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Core > Gastrointestinal: Spleen > Flashcards

Gastrointestinal: Spleen Flashcards

1
Q

What creates the tiger stripe appearance of the spleen on arterial phase imaging?

A

Different perfusion timing between the red and white pulp of the spleen

Note: The red pulp is filled with blood and enhances during the arterial phase.

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2
Q

Why is the spleen particularly susceptible to infarction?

A

It has only one major arterial supply (the splenic artery) without any significant collaterals

Note: The splenic artery is basically and end vessel.

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3
Q

Most splenic masses are benign, but what are the most common primary malignant splenic masses?

A
  • Lymphoma
  • Angiosarcoma
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4
Q

How does the spleen appear on MRI?

A
  • T1 dark (relative to liver)
  • T2 bright (relative to liver)
  • Restricts diffusion

Note: The spleen is basically a big watery lymph node (it restricts diffusion like a lymph node).

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5
Q

What is a possible reason for recurrence of hemolytic anemia s/p splenectomy?

A

Hypertrophy of a splenule

Note: Splenules should also be removed during a therapeutic splenectomy.

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6
Q

Wandering spleen

A

A normal spleen that moves to unusual places due to laxity of the peritoneal ligaments

Note: These pts are at a higher risk for splenic torsion and infarction.

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7
Q

Wandering spleen is associated with…

A

Abnormalities of intestinal rotation

Note: Also has a higher risk of splenic torsion and infarction.

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8
Q

What is the most common solid organ injured during trauma?

A

The spleen

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9
Q

How much blood does the spleen hold?

A

Approximately 1 liter

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10
Q

Why is a trauma scan done in the portal vinous phase?

A

To evaluate for splenic injury (avoids the tiger striped appearance in arterial phases)

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11
Q

What study can be used to determine that peritoneal nodules are splenules/splenosis and not metastases?

A

Sulfur colloid scan

Note: Heat-damaged RBC scan could also be used.

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12
Q

Splenosis

A

The development of multiple splenules due to prior splenic trauma

Note: These are usually in the upper abdomen, but can be anywhere (including the lungs if the diaphragm is traumatically disrupted at the time of spleen injury).

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13
Q

Numerous rounded soft tissue nodules in the peritoneal cavity of a pt who doesn’t have a spleen…

A

Think splenosis due to prior splenic trauma (spleen is often surgically removed if it is injured)

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14
Q

Imaging findings of the spleen in sarcoidosis

A
  • Splenomegaly (50-80%)
  • Numerous discrete hypodense splenic nodules representing granulomatous splenic tissue (more rare)
  • Massive splenomegaly with rupture (rare)
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15
Q

What is the most common GI tract location to be involved in sarcoidosis?

A

The gastric antrum

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16
Q
A

Splenomegaly with sideritic nodules (Gamna Candy bodies)

Note: These are small T2 dark foci of hemorrhage in the splenic parenchyma, usually associated with portal hypertension.

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17
Q

What is the most sensitive MRI sequence for splenic sideritic nodules (Gamna Candy bodies)?

A

Gradient echo

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18
Q
A

Peliosis (multiple blood-filled cyst-like spaces in solid organs, usually the liver and spleen)

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19
Q

Peliosis most commonly occurs in what pt populations?

A
  • Women on oral contraceptives
  • Men on anabolic steroids
  • AIDS pts
  • Renal transplant pts
  • Pts with Hodgkins lymphoma
20
Q

What is the most common visceral arterial aneurysm?

A

Splenic artery aneurysm

21
Q

At what point is a splenic artery aneurysm usually treated?

A

When it reaches 2-3 cm large

22
Q

_____ are at a 4x increased risk of splenic artery aneurysms

A

Woman of childbearing age who have had 2 or more pregnancies

23
Q

Common causes of splenic vein thrombosis

A
  • Pancreatitis
  • Diverticulitis
  • Crohn’s disease
24
Q

______ can lead to isolated gastric varices

A

Splenic vein thrombosis

25
Q

What is a common cause of spontaneous splenic infarction?

A

Sickle cell disease

26
Q

What is the most common radiographically-detected splenic infection?

A

Histoplasmosis (which appears as multiple round calcifications)

Note: TB can also look like this, but is much less common in the US.

27
Q
A

Multiple round splenic calcifications, consider histoplasmosis or tuberculosis infection

28
Q
A

“Bulls-eye” calcification in the spleen, consistent with chronic Brucellosis infection

29
Q

What splenic infection classically develops after splenic damage (e.g. trauma or sickle cell)?

A

Salmonella

30
Q

Common causes of a small spleen

A
  • Sickle cell disease
  • Radiation changes
  • Post thorotrast
  • Malabsorption syndromes (ulcerative colitis > Crohns)
31
Q

Common causes of splenomegaly

A
  • Passive congestion (e.g. heart failure, portal hypertension, splenic vein thrombosis)
  • Leukemia/lymphoma
  • Gauchers
  • Felty’s syndrome
32
Q

Felty’s syndrome triad

A
  • Splenomegaly
  • Rheumatoid arthritis
  • Neutropenia

Note: This is an abnormality of granulocytes.

33
Q

What is the most common cystic lesion in the spleen?

A

Post traumatic pseudocysts (followed by epidermoid cysts)

Note: These do not have an epithelial lining and so are not true cysts.

34
Q

Most likely diagnosis

A

Post traumatic splenic pseudocyst (followed by epidermoid cyst)

35
Q
A

Splenic hydatid cyst

Note: Daughter cysts.

36
Q

What is the most common benign neoplasm in the spleen?

A

Hemangioma

37
Q
A

Splenic hemangioma

Note: Peripheral nodular discontinuous enhancement (this is not always seen in the spleen, especially when small).

38
Q

Pediatric pt

A

Splenic cystic lymphangioma

39
Q

Differential for benign masses of the spleen

A
  • Post traumatic pseudocyst
  • Epidermoid cyst
  • Hydatid (Echinococcal) cyst
  • Hemangioma
  • Lymphangioma
  • Hamartoma
  • Littoral cell angioma
40
Q

Differential for malignant masses of the spleen

A
  • Lymphoma (by far the most common)
  • Angiosarcoma (rare)
  • Metastatic disease (rare)
41
Q

Why does a littoral cell angioma appear hypointense on T1 and T2?

A

Hemosiderin

42
Q
A

Splenic angiosarcoma
Note: Heterogeneously hypodense infiltrating mass in an enlarged spleen.

43
Q

What is the major complication of splenic angiosarcoma?

A

Splenic rupture (spontaneous rupture occurs in 30% of cases)

44
Q

What is the most common imaging finding of splenic lymphoma?

A

Splenomegaly (often the only finding in low grade disease)

Note: Hodgkins and high-grade lymphomas often show discrete hypodense nodules.

45
Q

What is the most common primary neoplasm to metastasize to the spleen?

A

Melanoma

Note: Splenic mets are rare.

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