Spleen

Question 1

Multiple targetoid/bulls eye lesions in spleen ddx

Answer 1

Mets
Lymphoma
Candida microabscess

Question 2

Whats the next step in suspected candida microabscesses with a negative sonogram?

Answer 2

MRI

Question 3

Which echinococcus presents with sharply defined cysts and daughter cysts? Which one with tiny cystic masses resembling malignancy?

Answer 3

Granulosus has daughter cysts

Multilocularis has cystic masses

Question 4

DDx for calcified splenic cystic lesion?

Answer 4

Echinococcus
Traumatic cyst
Splenic aneurysm

Question 5

Why is an echinoccocal cyst slightly higher attenuation than water?

Answer 5

Inflammatory cells and hydatid sand

Question 6

What is the differential for multiple splenic calcifications?

Answer 6

Healed granulomatous infection
Candida microabscesses
Extrapulmonary pneumocystis
Treated lymphoma
Treated mets

Question 7

How would sarcoid present in the spleen?

Answer 7

Multiple hypoattenuating lesions and/or hepatosplenomegaly

Question 8

What is the most common benign tumor in the spleen?

Answer 8

Hemangioma

Question 9

What is kasabach merrit syndrome?

Answer 9

Anemia, infarction, high output CHF, thrombocytopenia, coagulopathy

seen with large hemangiomas

Question 10

Heterogeneous mass on CT/US?

Answer 10

Hemangioma

Question 11

What are 3 associations with splenic hemangiomas

Answer 11

Klippel trenauny weber
Kasabach merrit
Portal venous hypertension

Question 12

What are the two types of splenic cyst?

Answer 12

True (with cellular lining) and false (without a cellular lining)

Question 13

What are the causes of false splenic cysts?

Answer 13

Trauma, infarction, infection

Question 14

What is a hamartoma?

Answer 14

Normal cellular elements in abnormal quantity, degree of differentiation, and/or cellular arrangment.

Question 15

What is the association with splenic hamartomas?

Answer 15

Hypersplenism

Question 16

What is an inflammatory pseudotumor?

Answer 16

Localized area of inflammatory and fibroblastic cells surrounding regions of hemorrhage and necrosis

Question 17

What is the ddx for a well circumscribed heterogeneously enhancing mass within the spleen

Answer 17

Lymphoma
Mets
Hemangioma
Inflammatory pseudotumor
Hamartoma

Question 18

What are gamma gandy bodies? how do they look on MRI?

Answer 18

Seen in cirrhosis and portal venous hypertension, these develop from prior organized hemorrhage.

Dark on T1 and T2 and bright in gradient echo

Question 19

What is the imaging progression of splenic infarct on US?

Answer 19

Acute - poorly delineated hypoechoic region

Chronic - well marginated and hyperechoic

Question 20

What is the most common malignant tumor in the spleen?

Answer 20

Lymphoma

Question 21

What are the 4 patterns of splenic lymphoma

Answer 21

homogenous enhancement
miliary involvement
multiple masses
solitary large mass

Question 22

How do melanoma mets present in the spleen?

Answer 22

Cystic necrosis with fluid centrally or a sonographic halo around the mass circumference

Question 23

What is the blood supply of the spleen

Answer 23

Splenic artery and short gastric

Question 24

Differentiate primary from secondary hemochromatosis

Answer 24

Primary will involve the pancreas and rarely involve the spleen

Secondary will involve the spleen and spare the pancreas

Question 25

What are the splenic findings with thorium dioxide exposure?

Answer 25

Hyperattenuating

can get fibrosis and atrophy

Question 26

Small densely calcified spleen suggests what disease

Answer 26

Sickle cell