Spleen

Question 1

The spleen is _____ organ located in the ___ _____ quadrant between the _____ and ______.

Answer 1

peritoneal
left upper
stomach and diaphragm

Question 2

Basic function of the spleen.

Answer 2

remove blood cells from circulation

• largest lymphoid organ, filters damaged cells, mircorganisims, and particulate matter
• and delivers antigens to the immune system

Question 3

What designates splenomegaly

Answer 3

> 12-13cm sup/inf diameter

if spleen is inferior to the lower pole of the LT kidney

Question 4

In the case of hepatomegaly or pregnancy what might be visualized?

Answer 4

left lobe may extend anterior to the spleen

Question 5

What is located on the visceral/medial surface of the spleen?

Answer 5

STO
Left kidney
pancreas
splenic flexure of the colon

Question 6

The fundus of the ____, lesser sac and pancreatic ____ are medial and _____ to the splenic hilum.

Answer 6

stomach
tail
anterior

Question 7

The tail of the pancreas is located ____ to the stomach and lesser sac as it approaches the splenic hilum.

Answer 7

posterior

Question 8

The left kidney lies _____ and _____ to the spleen.

Answer 8

inferior and medial

Question 9

The pancreatic tail is located ____ to the upper pole of the left kidney in the splenic hilum.

Answer 9

anterior (ventral)

Question 10

T/F - splenic artery should be tortuous

Answer 10

T

Question 11

Accessory spleen

Answer 11

aka splenunculi, is normal congenital ectopic splenic tissue

Question 12

What could be confused with a splenunculi?

Answer 12

enlarged lymphnodes around the spleen or a mass in the tail of the pancreas

Question 13

Accessory spleens are small rounded masses, less than ____cm in diameter and located near the ____ ____.

Answer 13

5cm

splenic hilum

Question 14

Granulomas

Answer 14

splenic calcifications, focal lesions resulting from prevous infection
-also found in the liver and lungs

Question 15

Most comon cause of granulomas

Answer 15

histoplasmosis

TB

Question 16

Sono appearance of granulomas

Answer 16

focal bright echogenic lesions, with or without shadowing

Question 17

Splenic calcs can be associated with:

Answer 17

splenic artery wall calc
splenic artery aneurysms calcs
oneumocystis carini infection
splenic infarcts

Question 18

What cystic lesions may be found in the spleen:

Answer 18

ADPKD
hydatid - usually liver
epidermoid cysts (true cysts lined with squamous epithelium)
Liquified infarcts or hematomas
Pancreatic Pseudocysts (can erode into the spleen and weaken vessels, causing PAs and bleeding into the pseudocyst)

Question 19

Sonographic findings of a splenic epidermoid cyst

Answer 19

typically solitary
10cm
may be calcified and the internal contents appera echogenic

Question 20

Most common benign primary neoplasm of the spleen?

Answer 20

hemangiomas

-primary neoplasms are rare

Question 21

METS to the spleen are _____. What 3 primaries in order?

Answer 21

uncommon

malignant melanoma, breast, lung

Question 22

Appearance of METS to the spleen

Answer 22

commonly hypoechoic but varies

Question 23

What kind of patients do splenic infarcts occur in?

Answer 23

common in patients with endocarditis and splenic artery aneurysms

Question 24

Sonographic appearance of splenic infarcts

Answer 24

generally present as a peripheral wedge-shaped hypoechoic lesion
it changes with the stages of blood coagulation….
-Initially, ischemia and edema appear as hypoechoic wedge of tissue
-With necrosis and liquification the area will appear anechoic and ultimately will calcify

Question 25

What are splenic abscesses the result of?

Answer 25

sepsis due to endocarditis, dental infections, urosepsis

Question 26

Sonographic appearance of splenic abscesses

Answer 26

complex cystic lesions | presence of gas may produce echogenic foci with an associated reverberation (comet-tail) artifact

Question 27

Sickle cell disease is due to a mutant hemoglobin S resulting in sickling of RBCs and teh complications of this include (7)

Answer 27

``` anemia - dec RBCs, hemoglobin infection - dec immunity acute chest syndrome - dec O2 pain - vascular occlusion and ischemia stroke - TCD monitoring cholecystitis - due to chronic hemolysis pulmonary HTN ```

Question 28

What happens to the spleen as a result of sickle cell disease?

Answer 28

- enlarges at the end of first year of life - remains enlarged due to splenic sequestration (pooling of sickled cells) and repeated infarction - over time, spleen becomes fibrotic and shrinks (autosplenectomy), typically before the end of childhood

Question 29

Mechanisms leading to splenomegaly (6)

Answer 29

- Conjestive* (cirrhosis - portal HTN, SV thrombosis) - Immune response hypertrophy (bacterial endocarditis, infectious mononucleosis) - RBC destruction hypertrophy (hereditary spherocytosis, thalassemia major) - Myeloproliferative (chronic myeloid metaplasia) - Infiltrative (sarcoidosis) - Neoplastic (chronic lymphocytic leukemia, lymphoma)

Question 30

When the spleen enlarges, what direction does it go in?

Answer 30

extends anterior, medial, and inferior

Question 31

blood disorder resulting in uncontrolled RBC production causing hyperviscosity and hypercoagulation

Answer 31

Polycythemia Vera

Question 32

Polycythemia Vera may be the result of(4)

Answer 32

splenomegaly budd-chiari syndrome portal vein thrombosis splenic infarcts

Question 33

How does a splenic artery aneurysm present on xray

Answer 33

calcified circle in the LUQ

Question 34

Sonographic appearance of a splenic artery aneurysm

Answer 34

May appear as a cystic mass or if calcified, a hyperechoic shadowing foci typically in the area of the splenic hilum

Question 35

Heterotaxy is due to early embryological disturbances that occur prior to the _____ week of gestation.

Answer 35

6th

Question 36

Classifications of heterotaxy

Answer 36

- complete/situs inversus - partial/incomplete situs inversus-limited number of organs are inversed or situs ambiguous (when a normally lateral organ is centrally located) - polysplenia - asplenia

Question 37

Polysplenia is _____-sided predominance and is associated with what abnormalities (6)

Answer 37

``` left Multiple LUQ spleens biliary atresia/absent GB intestional malrotation azygous continuation of interrupted IVC renal agenesis cardiac defects ```

Question 38

Asplenia is ____-sided predominance and is assoicated with what abnormalities (6)

Answer 38

``` right absent spleen ML liver and GB intetsional malrotation horseshoe kidney reversed positions of the Ao and IVC severe cardiac defects ```

Question 39

With splenic trauma, what can result if the splenic capsule remains intact

Answer 39

subscapular or intraparenchymal hematomas

Question 40

With spelnic trauma, what can result if the splenic capsule ruptures

Answer 40

perisplenic or intraperitoneal hematomas | -fluid tends to be loculated around the spleen but may spread within teh peritoneal cavity

Question 41

FAST looks at which areas

Answer 41

peritoneum pleural space pericardium -hemopericardium and hemothorax

Question 42

Ultrasound appearance of intraperitoneal blood depnds on the ____, _____ and ____ state of the clot.

Answer 42

age, amount, physical state timing of blood coagulation is not fully understood and acute bleeds may have various appearances -most assume the hemoperitoneum will appear anechoic, although, could see irregularly marginated echogenic mass that may mimic that of an enlarged spleen

Question 43

_______ is the volume of RBCs found in 100ml of blood. Blood spillage outside the circulatory system will result in a _____ _______.

Answer 43

hematocrit | decreased hematocrit

Question 44

Posttraumatic splenosis

Answer 44

In a patient with hx of splenic rupture or surgery, splenic cells may implant throughout the peritoneal cavity resulting in an ectopic spleen -often asymptomatic and may mimic otehr pathologies

Question 45

Thymus

Answer 45

lymphatic organ plays a vital role in the development of immune system during childhood disproportionately larger in infants as children grow, the thymu undergoes physiologic involution