Spleen

Question 1

accessory spenule clinical sigificance

Answer 1

mistaken for LN/mass; should follow spleen MR signal on all sequences

splenectomy for consumptive thrombocytopenia may not be curative if residual tissue present

Question 2

polysplenia syndrome

Answer 2

visceral heterotaxia with multiple foci of splenic tissue ; same side as stomach

associated with cardiac anomalies, iterruption of IVC with azygos/heiazygos continuation; preduodenal portal vein

Question 3

wandering spleen

Answer 3

abnormal laxity/absence of fixed ligamentous attachments for spleen

Question 4

splenic hemangioma

Answer 4

most common benign splenic neoplasm

associated with phleboliths and visceral hemangiomatosis syndromes (Kasabach Merrit and Klippel Trenaunay Weber syndrome )

Question 5

Kasabach Merrit syndrome

Answer 5

visceral hemangiomatosis;

anemia, thrombocytopenia, consumptive coagulopathy

Question 6

Klippel Trenaunay Weber

Answer 6

visceral hemangiomatosis;

cutaneous hemangioma, varicose veins, extremity hypertrophy

Question 7

splenic hemangioma imaging

Answer 7

T2 hyperintense, peripheral/homogenous enhancement

CT: iso/hypoattenuating noncontrast; hyperenhancing

Question 8

splenic hamartoma

Answer 8

malformed red pulp; associated with TS

Question 9

splenic hamartoma imaging

Answer 9

well-circumscribed iso/hypoattenuating mass

heterogenous enhancement after CT administration

T2 hyperintense

Question 10

benign splenic lesions

Answer 10

epithelial cyst, pseudocyst, intrasplenic pancreatic pseudocyst, lymphangioma

Question 11

congenital cyst

Answer 11

epithelial lining; may cause elevation of CA19-9 or CA125, CEA

may have septation, but no mural calcifications

Question 12

postraumatic pseudocyst

Answer 12

end result of evolving splenic hamartoma

fibrotic tissue surrounds; mural calcification; no septations; no peripheral enhancement (fibrotic)

Question 13

intrasplenic pancreatic pseudocyst

Answer 13

tail of pancreas pseudocyst extends into spleen (history of pancreatitis)

Question 14

lymphangioma

Answer 14

rare benign lesion typically diagnosed in chidhood; solitary or multiple

multilocular cystic struction with thin septations; septal enhancement?

Question 15

splenic sarcoidosis

Answer 15

multiple nodules with noncaseating granulomas; 1-3cm without enhancement and become coalescent;

splenomegaly (hepatomegaly and LN too)

Question 16

inflammatory pseudotumor

Answer 16

focal collection of immune cells and inflammatory exudate; unclear etiology

well circumscribed heterogenously enhancing mass

Question 17

splenic infections

Answer 17

pyogenic, fungal, parasitic infections

Question 18

fungal splenic abscesses

Answer 18

multiple, small <1 cm

immunocompromised

Candida, Aspergillus, Crytpococcus; pneumocystis jiroveci seen with AIDS and is multiple calcified lesions

Question 19

pyogenic abscess

Answer 19

solitary usually bacterial; irregular enhancing wall

wheel within wheel or bulls eye appearance

Question 20

echinococcal cyst

Answer 20

echinococcus granulosa; usually with involvement elsewhere

true cyst with cellular lining; internal undulating membrane and daughter cysts

Question 21

most common splenic malignancy

Answer 21

splenic lymphoma

solitary hypovascular mass; may extend beyond splenic capsule

Question 22

lymphomatous involvement of spleen (secondary)

Answer 22

miliary masses, multiple small/moderate masses, one large mass, splenomegaly

T1 hypoenhancing

cystic appearance on US but internal flow on doppler

Question 23

splenic mets

Answer 23

rare; likely due to antineoplastic properties of lympoid rich tissue

breast, lung, ovary, melanoma can met to spleen; ovarian/melanoma cause cystic mets

calcs rare unless mucinous adenocarcinoma

Question 24

angiosarcoma

Answer 24

enlarged heterogenous mass replaces spleen; very agressive/poor prognosis

no established association with Thorotrast, vinyl chloride, arsenic

Question 25

splenic infarct

Answer 25

emboli or thrombosis

wedge shaped peripheral region of nonenhancement

MR: T1 hyperinense/hemorrhagic; T1 hypointense/T2 hyperintense chronic

Question 26

entire spleen hypoenhancement

Answer 26

complete infarction, possible wandering spleen/torsion

Question 27

gamma gandy bodies

Answer 27

hemosiderin deposition from portal hypertension

low signal on all MR sequences; blooming artifact

Question 28

Gaucher disease – spleen

Answer 28

AR; deficiency of glucocerebrosidase

Erlenmeyer flask deformity of distal femurs, AVN of femoral heads/endplates; splenomegaly; multiple splenic nodules

Question 29

splenic trauma

Answer 29

MDCT grade I: Small (<1 cm) subcapsular hematoma, laceration, or parenchymal hematoma.
• MDCT grade II: Medium (>1 and <3 cm) subcapsular hematoma, laceration, or parenchymal hematoma.
• MDCT grade III: Splenic capsular disruption; or large (>3 cm) laceration or parenchymal hematomas.
• MDCT grade IVA: Active extravasation, vascular injury (pseudoaneurysm or arteriovenous fistula), or shattered spleen.
• MDCT grade IVB: Active intraperitoneal bleeding.