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KB-GI radiology > Spleen > Flashcards

Spleen Flashcards

1
Q

Spleen trivia:

  1. At what age does the spleen reach normal adult size?
  2. In HU, how does the spleen differ from liver?
  3. Most splenic lesions are benign except for these 3…
  4. Splenic appearance on MR.
  5. Most common cystic lesion?
    1. Most common benign neoplasm?
    2. Most common malignant tumour?
  6. Most common cause of splenomegaly?
A
  1. 15 yrs.
  2. Spleen 20 HU < liver.
  3. Malignant splenic lesions:
    1. Lymphoma
    2. Angiosarcoma
    3. Mets
  4. T1 dark relative to liver; T2 bright; restricts diffusion, just like a big lymph node.
  5. Post-traumatic cyst.
    1. Hemangioma.
    2. Lymphoma.
  6. Congestive: PHTN, heart failure.
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2
Q

Congenital splenic variants/anomalies: splenule/accessory spleens:

  1. What nucs exam can differentiate these from an enlarged pathologic LN?
  2. What can happen to one of these post-splenectomy?
  3. What % of pts w/accessory spleens have intrapancreatic accessory spleens?
A
  1. Tc-99m sulfur colloid.
  2. They can enlarge and then the original hematologic disease process can recur in it, e.g., ITP or autoimmune hemolytic anemia.
  3. ~17%
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3
Q

Congenital splenic variants/anomalies: splenosis:

  1. When does this occur?
    1. Rare occurrence w/a specific type of trauma.
  2. How does splenosis differ from polysplenia or accessory spleens (splenunculi)?
  3. Typical location?
  4. What % of traumas have these?
  5. How to Dx?
A
  1. Post-trauma, or post-splenectomy, a smashed spleen auto-implants then recruits blood supply.
    1. Thoracic splenosis: rare, but occurs following blunt trauma causing splenic injury + L hemidiaphragmatic rupture (see below).
  2. This is not congenital and does not retain arterial supply from the splenic artery. This is also not composed of normal splenic tissue.
  3. LUQ.
  4. 40-60%.
  5. Tc-99m sulfur colloid: as long as the deposit is at least 2cm diameter, or Tc-99m heat-damaged RBC (gold standard).
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4
Q

Congenital splenic variants/anomalies: wandering spleen

  1. What is this associated with?
  2. What can the unusual location of a wandering spleen lead to?
  3. What can happen if there is a chronic, partial torsion?
A
  1. Intestinal rotation abnormalities.
  2. Torsion & infarction.
  3. Splenomegaly +/- gastric varices.
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5
Q

Benign non-cystic splenic lesions: hemangioma

  1. What is its notoriety?
  2. Ix app?
  3. Does it have the classic look of a hepatic hemangioma?
A
  1. It’s the most common benign splenic neoplasm.
  2. Well-marginated, smooth, enhances w/delayed washout.
  3. Not necessarily, & especially if <2cm.
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6
Q

Benign non-cystic splenic lesions: hamartoma

  1. Commonality?
  2. Ix?
  3. When will they be hyperdense?
A
  1. Rare.
  2. Hypo or iso w/hetero enhancement.
  3. Will be hyperdense if they contain hemosiderin.
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7
Q

DDx cystic splenic lesions (mnemonic):

A

TEAM:

  1. traumatic
  2. echinococcal
  3. abscess
  4. mets
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8
Q

Benign cystic splenic lesions: post-traumatic pseudocyst:

  1. Notoriety.
  2. Causes-5.
  3. Real cysts or pseudo? Why?
  4. Typical features.
A
  1. Most common splenic cystic lesion (80%).
  2. Trauma, infarction, infection, hemorrhage, extension from pancreatic pseudocyst.
  3. Pseudocysts as they have no lining epithelium.
  4. Hypo-attenuating, thick-walled +/- peripheral calcs.
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9
Q

Benign cystic splenic lesions: congenital true, primary (aka epithelial, epidermoid) cyst:

  1. Notoriety.
  2. Origin?
  3. Lining cells?
  4. Typical size?
  5. Solitary/multifocal?
  6. Typical app.
A
  1. 2nd most common splenic cystic lesion after post-traumatic cyst.
  2. Congenital.
  3. Epithelial, so these are true cysts.
  4. >10cm usually.
  5. Usually solitary.
  6. Unilocular fluid, w/thin/smooth walls & no enhancement.
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10
Q

Benign cystic splenic lesions: lymphangioma

  1. Commonality?
  2. Demographic?
  3. Path? Cyst wall cells.
  4. Solitary/multiple?
  5. Typical app, location?
A
  1. Rare.
  2. Kids–rarely reported in adults.
  3. Abnormal dilation of lymphatic channels. Endothelial.
  4. Typically solitary, but if diffuse can be 2dry to lymphangiomatosis.
  5. Lobulated, multiloculated (but can be unilocular), peripheral lesions w/o solid component or significant enhancement.
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11
Q

Benign cystic splenic lesions: peliosis

  1. Common?
  2. Path?
  3. In what organ does this usually occur?
    1. If you see it in the spleen where else will it be?
    2. Is it commonly isolated to the spleen?
  4. 5 RFs.
  5. Sequela & imaging finding?
A
  1. Rare.
  2. Multiple blood-filled cyst-like spacees.
  3. Liver.
    1. If it’s in the spleen it’ll be in the liver as well.
    2. It’s never in the spleen, alone.
  4. RFs:
    1. women on OCPs
    2. men on anabolic steroids
    3. AIDS pts
    4. renal xplant pts: up to 20%
    5. Hodgkin lymphoma pts
  5. Hemorrhage, large volume hemoperitoneum.
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12
Q

Benign cystic splenic lesions: Littoral cell angioma

  1. Path.
  2. Clinical associations-2
  3. Typical app:
    1. US
    2. CT
    3. MR
A
  1. Benign 1° vascular tumour; Littoral cells line the sinusoids of red pulp, hence they’re vascular.
  2. Crohn’s, hypersplenism.
    1. US: bright masses.
    2. CT: splenomegaly + multiple hypoattenuating (late PV phase) nodules.
    3. MR: T1/T2 dark from hemosiderin
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13
Q

Inflammatory splenic lesions: sarcoidosis

  1. In what % of sarcoid pts is the spleen involved?
  2. What is the sole sign, usually?
    1. What is an alternate appearance & why does this occur?
  3. Rarely, what is the sequela?
  4. What is the most common site of sarcoidosis in the GI tract?
    1. What can this cause?
A
  1. The majority: 50-80%.
  2. Splenomegaly.
    1. Hypodense nodules, 1-2cm, when aggregates of granulomatous tissue congregate in the spleen.
  3. Splenomegaly & hemorrhage.
  4. Gastric antrum.
    1. Gastric outlet obstruction.
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14
Q

Splenic infection: general:

  1. In an immunocompetent pt, what kind of bug causes an abscess?
    1. What is the classic bug?
    2. In what 2 settings does this develop?
  2. In an immunecompomised pt, what are the 4 classic bugs?
    1. Typical Ix app?
    2. What US app do fungal infections have?
A
  1. Aerobic bacteria
    1. Salmonella
    2. In the setting of splenic damage, i.e., trauma or sickle cell (recall that sickle cell pts get a lot of Salmonella).
  2. Fungal, TB, MAI (mycobacterium avium-intracellulare), PCP.
    1. Multiple small micro-abscesses.
    2. Targetoid.
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15
Q

Splenic infection calcifications:

  1. What is the most commonly detected splenic infection?
    1. Appearance?
    2. What bug shows a similar appearance but much less common in the US?
  2. What is another common cause of calcified splenic lesions, and appearance?
A
  1. Histoplasmosis.
    1. Multiple round calcs.
    2. TB.
  2. Brucellosis.
    1. Solitary, 2cm or larger. May have a low density centre, encircled by calcification, showing a “bulls eye” appearance (see below).
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16
Q

Malignant splenic lesions: angiosarcoma

  1. ​Commonality?
  2. RF
  3. App: CT.
  4. Sequela.
  5. Prognosis?
A
  1. Rare but the most common primary malignant splenic mass.
  2. RF: thorotrast.
  3. CT: large, necrotic, poor contrast enhancement.
  4. 30% spontaneously rupture.
  5. Aggressive w/poor prognosis.
17
Q

Malignant splenic lesions: splenic lymphoma:

  1. Commonality?
  2. Most common Ix finding.
  3. Patterns in Hodgkins vs. NHL.
  4. Ix:
    1. CT
    2. MR
    3. PET
A
  1. Most common non-primary splenic malignancy.
  2. Splenomegaly–often there will be no nodules.
  3. Patterns:
    1. Hodgkins: have nodules.
    2. NHL: have non-nodules.
  4. Ix:
    1. CT: splenomegaly or low density nodules.
    2. MR: T1 dark.
    3. PET hot.
18
Q

Malignant splenic lesions: splenic mets:

  1. The most common splenic met?
    1. Typical app?
  2. Other common splenic mets.
A
  1. Melanoma.
    1. Low attenuation, almost like a cyst.
  2. The most common mets: breast, lung.
19
Q

Miscellaneous splenic lesions: splenic artery aneurysm:

  1. Notoriety?
  2. In what 2 cases can pseudoaneurysm occur?
  3. In what pop is incidence higher?
    1. 2 details regarding the above pop.
  4. At what size are they repaired?
A
  1. The most common visceral arterial aneurysm.
  2. Trauma, pancreatitis.
  3. Women who have had >=2 pregnancies.
    1. They are 4x more likely to get them, 3x more likely to rupture.
  4. 2-3cm.
20
Q

Miscellaneous splenic lesions: splenic vein thrombosis:

  1. 3 RFs.
  2. What can this lead to?
A
  1. Pancreatitis, diverticulitis, Crohn’s.
  2. Isolated gastric varices.
21
Q

Miscellaneous splenic lesions: splenic infarct:

  1. What is the classic cause (on MCQ exams)?
  2. Classic Ix finding?
  3. 2 RFs?
    1. For one of them, when do infarcts often occur?
A
  1. Sickle cell.
  2. Peripheral, wedge-shaped, low attenuation lesion, often multifocal.
  3. Cardiac souces of emboli; splenomegaly.
    1. Splenomegaly + hypotension.
22
Q

Miscellaneous splenic lesions: gamna-gandy bodies

  1. Pathologically, what are these?
  2. What clinical association?
  3. MR appearance?
    1. Which MR sequence is most sensitive?
A
  1. Siderotic nodules, i.e., small hemorrhagic foci.
  2. PHTN.
  3. T2 dark.
    1. GRE for susceptibility.
23
Q

Overview of splenic trauma:

  1. In what phase is a trauma scan done & why?
A
  1. PV phase (70 sec) as it is impossible to tell if the tiger-striped arterial phase spleen is lacerated.
24
Q

DDx small spleen

A
  1. Sickle cell: small, calcified; auto-splenectomy (see below).
  2. Post-radiation
  3. Post-Thorotrast: causes cholangio too
  4. Malabsorption syndromes: UC > Crohns.
25
Q

DDx: splenomegaly

A
  1. Passive congestion: PHTN, heart failure, splenic vein thrombosis.
  2. Lymphoma
  3. Leukemia
  4. Gauchers
  5. Sarcoid: more common in women & w/respiratory complaints.
  6. Myelofibrosis
26
Q

What is the best test to confirm the etiology of this lesion?

A
  • Heat-damaged RBC scintiscan.
    • This is the most specific modality for the diagnosis.
  • This is an intra-pancreatic accessory spleen.
  • This would be FDG avid on PET but could be confused w/tumour.

KB-GI radiology (11 decks)

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