Ardms Spleen Abdomen Nikki

Front 1

What are the normal dimensions of the spleen?

Back 1

12cm long (coronal measurement) and 6 cm wide (straight across from hilum)

Middleton 210

Front 2

What covers the spleen (except the hilum)?

Back 2

peritoneum

Front 3

The spleen is part of the reticuloendothelial system, and is composed of ___ tissue, ___ pulp, and ___ pulp

Back 3

reticuloendothelial
red
white

Front 4

What are the vessels that enter and leave the spleen at the hilum?

Back 4

splenic vein - joins the SMV at the PV confluence
splenic artery - arises from the celiac axis

Front 5

Name 4 primary functions of the spleen

Back 5

disease defense (especially kids)
iron storage
RBC destruction
WBC production

Front 6

What is an splenule?

Back 6

AN accessory spleen seen in about 10% of the population, usually located near the hilum or along the major vessels

Front 7

What does a splenule look like?

Back 7

small
round or oval
same texture as the spleen

Middleton 211 Fig 8-2

Front 8

What patient position is best for scanning the spleen?

Back 8

high posterolateral intercostal approach with the patient supine - deep inspiration can obscure view
or
anterolateral subcostal with the patient in the right lateral decubitus position - deep inspiration can help in this position

Front 9

What lab values are usually affected if the spleen is diseased or damaged?

Back 9

RBC
WBC

Front 10

Indications for spleen US / causes of splenomegaly

Back 10

portal hypertension
heart failure
infections (hepatitis, abscess, TB, mononucleosis, AIDS, malaria)
metastatic disease (especially lymphoma or leukemia)
hemolytic anemia
connective tissue disorders (RA)

Front 11

Are benign primary masses in the spleen common or uncommon?

Name 3

Back 11

Uncommon

hemangiomas
hamartomas
lymphangiomas
extramedularry hematopoiesis

Front 12

What are the 2 types of lymphoma?

Back 12

Hodgkins
Non-Hodgkins

Front 13

What is the appearance of lymphoma in the spleen?

Back 13

Solitary or multiple solitary masses that are hypoechoic or anechoic

Front 14

Are malignant primary masses of the spleen common or uncommon?

Back 14

Very rare

Front 15

Name the 2 malignancies that most commonly metastasize to the spleen

Back 15

thyroid cancer
melanoma

Front 16

Are cysts common or uncommon in the spleen?

Back 16

uncommon

Front 17

What are some causes of echogenic granulomatous disease in the spleen? (2)

Back 17

TB
Histoplasmosis (Midwest)

Front 18

What is the sonographic appearance of granulomatous disease in the spleen?

Back 18

multiple calcified foci with shadowing

Middleton 216 Fig 8-14

Front 19

Are splenic abscesses common or uncommon?

Back 19

uncommon

Front 20

What are some causes of splenic abscesses?

Back 20

bacterial endocarditis
sepsis
IVDA
splenic infarcts
immunologic deficiencies
trauma with hematoma

Front 21

What is the sonographic appearance of a splenic abscess?

Back 21

Ill-defined, complex
Gas could appear as high-level echos with acoustic shadowing

Middleton 216 Fig 8-13

Front 22

What is the most common cause of a spleen hematoma?

Back 22

trauma

Front 23

What 2 findings can be seen with spleen trauma?

Back 23

intact capsule = intraparenchymal or subcapsular hematoma

disruption of capsule (splenic fracture) = hemoperitoneum and splenic hematoma

Front 24

What is the sonographic appearance of a splenic fracture

Back 24

irregular splenic border or visible fracture line

Front 25

What is the sonographic appearance of a splenic hematoma?

Back 25

Varies with age, initially hypoechoic but more echogenic/isoechoic with age. At this stage US not very sensitive to bleeding. Later may liquefy and become hypoechoic/anechoic.

Front 26

What is the most common cause of splenic infarction?

Back 26

sickle cell disease

Front 27

What is the sonographic appearance of splenic infarction?

Back 27

recent infarction - hypoechoic areas with coarsened echotexture, may be peripheral and wedge-shaped
past infarction - spleen can shrink and become too small to find

Middleton 218 Fig 8-19

Front 28

What is the sonographic appearance of a perisplenic infarction?

Back 28

blood follows the contour of the spleen or pools alongside the spleen

Front 29

What is a splenic cleft?

Back 29

thin, bright, linear reflections that extend from the periphery of the spleen into the splenic parenchyma

Middleton 211 Fig 8-3

Front 30

Compare the order of echogenicity of the following: kidney, liver, spleen, pancrease

Back 30

kidney < liver < spleen
spleen <=> pancreas

Front 31

How can you differentiate a splenule from a renal mass or pancreatic tail mass?

Back 31

The echogenicity is similar to the spleen and it is located near the hilum

Front 32

What percentage of people have splenule on autopsy?

Back 32

30%
10% are multiple

Front 33

Name a common variation of the spleen anatomy located medially

Back 33

Medial tubercle which extends as a tongue-shaped protrusion, usually positioned over the upper pole of the left kidney

Front 34

What is the most common cause of a splenic cyst?

Back 34

trauma - initially a hematoma, it evolves into a seroma and forms a pseudocapsule

Middleton 212 Fig 8-4

Front 35

Does calcification of a splenic cyst increase risk of neoplasm?

Back 35

No

Front 36

What are some causes of splenic cysts?

Back 36

Congenital epithelial-lined cyst
Epidermoid cyst - filled with squamous cells
Parasitic cysts - echinococcus
Vascular - use doppler to r/o
Perisplenic cyst (pancreatic pseudocyst, renal cyst, endometriosis)
Post-traumatic

Middleton 212 Fig 8-5, 213 Fig

Front 37

Are hemangiomas seen as commonly in the spleen as they are in the liver?

Back 37

Hemangiomas are less commonly seen in the spleen than the liver and their appearance is more variable.

Middleton 213 Fig 8-7

Front 38

What is the sonographic appearance of splenic lymphoma or leukemia?

Back 38

Almost always hypoechoic
Unifocal, multifocal, or diffuse

Middleton 214

Front 39

Metastatic spread to the spleen is less common than that to the liver and is usually a late manifestation of metastatic disease. T/F

Back 39

true

Front 40

What is the sonographic appearance of metastatic splenic disease

Back 40

variable appearance
splenomegaly with diffuse disease

Middleton 214 Fig 8-10

Front 41

What can you do if you suspect a splenic mass?

Back 41

further imaging (CT, MRI, etc)
US guided biopsy of spleen or other site
follow with US over time for stability

Front 42

What is the sonographic appearance of splenic sarcoid?

Back 42

Multiple solid hypoechoic masses

Middleton 217 Fig 8-15

Front 43

Volume averaging and the concave shape of the spleen can lead to a splenic pseudolesion appearance from the fibrofatty tissue in the splenic hilum. How can you evaluate to avoid this pitfall?

Back 43

Get transverse and longitudinal views. It will only be visible on one view.

Middleton 215 Fig 8-11

Front 44

Describe how an elongated left lobe of the liver can cause pseudo-perisplenic fluid. How can you avoid this pitfall?

Back 44

The liver can insinuate itself between the spleen and the diaphragm, and because it has less echogenicity than the spleen, can be misinterpreted as perisplenic fluid. Color doppler will confirm multiple vessels within the hepatic parenchyma

Middleton 217 Fig 8-17

Front 45

What is splenosis?

Back 45

Seen after trauma, splenic material can implant onto intraperitoneal surfaces with subsequent vascularization and growth into homogeneous round/ovoid masses. You can further evaluate with a tagged damaged RBC scan.

Middleton 218 Fig 8-18