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ARDMS Abdominal Review > Spleen > Flashcards

Spleen Flashcards

1
Q

A 20 year old comes in after an MVA complaining of shortness of breath and left shoulder pain. What ultrasound will the ER most likely order?

a) spleen
b) carotid
c) chest
d) left shoulder soft tissue

A

A) spleen

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2
Q

What is the largest lymphoid organ that filters damaged cells, microorganisms and particulate matter?

A

Spleen

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3
Q

What is the average size of the adult spleen

A

12 cm long
8 cm trans
4 cm thick

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4
Q

Splenomegaly is indicated when the spleen is how many cm

A

greater than 12 cm

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5
Q

What 4 structures are located on the visceral surface of the spleen

A

1) stomach
2) left kidney
3) pancreas
4) splenic flexure of the colon

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6
Q

The fundus of the stomach and the lesser sac are _____ and ____ to the splenic hilum

A

medial and anterior

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7
Q

The tail of the pancreas is located ____ to the stomach and lesser sac as it approaches the splenic hilum

A

Posterior

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8
Q

The left kidney lies_____ and ____ to the spleen

A

Inferior, and medial

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9
Q

The pancreatic tail is located ______ to the upper pole of the left kidney in the splenic hilum

A

anterior (Ventral)

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10
Q

What are focal lesions resulting from previous infections

A

Granulomas

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11
Q

What is seen as focal bright echogenic lesions, with or without shadowing

A

Granulomas

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12
Q

What are the 2 most common causes of granulomas

A

1) histoplasmosis

2) tuberculosis

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13
Q

What 2 areas can granulomas be found

A

1) liver

2) lungs

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14
Q

Name 3 other splenic calcifacations can be associated with

A

1) splenic artery or splenic artery aneurysms
2) pneumocystis carinii infection
3) splenic infarcts

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15
Q

Name 5 examples of cystic lesions that may be found in the spleen

A

1) autosominal dominant PKD
2) hydatid cysts
3) epidermoid cysts
4) liquified infarcts of hematomas
5) pancreatic psuedocysts

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16
Q

What are true cysts lined by squamous epithelium typically averaging 10 cm in size

A

Epidermoid cyst

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17
Q

This can erode into the spleen and may weaken vessels causing psuedoaneurysms and bleeding into the pseudocyst

A

Pancreatic pseudocysts

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18
Q

What is the most common benign primary neoplasm of the spleen

A

Hemangiomas

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19
Q

What frequently metastasizes to the spleen followed by breast and lung cancer

A

Malignant melanoma

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20
Q

Splenic infarcts are common in patients with

A

1) bacterial endocarditis

2) splenic artery aneurysms

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21
Q

What presents as a peripheral wedge shaped hypoechoic lesion

A

Splenic infarcts

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22
Q

What is associated with general abdominal sepsis

A

Splenic infection

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23
Q

Sonographically, splenic abscesses are seen as

A

complex cystic lesions

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24
Q

What is associated with reverberation (comet-tail) artifact

A

Splenic abscess

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25
Q

Name 12 causes of splenomegaly

A

1) viral infections
2) bacterial infections
3) malaria
4) schistosomiasis
5) rheumatoid arthritis
6) hemolytic anemia
7) leukemia
8) lymphoma
9) portal hypertension
10) congestive heart failure
11) storage disease
12) sickle cell anemia

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26
Q

The spleen is located in the LUQ, so when it enlarges it extends into the _____, ______, and _____ direction

A

Anterior, medial, and inferior

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27
Q

What is due to alcoholic cirrhosis and is the most common cause of splenomegaly in adults

A

Portal hypertension

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28
Q

Name 2 things that are the disruption in the development of the normal asymmetric arrangement of abdominal organs and vessels

A

1) heterotaxia

2) situs ambiguous

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29
Q

What term defines the misarrangement of abdominal structures

A

Heterotaxia

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30
Q

Name the 2 classifications of heterotaxia

A

1) polysplenia

2) asplenia

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31
Q

What is defined as bilateral left-sidedness

A

Polysplenia

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32
Q

Name the 5 abnormalities polysplenia is associated with

A

1) multiple LUQ spleens
2) biliary atresia/absent gallbladder
3) intestinal malrotation
4) azygous continuation of interrupted IVC
5) cardiac defects

33
Q

What is defined as bilateral right-sidedness

A

Asplenia

34
Q

Name 5 abnormalities asplenia is associated with

A

1) absent spleen
2) midline liver and gallbladder
3) intestinal malrotation
4) reversed positions of AO and IVC
5) cardiac defects

35
Q

Name 2 thing that result when the splenic capsule remains intact

A

1) intraparenchymal

2) subscapular hematomas

36
Q

Name the 2 hematomas that result with capsule rupture

A

1) Perisplenic

2) intraperitoneal

37
Q

In a patient with a history of splenic rupture, splenic cells may implant through the peritoneal cavity resulting in an ectopic spleen. This occurrence is called

A

Post traumatic splenosis

38
Q

What is responsible for the production of antibodies

A

Lympahtic follicle

39
Q

What are capable of storing more than 300 mL of blood

A

Venous sinuses

40
Q

The highly vascular spleen receives it arterial blood from the _____ artery which is a branch of the ____ _____

A

Splenic, celiac axis

41
Q

The splenic vein unites with the ____ posterior to the neck of the pancreas to form the _____

A

SMV, hepatic portal vein

42
Q

Physiologically, what are the 4 major functions of the spleen

A

1) reserving
2) filtering
3) producing
4) defending blood products

43
Q

Name the 3 areas a sonographer much examine suggesting a splenic rupture

A

1) pelvis
2) Morrison pouch
3) flanks

44
Q

A rare malignant tumor of the spleen that consists of blood vessels is an

a) lymphoma
b) angiosarcoma
c) hemangioma
d) granuloma

A

b) angiosarcoma

45
Q

What is the most common sonographic appearance of a splenic hemangioma

a) echogenic
b) hypoechoic
c) anechoic
d) complex

A

a) echogenic

46
Q

A 32 year old female patient presents to the ultrasound department for an abdominal sonogram. An evaluation of the spleen reveals a 1 cm rounded echogenic mass that does not produce acoustic shadowing. What is the most likely diagnosis?

a) Pheochromocytoma
b) Lipoma
c) Splenic mets
d) hemangioma

A

D) hemangioma

47
Q

What is the most common malignant disease to affect the spleen

A

Lymphoma

48
Q

Most metastatic lesions found within the spleen demonstrate what

A

a bull’s eye appearance with a hypochoic halo

49
Q

What is another name for splenomas

A

Hamartomas

50
Q

The splenic artery is a branch of what

A

celiac axis

51
Q

The spleen is cresent shaped with a _____ superior lateral border and _____ medially

A

Convex, and concave

52
Q

What is the most common congenital anomaly of spleen

A

Accessory spleen

53
Q

What is a spleen in a ectopic location usually found in the pelvis called

A

Wandering spleen

54
Q

When accessory spleens are present, where are they usually located?

a) at the superior margin of the spleen
b) on the posterior aspect of the spleen
c) near the kidney
d) near the splenic hilum
e) near the left diaphragm

A

d) near the splenic hilum

55
Q

A patient in the late stages of sickle cell anemia will have a spleen that is which of the following?

a) enlarged and lobulated
b) enlarged and echogenic
c) small and hypoechoic
d) small and echogenic
e) atrophic and isoechoic

A

d) small and echogenic

56
Q

Which one of the following statements correctly describes the anatomic location of structures adjacent to the spleen

a) the diaphgram is superior, lateral, and inferior to the spleen
b) the fundus of the stomach and lesser sac are medial to the posterior to the splenic hilum
c) the left kidney lies inferior and medial to the spleen
d) the pancreas lies anterior and medial to the spleen
e) the adrenal gland is anterior, superior, and lateral to the spleen

A

c) the left kidney lies inferior and medial to the spleen

57
Q

The splenic artery

a) originates from the anterior abdominal aorta
b) lies posterior to the IVC
c) is tortuous, and courses along the superior aspect of the body and tail of the pancreas
d) is the first branch of the abdominal AO
e) courses along the posterior aspect of the body and tail of the pancreas

A

c) is tortuous, and courses along the superior aspect of the body and tail of the pancreas

58
Q

Which of the following is a representative of a post-trauma fluid collection located between the diaphragm and the spleen?

a) ascites
b) a pleural effusion
c) a subcapsular hematoma
d) a subphrenic abscess
e) retroperitoneal fibrosis

A

d) a subphrenic abscess

59
Q

Splenomegaly may be caused by all of the following except which one?

a) an inflammatory process
b) portal vein thrombosis
c) a left subphrenic abscess
d) polycythemia vera
e) chronic leukemia and lymphoma

A

c) a left subphrenic abscess

60
Q

A patient who has blunt trauma to the abdomen earlier in the day presents with LUQ pain and a decrease in hematocrit. An echogenic mass is seen in the spleen. What is this consistent with?

a) abscess
b) lymphoma
c) infection
d) hematoma
e) leukemia

A

d) hematoma

61
Q

Splenomegaly is diagnosed when the spleen is greater than how many centimeters?

a) 8 cm
b) 11 cm
c) 13 cm
d) 15 cm
e) 18 cm

A

c) 13 cm

62
Q

Which of the following infectious diseases are associated with splenomegaly

a) infective endocarditis
b) tuberculosis
c) syphilis
d) schistosomiasis
e) all of the above

A

e) all of the above

63
Q

Which of the following diseases would result in splenic atrophy (autosplenectomy)

a) infectuous mononucleosis
b) typhoid fever
c) splenitis
d) sickle cell anemia
e) HIV

A

d) sickle cell anemia

64
Q

All of the following are functions of the spleen except:

a) production of plasma cells
b) production of lymphocytes
c) destruction of red blood cells
d) destruction of white blood cells
e) all of the above

A

b) production of lymphocytes

65
Q

Splenomegaly can be encountered in

a) chronic myelogenous leukemia
b) portal hypertension
c) sickle-cell disease
d) A and B

A

d) A and B

66
Q

A wedge-shaped lesion within the spleen is associated with

a) sickle-cell disease
b) lymphoma
c) splenic infarct
d) splenic artery aneurysm
e) leukemia

A

c) splenic infarct

67
Q

Which of the following is not associated with splenic trauma

a) decreasing hematocrit
b) perisplenic fluid collection
c) subcapsular fluid collection
d) pelvic fluid collection
e) perinephric fluid collection

A

e) perinephric fluid collection

68
Q

Which of the following is not a cause of splenomegaly

a) lymphoma
b) portal hypertension
c) pancreatitis
d) mononucleosis
e) cirrhosis

A

c) pancreatitis

69
Q

Splenic rupture with an intraperitoneal hematoma may present as

a) anechoic fluid surrounding the spleen
b) isoechoic clot mimicing splenic parenchyma
c) an irregularly marginated echogenic mass
d) depends on the timing of the trauma and when the patient was scanned due to the organization and reliquifaction of blood

A

d) depends on the timing of the trauma and when the patient was scanned due to the organization and reliquifaction of blood

70
Q

Which of the following is responsible for extramedullary hematopoiesis

a) kidneys
b) thyroid
c) spleen
d) gallbladder

A

c) spleen

71
Q

A retrorenal spleen is an important consideration when planning

a) a left renal biopsy
b) treatment for portal hypertension
c) AAA repair
d) the point of entry for a paracentesis

A

a) a left renal biopsy

72
Q

Retrograde flow in the splenic artery would most likely indicate

a) left gastric artery occlusion
b) chronic systemic HTN
c) celiac axis occlusion
d) mild portal HTN

A

c) celiac axis occlusion

73
Q

Why does the spleen have an increased risk of infarction compared to the other abdominal organs

a) because it is non-encapusulated
b) because intrasplenic arteries do not have communicating branches
c) because there is only one intrasplenic artery
d) because the small size of the splenic vein and increased risk of stasis thrombosis

A

b) because intrasplenic arteries do not have communicating branches

74
Q

Which of the following is associated with an autosplenectomy

a) splenic hamartoma
b) splenic lymphoma
c) wandering spleen
d) sickle cell anemia

A

d) sickle cell anemia

75
Q

Which of the following patients would most likely demonstrate a 10 cm spleen with homogeneous echotexture

a) 65 year old female with mononucleosis
b) 5”10” 250Ib male born with homozygous sickle cell anemia
c) 30 year old female with lymphoma
d) 50 year old male with a splenic artery aneurysm

A

b) 5”10” 250Ib male born with homozygous sickle cell anemia

76
Q

A splenic _______ is a cartilaginous tumor

a) hamartoma
b) osteoma
c) chondroma
d) fibroma

A

c) chondroma

77
Q

Which of the following is a common cause of splenic abscess

a) endocarditis
b) portal HTN
c) Gaucher disease
d) Cholecystitis

A

a) endocarditis

78
Q

Which of the following correctly describes angiosarcoma of the spleen

a) very responsive to chemotherapy with good prognosis
b) most common primary malignancy of the spleen
c) usually presents as a homogeneous hyperechoic mass near the periphery of the spleen
d) arises from the vascular endothelium and demonstrates increased vascularity

A

d) arises from the vascular endothelium and demonstrates increased vascularity

79
Q

Congestive splenomegaly is an expected finding in patients with

a) autosomal dominant polycystic kidney disease
b) multicystic kidney disease
c) lymphoma and leukemia
d) congestive heart failure and splenic thrombosis

A

d) congestive heart failure and splenic thrombosis

ARDMS Abdominal Review (14 decks)

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