that which is not necessary Flashcards by エリシモン

what is the most common splenic pathology

splenomegaly

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what is the most common reason for splenomegaly

portal HTN

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other causes for splenomegaly

blood disorders
lymphoma
leukemia
viral infection
chronic inflammatory diseases

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what is more common in spleen than in the liver

abscesses
infarcts
hematomas
calcifications

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what is the most common malignancy of the spleen

lymphoma

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what is more common in the liver than in the spleen

focal lesions, mets and cysts are more common in the liver

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post traumatic autottransplantation of splenic tissue

splenosis

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ptosis of enlarged spleen (uncommon)

wandering spleen

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congenital association with heterotaxy

polysplenia

asplenia

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what is often seen with dominant LEFT sided features

polysplenia

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what absence might you expect with polysplenia

absence of prox IVC

absence of GB

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dominant RIGHT sided features, would expect what abnormality involving the spleen

asplenia (no spleen)

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what deformity of the great vessels would you expect with the presence of congenital asplenia

IVC and Ao on same side of the spine (RIGHT)

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what are the functions of the spleen

phagocytosis

lymphopoiesis

immune response

RBC storage

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what is the cellular structure of the splenic tissue

red and white pulp supporting stroma

surrounding capsule

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relationship to peritoneum

intraperitoneal

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what is considered big for spleen

> /= 12 cm

> 200cc

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echogenicity in comparison to the liver

echogenic

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likely dx with palpable spleen, +/- LUQ pain and +/- satiety

diffuse splenomegaly

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portal HTN aka

splenic congestion

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what else are you going to look for when you find splenomegaly in association with portal HTN

splenic hilar varices

splenorenal varices

other collaterals (coronary v, recanalized paraumb, GE varices)

size of MPV (>/= 1cm)

portal flow direciton

ascites

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what is the normal direction of portal flow

hepatopetal

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what is the normal direction of splenic vein

hepatopetal

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hematologic causes of splenomegaly

polycythemia vera

sickle cell anemia

myelofibrosis

thrombotic thrombocytopenia purpura

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neoplastic causes of splenomegaly

leukemia lymphoma

infectious causes of splenomegaly

histoplasmosis mononucleosis AIDS

chronic inflammatory causes of splenomegaly

sarcoidosis malaria TB

congestive causes of splenomegaly

portal HTN

MD feels palpable spleen but it's a normal friend on u/s - what is this called? what are you going to do?

pseudosplenomegaly look for reasons it might be displaced inferiorly **LLL enlargement **LT subphrenic mass **LT PE **cardiomegaly

types of benign neoplasms of the spleen

hemangioma hamartoma lymphangioma **solid, echogenic

1/3 of __ malignancies have splenic involvement

lymphoma

sono feature of primary malignant lesion of the spleen

focal, solid and hypoechoic diffuse splenomegaly spleen may look normal

what is the name of the fancy scan that can localize metabolically active tissue (used for tumour imaging)

PET with FDG **positron emission tomography with fluorodeoxyglucose

primary cancers associated with the rare occurence of splenic mets

GI HCC ovarian

if you see mets in the spleen, where else do you expect to see mets?

liver lungs adrenal **very rare to be isolated

sono feature of mets

focal, solid nodule hyper or hypoechoic single or multiple sometimes demonstrate 'bullseye' or thick capsule

causes for splenic cysts

post trauma pancreatic pseudocysts hydatid congenital **uncommon +/- fluid levels +/- wall calc +/- internal echoes

congenital cysts aka

true cysts rare in the spleen

hydatid cyst aka

echinococcus granulosus

sono features of hydatic cysts

daughter cysts 'water lily' sign calcified rim low level echoes ('hydatid sand') **use hx

collection of pus typically due to a bacterial infection

abscess **can be fungal, amebic

what demographic are you most likely see abscess in spleen

hospitalized pt **hematogenous spread

if you see a bullseye sign in a spleen, what should you think of first

abscess more common than mets in spleen and can demonstrate this appearance **should be avascular

small echogenic foci seen within the spleen

granulomas

sono features of granulomas

+/- shadowing often multiple pt typically well and asymptomatic old tuberculosis or histoplasmosis

what are the two types of infarcts

segmental total

where is the most likely area for splenic infarcts

peripheral

causes of segmental splenic infarcts

septic emboli local arterial thrombosis

sono feature of a segmental infarct

wedge-shaped peripheral lesion hypoechoic = recent hyperechoic = chronic

causes of total splenic infarction

splenic vein thrombosis **pancreatitis; panc cancer splenic artery thrombosis **usually pt is already hospitalized

what is more common, a venous thrombosus or an arterial thrombus

venous

sono features of total splenic infarct

normal or enlarged spleen +/- heterogeneous no perfusion of spleen ***use power Doppler to assess

__ sign is acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity. **demonstrated in the LEFT is highly suggestive of ____

Kehr's sign suggestive of splenic rupture

focal areas of siderosis (iron deposition) that may occur due to portal HTN

gamna gandy bodies

sono feature of gamna gandy bodies

appear as punctate echogenic foci (indistinguishable form granuloma)

what causes increased incidence of splenic artery calcification

age DM

why do you put Doppler on a thrombus?

to rule out tumour thrombus

what are the 2 criteria to help determine wandering spleen

congenitally extra long and mobile mesentery splenomegaly

situs solitus aka

normal situs

situs inversus totalis aka

mirror image of situs solitus

situs ambiguous aka

HETEROTAXY left atrial isomerism (dominant left) or right atrial isomerism (dominant right)

2 left atria, 2 bilobed lungs, polysplenia, and absence of GB

left atrial isomerism

2 right atria, 2 trilobed lungs, asplenia, ML liver, IVC and Ao on same side of spine

right atrial isomerism

which atrial isomerism (heterotaxy) is associated with increased incidence of anomalies

right atrial isomerism *increase risk of heart problems, infections, etc.

how does the spleen filter blood

phagocytosis performed by macrophages

what is the breakdown product from RBCs

bilirubin is produced from breakdown and sent to liver to be excreted in bile

what stores the RBCs, platelets and plasma

red pulp in spleen 1/4 L

what stores WBCs

white pulp 25% of lymphocytes in body (B and T cells)

why is the spleen important for immune system

makes antibodies B cells in white pulp activated by antigens; resulting in release of specific antibodies