Spleen Pathology power point Flashcards
}May be classified as parasitic or nonparasitic in origin
}Most are secondary cysts caused by trauma, infection, or infarction.
Splenic Cysts
}appear as anechoic lesions with possible daughter cysts and calcification or as solid masses with fine internal echoes and poor distal enhancement.
Parasitic cysts
is the only parasite that forms splenic cysts; it is uncommon in the United States.
Echinococcus
cysts
are found in the spleen
Cysts associated with polycystic disease
are similar to those found in the liver and can be distinguished by their intracystic contents such as daughter cysts
Hydatid cysts
True cysts. Solitary and average 10 cm in size. Wall may appear calcified and internal contents may appear echogenic due to cholesterol crystals
Epidermoid cysts
represent old infarcts or hematomas.
Most asymptomatic cysts
}Asymptomatic
}LUQ pain can occur with hemorrhage
Clinical findings of simple splenic cysts
}Thin walled
}Anechoic mass
}Posterior acoustic enhancement
}However…… in the spleen, they can appear complex, esp if associated with trauma
Sonographic findings of simple splenic cysts
}May be single or multiple
}May be found in a normal or in an enlarged spleen
}Major nontraumatic causes of focal splenic defects
◦Tumor (benign and malignant)
◦Infarction
◦Abscess
◦Cyst
}Splenic defects may be discovered incidentally, as in another imaging study, or specifically, as in the case of a splenic infarction or abscess.
Focal Disease
}Tissue that has deprived of oxygen will die
}Clinical findings will be sudden onset of LUQ pain
Splenic infarction
§Most common cause of focal splenic lesions is occlusion of the major splenic artery or any of its branches.
§Are almost always the result of emboli that arise in the heart, produced either from mural thrombi or from vegetation on the valves of the left side of the heart.
Other causes include septic emboli and local thrombosis in patients with pancreatitis, leukemia, lymphomatous disorders, sickle cell anemia, sarcoidosis, or polyarteritis nodosa
Splenic Infarction causes
◦May see localized hypoechoic area, depending on the time of onset.
◦Fresh hemorrhage has a hypoechoic appearance.
◦Healed infarctions appear as echogenic, peripheral, wedge-shaped lesions with their base toward the subcapsular surface of the spleen.
◦Infarction may become nodular or hyperechoic with time.
Splenic Infarction
}Sonographic findings
; may be benign or malignant
Primary splenic tumors are rare
◦Splenomegaly is the first indication of an abnormality.
◦Most of these tumors appear isoechoic compared with the normal splenic parenchyma.
Benign primary tumors include hamartoma, cavernous hemangioma, and cystic lymphangioma
}Benign primary tumors
}Most common benign tumor
}Clinical findings-asymptomatic, unless it becomes very large and compresses adjacent organs
}Sonographic findings-isolated, heterogenous echogenic mass with numerous hypoechoic areas within
Cavernous hemangioma
}Consists of lymphoid tissue
}May be multiple or solitary
}Well defined
}Echogenic
}Not encapsulated
Hamartoma
◦Appears as a mass with extensive cystic replacement
of splenic parenchyma
Splenic involvement is rare; however, when it occurs, a multicystic appearance is characteristic
Cystic Lymphangioma Sonographic findings
}Hemangiosarcoma/Angiosarcoma
}Arises from the vascular endothelium
}Sonographically complex or solid
Malignant Primary Neoplasms
}Lymphoma- Hodgkin and non-Hodgkin
}Differentiated is determined by the presence of Reed-Sternberg cells
}Hodgkin has these and the cure rate is very high
}Non-Hodgkin is not as easily managed and is more common than Hodgkin lymphoma
Malignant processes that can cause focal disease in the spleen
}Epstein-Barr infection associated with mononucleosis will cause splenomegaly
}Sickle cell anemia will cause splenomegaly
Pediatric pathology of the spleen
is where the RBC shape is sickle shaped instead of round. Found more often in African-American and Hispanic children of Caribbean descent in the US
Sickle cell
}Spleen more likely to be injured if preexisting splenic disease is present.
}Subcapsular hematoma: Splenic capsule remains intact.
}Perisplenic or Intraperitoneal Hematoma: Capsule ruptures.
}**Immediately after injury hematoma may resemble splenic echogenicity. Later reliquefies and becomes anechoic and easier to identify.
}Splenectomy preferred.
}Rupture of spleen associated with left pleural effusion.
Splenic Trauma
}The spleen is most commonly injured as a result of blunt abdominal trauma.
}If the patient has severe left upper quadrant pain secondary to trauma, a splenic hematoma or subcapsular hematoma should be considered.
}The tear may result in linear or stellate lacerations or capsular tears, puncture wounds from foreign bodies or rib fractures, or subcapsular hematomas.
Splenic Trauma causes
}Patient typically has left upper quadrant pain, left shoulder pain, left flank pain, or dizziness.
}May have tenderness over the left upper quadrant, hypotension, and decreased hemoglobin, which indicates a bleed.
A timely response to this emergent situation
may save the patient from having to undergo peritoneal lavage or exploratory surgery
Splenic Trauma symptoms
}are the result of a hematogenous spread from another primary site.(spread by the blood)
}The spleen is the tenth most common site of metastases, which may originate from the breast, lung, ovary, stomach, colon, kidney, or prostate, as well as from melanoma.
Metastatic tumors may be microscopic, causing no symptoms
Metastases
is an infection caused by breathing in spores of a fungus often found in bird and bat droppings. also most commonly transmitted when these spores become airborne, often during cleanup or demolition projects.
Soil contaminated by bird or bat droppings also can transmit so farmers and landscapers are at a higher risk of the disease. In the United States, most commonly occurs in the Mississippi and Ohio river valleys.
Histoplasmosis
are focal lesions resulting from previous infections (Histoplasmosis or Tuberculosis are the most common cause!)
}Bright echogenic lesions with or without shadowing
}Associated with hepatic and pulmonary calcifications.
}Curvilinear calcification seen in the splenic artery or a splenic artery aneurysm are seen commonly at the splenic hilum
}Splenic calcifications are associated with pneumocystic carinii
}Calcification of splenic infarcts can occur in sickle cell disease
Splenic Calcifications
}Granulomas
}Most common manifestation of splenic disease.
}Congestive splenomegaly: Heart failure, portal hypertension
}Neoplasm
}Storage Diseases: diabetes mellitus
}Infection: Mononucleosis
}Hemolytic anemia
Splenomegaly
◦Volume measurements are needed to determine the exact size of the spleen.
◦Evaluate splenic contour and homogeneity to determine whether a disease process involves the spleen.
◦Evaluate the splenic parenchyma and vascular patterns to confirm changes in the size, texture, and vascularity.
◦The spleen may grow to enormous size with extension into the iliac fossa.
The medial segment may cross the midline of the abdomen to mimic a mass inferior to the left lobe of
the liver
Splenomegaly
}Sonographic evaluation
}Congestion
}Neoplasm
}Storage disease
}Infection
}Hemolytic anemia
}Extramedullary hematopoiesis
}Collagen-vascular disease
}Trauma
}Portal hypertension
Causes of Splenomegaly
The tip of the spleen covers the lower pole of the kidney in patients with splenomegaly
Patterns of Splenomegaly
Color Doppler shows dilated splenic vessels that may be seen with portal hypertension.
Congestion of the Spleen
}Heart failure
}Portal hypertension
}Cirrhosis
}Cystic fibrosis
}Portal or splenic vein thrombosis
}Acute splenic sequestration crisis of sickle cell disease
Causes of Congestive Splenomegaly
}Chronic disease of unknown cause that involves all bone marrow elements
}Characterized by an increase in red blood cell mass and hemoglobin concentration
◦
Polycythemia Vera
Weakness and fatigue
◦Vertigo
◦Tinnitus
◦Irritability
◦Splenomegaly
◦Flushing of the face
◦Redness and pain in the extremities
◦Blue-and-black spots
Polycythemia Vera Clinical symptoms
◦Spleen is variably enlarged, rather firm, and blue-red.
Infarctions and thromboses are common
Polycythemia Vera
}Sonographic findings
