Spleen Pathology power point Flashcards
(37 cards)
}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
