Spleen Pathology power point

Question 1

}May be classified as parasitic or nonparasitic in origin
}Most are secondary cysts caused by trauma, infection, or infarction.

Answer 1

Splenic Cysts

Question 2

}appear as anechoic lesions with possible daughter cysts and calcification or as solid masses with fine internal echoes and poor distal enhancement.

Answer 2

Parasitic cysts

Question 3

is the only parasite that forms splenic cysts; it is uncommon in the United States.

Answer 3

Echinococcus

Question 4

cysts
are found in the spleen

Answer 4

Cysts associated with polycystic disease

Question 5

are similar to those found in the liver and can be distinguished by their intracystic contents such as daughter cysts

Answer 5

Hydatid cysts

Question 6

True cysts. Solitary and average 10 cm in size. Wall may appear calcified and internal contents may appear echogenic due to cholesterol crystals

Answer 6

Epidermoid cysts

Question 7

represent old infarcts or hematomas.

Answer 7

Most asymptomatic cysts

Question 8

}Asymptomatic
}LUQ pain can occur with hemorrhage

Answer 8

Clinical findings of simple splenic cysts

Question 9

}Thin walled
}Anechoic mass
}Posterior acoustic enhancement
}However…… in the spleen, they can appear complex, esp if associated with trauma

Answer 9

Sonographic findings of simple splenic cysts

Question 10

}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.

Answer 10

Focal Disease

Question 11

}Tissue that has deprived of oxygen will die
}Clinical findings will be sudden onset of LUQ pain

Answer 11

Splenic infarction

Question 12

§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

Answer 12

Splenic Infarction causes

Question 13

◦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.

Answer 13

Splenic Infarction
}Sonographic findings

Question 14

; may be benign or malignant

Answer 14

Primary splenic tumors are rare

Question 15

◦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

Answer 15

}Benign primary tumors

Question 16

}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

Answer 16

Cavernous hemangioma

Question 17

}Consists of lymphoid tissue
}May be multiple or solitary
}Well defined
}Echogenic
}Not encapsulated

Answer 17

Hamartoma

Question 18

◦Appears as a mass with extensive cystic replacement
of splenic parenchyma
Splenic involvement is rare; however, when it occurs, a multicystic appearance is characteristic

Answer 18

Cystic Lymphangioma Sonographic findings

Question 19

}Hemangiosarcoma/Angiosarcoma
}Arises from the vascular endothelium
}Sonographically complex or solid

Answer 19

Malignant Primary Neoplasms

Question 20

}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

Answer 20

Malignant processes that can cause focal disease in the spleen

Question 21

}Epstein-Barr infection associated with mononucleosis will cause splenomegaly
}Sickle cell anemia will cause splenomegaly

Answer 21

Pediatric pathology of the spleen

Question 22

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

Answer 22

Sickle cell

Question 23

}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.

Answer 23

Splenic Trauma

Question 24

}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.

Answer 24

Splenic Trauma causes

Question 25

}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

Answer 25

Splenic Trauma symptoms

Question 26

}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

Answer 26

Metastases

Question 27

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.

Answer 27

Histoplasmosis

Question 28

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

Answer 28

Splenic Calcifications

}Granulomas

Question 29

}Most common manifestation of splenic disease.
}Congestive splenomegaly: Heart failure, portal hypertension
}Neoplasm
}Storage Diseases: diabetes mellitus
}Infection: Mononucleosis
}Hemolytic anemia

Answer 29

Splenomegaly

Question 30

◦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

Answer 30

Splenomegaly
}Sonographic evaluation

Question 31

}Congestion
}Neoplasm
}Storage disease
}Infection
}Hemolytic anemia
}Extramedullary hematopoiesis
}Collagen-vascular disease
}Trauma
}Portal hypertension

Answer 31

Causes of Splenomegaly

Question 32

The tip of the spleen covers the lower pole of the kidney in patients with splenomegaly

Answer 32

Patterns of Splenomegaly

Question 33

Color Doppler shows dilated splenic vessels that may be seen with portal hypertension.

Answer 33

Congestion of the Spleen

Question 34

}Heart failure
}Portal hypertension
}Cirrhosis
}Cystic fibrosis
}Portal or splenic vein thrombosis
}Acute splenic sequestration crisis of sickle cell disease

Answer 34

Causes of Congestive Splenomegaly

Question 35

}Chronic disease of unknown cause that involves all bone marrow elements
}Characterized by an increase in red blood cell mass and hemoglobin concentration

◦

Answer 35

Polycythemia Vera

Question 36

Weakness and fatigue
◦Vertigo
◦Tinnitus
◦Irritability
◦Splenomegaly

◦Flushing of the face
◦Redness and pain in the extremities
◦Blue-and-black spots

Answer 36

Polycythemia Vera Clinical symptoms

Question 37

◦Spleen is variably enlarged, rather firm, and blue-red.
Infarctions and thromboses are common

Answer 37

Polycythemia Vera
}Sonographic findings