Spleen

Question 1

Where are splenules most commonly found?

Answer 1

Splenic hilum

Question 2

What is a splenule?

Answer 2

focus of normal splenic tissue separate from the the main body of the spleen. Due to embryologic failure of fusion

Question 3

Heterotaxy syndrome with multiple foci of splenic tissue

Answer 3

Polysplenia

Question 4

Polysplenia is associated with:

Answer 4

cardiac abnormalities heterotaxy venous anomalies including interruption of the IVC with azygos or hemiazygos continuation Pre-duodenal portal vein

Question 5

Pre-duodenal vein is associated with what condition

Answer 5

polysplenia

Question 6

How does a wandering spleen typically present?

Answer 6

abdominal mass pain (secondary to torsion)

Question 7

Abnormal laxity or absence of the fixed splenic ligamentous attachments is often referred to as a:

Answer 7

wandering spleen the laxity of the ligaments results in torsion or abnormal movement of the spleen

Question 8

Most common benign splenic neoplasm:

Answer 8

hemangioma

Question 9

Splenic hemangiomas are associated with

Answer 9

Kasabach-Merrit syndrome (anemia, thrombocytopenia, consumptive coagulopathy) and Kippel Trenaunay Weber syndrome (cutaneous hemangiomas varicose veins, and extremity hypertrophy)

Question 10

What splenic finding is associated with Kasabach-Merrit syndome?

Answer 10

splenic hemangiomas

Question 11

What splenic finding is associated with Kippel-Trenaunay-Weber syndome?

Answer 11

splenic hemangiomas

Question 12

With visceral hemangiomatosis syndromes, what imaging characteristic is associated with splenic hemangiomas?

Answer 12

phleboliths

Question 13

MRI characteristics of splenic hemangiomas

Answer 13

T2 bight enhancement peripherally or homogenously

Question 14

Splenic hamartomas are associated with:

Answer 14

TSC

Question 15

What markers are increased in patients with true splenic cysts?

Answer 15

CA19-9, CA125, CEA

Question 16

Most splenic cysts are acquired or congenital?

Answer 16

acquired

Question 17

possible intrasplenic finding in a patient with pancreatitis?

Answer 17

intrasplenic pseudocyst

Question 18

Classic imaging appearance of splenic lymphangioma:

Answer 18

single or multiple multilocular cystic structure with thin septations with septal enhancement

Question 19

single or multiple multilocular cystic structure with thin septations with septal enhancement

Answer 19

Splenic lymphangioma cysts and pseudocyts are typically unilocular

Question 20

spleen in sarcoidosis

Answer 20

If spleen is involved in sarcoid, will see splenomegaly and hepatomegaly less commonly numerous hypoattenuating 1-3cm lesions without enhancement (noncaseating granulomas)

Question 21

rare focal collection of immune cells and associated inflammatory exudate, of unclear etiology. Patients often have constitutional symptoms including fever and malaise.

Answer 21

Inflammatory pseudotumor

Question 22

What is an inflammatory pseudotumor?

Answer 22

rare focal collection of immune cells and associated inflammatory exudate, of unclear etiology. Patients often have constitutional symptoms including fever and malaise.

Question 23

Single splenic abscess more likely to be:

Answer 23

bacterial

Question 24

Multiple splenic abscesses are more likely to be:

Answer 24

fungal

Question 25

Wheel within a wheel/ bull's eye appearance on US:

Answer 25

Splenic abscess describes concentric hyperechoic and hypoechoic rings surrounding the abscess

Question 26

treatment for splenic abscess

Answer 26

CT or US guided percutaneous drainage + ABX

Question 27

Immunocompromised pt with fever and multiple small \<1cm splenic foci

Answer 27

fungal splenic abscesses

Question 28

Most common fungi to cause splenic abscesses

Answer 28

candida, aspergillus, cryptococcus

Question 29

Multiple calcified splenic nodules in an AIDS patient

Answer 29

pneumocystits jiroveci

Question 30

Splenic cyst with internal undulating membrane and daughter cysts

Answer 30

echinococcal cyst splenic involvement is seen in only 1-3% of cases

Question 31

Most common splenic malignancy

Answer 31

lymphoma

Question 32

Is primary or secondary lymphoma more common?

Answer 32

secondary

Question 33

US appearance of splenic lymphoma

Answer 33

cyst like (due to homogeneity of structure without interfaces) But with show internal flow

Question 34

Most common primary tumors to metastasize to the spleen:

Answer 34

breast lung ovarian melanoma

Question 35

Which cancers commonly cause cystic mets in the spleen?

Answer 35

ovarian melanoma

Question 36

Very aggressive primary malignancy of the spleen

Answer 36

angiosarcoma presents as enlarged heterogenous mass that may completely replace normal spleen.

Question 37

Chronic splenic infarct MR appearance

Answer 37

T1 dark T2 bright

Question 38

What are gamma gandy bodies?

Answer 38

multiple tiny foci of hemosiderin from portal hypertension

Question 39

Splenic manifestations of Gaucher disease

Answer 39

splenomegaly multiple splenic nodules (seen in one third of Gaucher patients)

Question 40

Phase of contrast needed to evaluate splenic injury:

Answer 40

portal venous

Question 41

Most widely accepted splenic injury grading system:

Answer 41

MDCT

Question 42

MDCT grade 1 injury

Answer 42

small \<1cm subcapsular hematoma, laceration or parenchymal hematoma

Question 43

MDCT grade 2 injury

Answer 43

medium (\>1 and \< 3 cm) subcapsular hematoma, laceration or parenchymal hematoma

Question 44

MDCT grade 3 injury

Answer 44

splenic capsular disruption or large (\>3cm) laceration or parenchymal hematoma

Question 45

MDCT grade 4a injury

Answer 45

active exstravasation vascular injury (pseudoaneurysm or AV fistula) shattered spleen

Question 46

MDCT grade 4b

Answer 46

active intraperitoneal bleeding

Question 47

Answer 47

ploysplenia

Question 48

Answer 48