Spleen Patho & Lymphatic Flashcards
What is wandering spleen?
abnormal migration during developmental stages of embryology
Where is the spleen located with wandering spleen?
outside of the normal LUQ, somewhere in abd/pelvis
What are the S&S of wandering spleen?
asymptomatic, tenderness, possible torsion
What is the sono appearance of wandering spleen?
abdominal/pelvic mass, decreased color flow in complete torsioin
What is splenic agenesis?
complete embryologic absence of spleen, occurring with addl congenital abnormalities
What is splenic agenesis AKA?
asplenia
What are S&S of splenic agenesis?
increased risk of infectious disease
What is accessory spleen?
collection of splenic tissue separate from the spleen
How many people have splenule(s)?
30%
What are S&S of accessory spleen?
asymptomatic, palp lump depending on size/location
What is the sono app of accessory spleen?
homogenous, iso to spleen, near hilum or sup border
What is splenic atrophy?
decrease in splenic tissue volume, technically benign but assoc with wasting diseases
What are S&S of autosplenectomy?
asymptomatic, symptoms assoc with causative disease
What is the sono app of splenic atrophy?
small spleen or not visualized due to lack of tissue
What are S&S of splenomegaly?
infectious patients, metabolic disturbances, hematopoietic disorders
What is the sono app of splenomegaly?
changes in size, texture, vascularity, increased volume
What is amyloidosis?
excessive production of amyloid proteins in organs, most commonly the spleen
What are S&S of amyloidosis?
- systemic diseases
- fatigue, weakness
- joint pain
- weight loss
- skin changes
What is the sono app of amyloidosis?
enlarged, size depends on amount of build-up
What is Gaucher’s disease?
rare metabolic disorder, abnormal accumulation of specific lipid cells in specific organs
Where does Gaucher’s disease mostly affect?
liver and spleen
Who is affected by Gaucher’s disease?
all ages
50% younger than 8
17% younger than 1
What is the sono app of Gaucher’s disease?
splenomegaly, heterogenous spleen, multiple hyperechoic nodules
What is Neimann-Pick disease?
metabolic disorder that causes inability to metabolize lipid cells, cells malfunction = apoptosis
Who is affected by Neimann-Pick disease?
hepatomegaly, lymphadenopathy, digestive complications
What are S&S of sickle cell anemia?
- fatigue, weakness
- infections
- joint pain
- dizziness
What is the sono app of sickle cell anemia?
early: enlarged spleen
late: infarction, fibrosis, atrophy
What is hemolytic anemia?
inadequate healthy RBC, decreased lifespan of erythrocytes
What is autoimmune hemolytic anemia?
caused by autoimmune response or disease
What do primary and secondary autoimmune hemolytic anemia refer to?
primary: without disease
secondary: with disease
What are some causes of autoimmune hemolytic anemia?
lymphoma, leukemia, infectious mono
How large are splenules typically?
< 1 cm
The spleen should be under ____ cm long
12
What percentage of African Americans have sickle cell anemia?
8%
What is the sono app of autoimmune hemolytic anemia?
splenomegaly
What is polycythemia vera?
excess RBC, unknown cause that involves all bone marrow elements
What are S&S of polycythemia vera?
- weakness, fatigue
- vertigo, tinnitus
- irritability
- erythema, painful extremities, contusions
What is polycythemia vera?
splenomegaly, infarction, thrombosis
What is thalassemia?
inadequate amount of hemoglobin leading to anemia, causes destruction of RBC
What is the sono app of splenic infarction?
hypoechoic triangles in the spleen
How do you get thalassemia?
inherited
What is the sono app of thalassemia?
splenomegaly
What are S&S of mono?
- tenderness/swelling in LUQ
- swollen lymph nodes
- fever
- sore throat
What is FAST exam?
focused assessment with sonography for trauma
What needs to be checked during FAST exam?
- 4 quads
- morisons pouch
- subdiaphragm
- liver/splenic capsules
- bladder/rectal regions
What are S&S of trauma?
decreased hematocrit and shock
What is being evaluated during a trauma exam?
looking for hemorrhage or free fluid
Who is at increased risk of splenic abscess?
- drug use
- endocarditis
- decreased immunity
- trauma
What is the sono app of splenic abscess?
- focal collection of purulent material within parenchyma
- target appearance
- splenomegaly
What is splenic infarction?
death of focal splenic tissue, can affect segment or entire organ
What is splenic infarction the most common cause of?
focal splenic lesions
What causes infarction?
occlusion of splenic artery/branches
Who is likely to experience splenic infarction?
Pts with
- pancreatitis
- leukemia
- lymph disorders
- SCA
What is the sono app of infarction?
acute: hypoechoic wedge
chronic: echogenic wedge
What is splenic hemangioma?
proliferation of vascular channels, cluster of blood vessels
What is the most common benign splenic tumor?
hemangioma
What is the sono app of hemangioma?
- isolated
- heterogenous echogenic mass w multiple sm hypo areas
What causes heterogeneity of a hemangioma?
areas of cystic changes or hemorrhage
What is hemangiosarcoma?
rare malignant neoplasm rising from vascular endothelium of spleen
What are S&S of hemangiosarcoma?
- weakness, fatigue
- loss of appetite, weight loss
- tumor rupture, hemorrhage
What is the sono app of hemangiosarcoma?
cystic/solid components, hyperechoic
What is hamartoma?
abnormal mixture of cells and tissues, mainly lymphoid tissues
Is hamartoma benign?
yes
What is the sono app of hamartoma?
cystic/solid components, iso/hyper echoic
What is lymphangioma?
malformation of lymphatics, consists of cystic spaces varying in size, may involve other organs
Is lymphangioma benign?
yes
What are S&S of lymphangioma?
asymptomatic and possible tenderness in spleen, variable symptoms depending on addl organs
What is the sono app of lymphangioma?
multiple cysts, solitary or grouped
How does lymphoma affect the spleen?
spleen is most commonly involved organ, MC Hodgkin’s & Non-Hodgkin’s
What is the sono app of lymphoma in spleen?
- difficult to visualize
- focal or diffuse lesions
- possible splenomegaly
What is the sono app of AIDS lymphoma?
uniform decreased echogenicity or focal hypoechoic lesions
How does cancer spread to the spleen?
hematogenous spread (through blood supply)
How common are mets to the spleen?
10th MC site of mets
What is the sono app of mets to the spleen?
- multiple or solitary
- nodularity
- diffuse lesions
- target or halo lesions
What is the immune system?
network of tissues and organs that work together to fight off bacteria, infections, viruses, toxins
What is the difference between lymphatic and immune systems?
lymphatic system is part of the immune system
What is the thymus?
Where lymphocytes mature, lymphatic
What are the tonsils/adenoids?
filters bacteria entering mouth/nose, immune
What are lymph nodes?
distribute WBCs and filter lymph fluid
What does the spleen do?
controls amount of RBCs, produces WBCs, lymphatic
What does bone marrow do?
produces RBCs, platelets, WBCs, lymphatic
Where are mucous membranes located?
nose, throat, bladder, genitals
What is the lymphatic system?
Collects and filters excess fluid and returns it back to bloodstream, vital to immune defense
Once fluid is absorbed into lymph ducts, it is known as
lymph fluid
What is the lymphatic system made up of?
- lymph nodes
- lymphatic vessels
- lymphatic ducts
- lymph fluid
What are lymph vessels?
thin walled vessels that transport lymph fluid around different parts of the body
What do afferent lymph vessels do?
Bring lymph into lymph node
What do efferent lymph vessels do?
Drain processed lymph from lymph node and back into lymph vessels
What kind of tubes are lymph ducts?
Blind ended or non-continuous
What direction is lymph fluid transported? How is this ensured?
proximally (up the body), valves in the vessels keep fluid moving proximally
How is lymph fluid transported?
lymph ducts, lymph vessels, lymph nodes, lymph vessels, venous system
What is lymph fluid?
clear, colorless fluid
contains proteins, minerals, nutrients, damaged cells, cancer cells, foreign particles
When is lymph fluid produced?
When fluid leaves the capillary bed in tissues due to hydrostatic pressure
What percentage of blood volume becomes lymph?
~ 10%
What are lymph nodes?
small bean shaped glands
Where are lymph nodes located?
Along lymphatic system throughout body
MC seen on US in axilla, groin, submandib region
What do lymph nodes contain?
WBCs used to fight infection while filtering lymph fluid
What is the composition of a lymph node?
- hilum
- medulla
- cortex (hypo border)
- surrounded by fibrous capsule
What are lymph nodes located closely called?
Lymph node chain
How many lymph nodes are in the body? Where are they largest?
600 lymph nodes, largest in axilla, inguinal region, submandib
What is the sono app of a normal lymph node?
- hypoechoic to surrounding muscle
- echogenic fatty hilum
- smooth borders
- central hilar vascularity
How thick should the cortex of a normal lymph node be?
3 mm max, measure anterior cortex
What is compartment 1A?
submental nodes (anteromedial)
What is compartment 1B?
submandibular nodes (posterolateral)
What is compartment 2A? 2B?
anterior to IJV, posterior to IJV
What is compartment 3?
from hyoid bone to cricoid cartilage
What is compartment 4?
from cricoid cartilage to clavicle
What is compartment 5A? 5B?
superior to cricoid cartilage, inf to cricoid cartilage
What is compartment 6?
from hyoid bone to sternal notch
What are malignant characteristics of lymph nodes?
- enlarged
- round
- mostly hypoechoic
- loss of hilum
- heterogenous
- thickened cortex
- microcalcs
- cystic components
- ill defined borders
- hypervascular, peripheral flow
What should you do when documenting a lymph node in the neck?
Document the palp node and take images of bilateral cervical node chain
What should you do when documenting a lymph node in the axilla?
Document palp node and show other surrounding nodes, # of nodes in axilla
