texture as normal splenic 
parenchyma. (p.728)
A

ACCESSORY SPLEENS

- may be single or multiple and 
are usually located near the 
splenic hilum
- Technetium sulfur colloid 
radionuclide scans can be used to 
confirm suspected accessory 
spleens as functioning splenic tissue.
81
Q 
\_\_\_\_ is the term applied to
a normal spleen positioned
outside of its normal location
in the left upper quadrant.
(p.729)
A

WANDERING SPLEEN

- laxity of the splenic ligaments;
commonly found in association 
with abnormalities of intestinal 
rotation; allows the spleen to be 
positioned anywhere in the 
abdominal cavity.
82
Q 
TRUE OR FALSE.
A wandering spleen may be 
present as a palpable abdominal mass; although
 most cause no symptoms.
(p.729)
A

TRUE

  • because of lax ligament;
    the spleen may rotate and torse
    causing acute or recurrent
    abdominal pain.
83
Q

How is a wandering spleen

diagnosed? (p.729)

A 
The diagnosis is made by 
recognizing the normal shape 
and tissue texture of the spleen;
noting the absence of normal
spleen in the left upper abdomen;
and by identifying the blood supply
from splenic vessels.
  • radionuclide scans confirm
    functioning splenic tissue
84
Q 
\_\_\_ refers to multiple 
implants of ectopic 
splenic tissue that may occur 
after traumatic splenic 
rupture. (p.729)
A

SPLENOSIS

- Splenic tissue can implant 
anywhere in the abdominal cavity 
or even in the thorax if the 
diaphragm has been ruptured.
- the tissue fragments enlarge
over time and may simulate
peritoneal metastases. 
- Splenosis complicates 
40% to 60% of traumatic splenic 
injuries.
85
Q 
TRUE OR FALSE.
After splenectomy; remaining
accessory spleens or 
splenules resulting from 
traumatic peritoneal seeding 
of splenic tissue; may enlarge
and resume the function of 
the resected spleen. (p.729)
A

TRUE

86
Q 
When the spleen is removed;
bits of nuclear material; called
\_\_\_\_\_; are routinely seen in
red cells on peripheral blood 
smears. (p.729)
A

HOWELL-JOLLY BODIES

  • Normal splenic tissue routinely
    clears red blood cells containing
    Howell-Jolly bodies from the
    peripheral blood.
87
Q

Disappearance of Howell-Jolly
bodies from peripheral blood
is a clinical sign of ___. (p.729)

A

SPLENIC REGENERATION

88
Q 
Imaging studies demonstrate
single or multiple spleen-like 
masses in the abdominal
cavity in patients with a
history of \_\_\_. (p.729)
A

history of SPLENECTOMY

89
Q 
\_\_\_\_ is a rare congenital 
anomaly that features
multiple small spleens; 
usually located in the 
right abdomen and associated 
with situs ambiguous. (p.729)
A

POLYSPLENIA

  • Both lungs are two-lobed.
    Most patients also have
    cardiovascular anomalies.
90
Q 
\_\_\_\_\_ (\_\_\_\_ syndome) is 
the congenital absence of the
spleen; found in association
with bilateral right-sidedness;
midline liver; and bilateral
three-lobed lungs. (p.729)
A

ASPLENIA
(IVEMARK SYNDROME)

  • major cardiac anomalies are
    present in 50% of cases
  • most patients die before 1 year
    of age.
91
Q 
TRUE OR FALSE.
The diagnosis of splenic 
enlargement on 
imaging studies is usually 
made subjectively. (p.729)
A

TRUE

92
Q

4 Imaging findings that
are suggestive of
SPLENOMEGALY. (p.729)

  • enlarged spleen frequently
    compress and displace adjacent organs;
    especially the left kidney.
A 
1. any spleen dimension greater 
than 14 cm
2. projection of the spleen ventral
to the anterior axillary line
3. inferior spleen tip extending
more caudally than the inferior
liver tip
4. inferior spleen tip extending
below the lower pole of the 
left kidney.
93
Q 
TRUE OR FALSE.
MR offers NO significant 
benefit to the differential
diagnosis of splenomegaly.
(p.730)
A

TRUE

94
Q

Mild to moderate
splenomegaly is seen with
____. (p.730)

A
  1. Portal Hypertension
  2. AIDS
  3. Storage diseases
  4. Collagen Vascular Disorders
  5. Infection
95
Q

More marked splenomegaly
is usually associated with
____. (p.730)

A
  1. LYMPHOMA
  2. LEUKEMIA
  3. INFECTIOUS MONONUCLEOSIS
  4. HEMOLYTIC ANEMIA
  5. MYELOFIBROSIS
96
Q

____ is the most common
malignant tumor involving
the spleen. (p.730)

A

LYMPHOMA

- commonly; the spleen involved
with diffuse infiltrative lymphoma
appears normal on all imaging 
studies. 
- CT is only 65% sensitive in
demonstrating splenic 
involvement with lymphoma.
97
Q

5 Patterns of lymphoma
involvement of the spleen
on imaging studies. (p.730)

A
  1. Diffuse Splenomegaly
  2. Multiple masses of varying
    sizes
  3. Miliary nodules resembling
    microabscesses
  4. Large solitary mass
  5. Direct invasion from adjacent
    lymphomatous nodes
98
Q 
TRUE OR FALSE.
ADENOPATHY is frequently
evident elsewhere in
the abdomen when the 
spleen is involved with 
lymphoma. (p.730)
A

TRUE

  • is a common predisposing
    condition for splenic infarction
99
Q 
TRUE OR FALSE.
Most splenic metastases are 
microscopic and are not 
detectedby imaging studies. 
(p.730)
A

TRUE

  • on MR; metastases are
    T1WI: low intensity
    T2WI: high intensity
- the increased signal intensity
of the lesions parallel the increased
signal intensity of the normal splenic
parenchyma on T2WI; and the lesions
may not be evident.
100
Q

6 most common tumors
to the metastasize to the
spleen are ___. (p.730)

A
  1. Malignant Melanoma
  2. Lung CA
  3. Breast CA
  4. Ovarian CA
  5. Prostatic CA
  6. Gastric CA
101
Q 
TRUE OR FALSE.
Contrast enhancement is 
recommended for both
CT and MR demonstration
of metastases. (p.730)
A

TRUE

  • Calcification is rare in splenic
    metastases
  • Melanoma metastases commonly
    appear cystic.
102
Q

Splenic infarction is

produced by ___. (730)

A

OCCLUSION OF THE MAIN OR

BRANCH SPLENIC ARTERIES

103
Q

5 causes of splenic infarction.

p.730

A 
1. Emboli (owing to endocarditis;
atherosclerotic plaques; or cardiac
valve thrombi)
2. Sickle cell disease
3. Pancreatitis
4. Pancreatic tumors
5. Arteritis
  • additional predisposing
    conditions include
    myeloproliferative disorders;
    hemolytic anemias and sepsis.
104
Q

Splenic infacts
typically appear
as _____ in the splenic
parenchyma. (p.730)

A

WEDGE-SHAPED DEFECTS

- multiple infarcts may fuse;
however; and the wedge shape
may be lost.
- KEY FINDING: extension of the 
abnormal parenchymal zone to
an intact splenic capsule
105
Q

3 complications of splenic

infarctions. (p.731)

A
  1. Subcapsular hematomas
  2. Infection
  3. Splenic rupture with
    hemoperitoneum
106
Q 
\_\_\_\_\_ ( as called \_\_\_\_ )
 are small hemorrhages in the
spleen caused by portal 
hypertension and resulting
in foci of hemosiderin
deposition.
A

GAMMA GANDY BODIES
(also called SIDEROTIC NODULES)

  • best seen on MR as multiple
    small low-intensity nodules on T1WI
    and T2WI
107
Q

Signal intensity of
GAMMA GANDY BODIES
is LOW because of ___.
(p.731)

A

signal intensity is LOW because of
HEMOSIDERIN content.

  • THEY DO NOT ENHANCE.
108
Q

____ is the most common
primary neoplasm of the
spleen; found in 14% of
patients on autopsy series.

  • the tumor consists of
    vascular channels of varying
    size lined by a single layer of
    endothelium. (p.731)
A

HEMANGIOMA

  • US: well-defined hyperechoic mass
  • CT: the lesion may appear solid
    and may have central punctate or
    peripheral curvilinear calcification
  • MR: the lesion is low in signal
    intensity on T1WI and high in
    signal intensity on T2WI
  • the contrast enhancement
    pattern is variable
109
Q 
TRUE OR FALSE.
The nodular enhancement
form the periphery described 
for liver hemangiomas is not 
often seen with splenic 
hemangiomas. (p.731)
A

TRUE

110
Q

_____ is very rare but is still
the most common malignancy
arising in the spleen. (p.731)

  • tumor is aggressive usually
    presenting with widespread
    metastases; esp. to the liver.
A

ANGIOSARCOMA

- imaging studies demonstrate
multiple well-defined enhancing 
nodules or diffuse spleen 
abnormality
- patient thorotrast exposure are
at increased risk
111
Q

___ are false splenic cysts
that lack an epithelial lining.
(p.731)

A

POSTTRAUMATIC CYSTS

- generally have thick walls and 
septations that commonly 
become calcified (30% to 40%)
- the internal fluid may be 
complex owing to blood products; 
cholesterol crystals or cellular
debris
112
Q

_____ account for 80% of all

splenic cysts. (p.731)

A

POSTTRAUMATIC CYSTS

  • posttraumatic cysts result
    from previous hemorrhage;
    infarction or infection
113
Q

___ cysts are true epithelial-
lined cysts that are probably
developmental in origin.
(p.731)

A

EPIDERMOID CYSTS

  • similar apperance to
    posttraumatic cysts but less
    frequently have calcification
    in their walls (5%)
114
Q

TRUE OR FALSE.

Pancreatic pseudocysts extend beneath the splenic capsule by tracking along the pancreatic tail to the splenic hilum.

A

TRUE

  • Splenic subcapsular pancreatic fluid collections develop in 1%
    to 5% of patients with pancreatitis
  • internal debris and hemorrhage are commonly present
  • imaging studies demonstrate associated findings of pancreatitis
115
Q

TRUE OR FALSE.

Bacterial abscesses occur most commonly in spleens that are already diseased. (p.732)

A

TRUE

  • they present with vague symptoms but have a high mortality when
    left untreated.
  • they result from: hematogeneous spread of infection (75%);
    trauma (15%) or infarction (10%)
116
Q

Splenic Abscesses appear as ___. (p.732)

A

SINGLE or MULTIPLE LOW-DENSITY MASSES WITH
ILL-DEFINED THICK WALLS

  • US demonstrates internal echoes resulting from inflammatory
    debris
  • MR T1WI: low signal intensity
  • MR T2WI: high signal intensity
  • may contain gas or demonstrate air-fluid levels
  • perisplenic fluid collections and left pleural effusions are common
  • image-guided aspiration confirms the diagnosis
  • Treatment is by catheter drainage or splenectomy
117
Q

Splenic _____ are found in patients with compromised

immune systems attributable to AIDS; organ transplantation; lymphoma or leukemia. (p.732)

A

MICROABSCESSES

  • causes of microabscesses: fungi; TB; Pneumocystis carinii; histoplasmosis and CMV
118
Q

DIAGNOSIS?
Imaging studies demonstrate multiple small defects in the
spleen; usually 5 to 10 mm up to 20 mm; in size.(p.732)

A

MICROABSCESSES

119
Q

Hydatid cysts of the spleen is found only in ___ % of patients with hydatid disease.(p.732)

A

2%

  • hydatid cysts are usually also present in the liver or lung
  • the lesion consists of spherical Mother Cysts that contain smaller
    daughter cysts and have internal septations and debris representing
    hydatid sand.
  • ring-like calcification in the wall
    are usually prominent in the chronic stage
120
Q

Most common finding in patients with AIDS.(p.732)

A

SPLENOMEGALY ASSOCIATED WITH GENERALIZED LYMPHOID HYPERPLASIA

  • focal lesions in the spleen are usually caused by oppurtunistic
    infections such as atypical mycobacterium; Candida or Pneumocystis jiroveci.
  • P. jiroveci infection may cause multiple splenic calcifications
121
Q

TRUE OR FALSE.
AIDS associated lymphoma and Kaposi sarcoma may also
cause single or multiple solid-appearing lesions in the spleen.

A

TRUE

122
Q

__ offers an excellent invasive method of imaging the pancreatic duct as well as the biliary system. (p.720)

A

MR Cholangiopancreatography (MRCP)

KEVIN BURANT IV (20 decks)

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