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7 Cards in this Set

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What are the differential possiblities of cystic splenic mass/es?
1. Acquired splenic cyst:
- result of prior trauma, infection, infarction.
- represent 80% of splenic cysts
- may have calcified wall

2. Congenital splenic cyst:
- same appearance as acquired cyst.
- has epithelial lining

3. Splenic Trauma
- Acute splenic hematoma is hyperechoic (US), heterogeneous, hyperdense (NECT)
- May evolve into sonolucent, hypodense, cystic lesion.

4. Splenic Infarction
- May evolve into splenic cyst after a few days to weeks

5. Splenic Metastases and Lymphoma:
- From cystic primary tumors (e.g., ovarian)
- Other metastatic lesions & lymphoma are solid lesions but may be homogeneously hypovascular and mimic cyst on imaging (CT, US and MR).
- Direct invasion of spleen by cancer of stomach or pancreas
- Check for involvement of liver, nodes; consider biopsy

6. Splenic Infection and Abscess
- Microabscesses usually due to Candida albicans; immunocompromised patients
- Pyogenic abscess uncommon; often result of infection of infarcted splenic tissue
- Hydatid abscesses are rare

7. Splenic Tumors
- Primary splenic tumors are uncommon
- Usually lymphangioma or hemangioma
- Appearances are variable and nonspecific; often include cystic and solid components

8. Angiosarcoma:
- Rare primary splenic tumor
- Usually heterogeneously hypervascular
- Usually have liver tumors as well

9. Pancreatic Pseudocyst
- Pancreatitis involving tail segment can easily spread into spleen via splenorenal ligament
- May evolve into intrasplenic pseudocyst
- Crescentic, subcapsular cystic lesion with compression & distortion of parenchyma
1. What is the cause of splenosis?
2. What can splenosis mimic in a patient with cancer?
3. What nuclear medicine test can confirm the nature of these soft tissue masses?
1. Splenosis is traumatic rupture of spleen resulting in implantation of splenic tissue throughout the peritoneal cavity.
2. Enhancing nodules of splenosis closely simulate metastases.
3. Heat-damaged red blood cell (RBC) scintiscan
What is polysplenia associated with?
Polysplenia is often part of multisystem congenital anomalies including,
1. situs inversus
2. severe cardiovascular anomalies
Grading system for splenic laceration:
- Grade I: <1cm parencymal depth.
- Grade II: 1-3 cm and no trabecular vessel involvement
- Grade III: >3 cm or involvement of trabecular vessel
- Grade IV: major devascularization, or involvement of segmental or hilar vessel
Grade V: shattered spleen: mutliple splenic lacerations with disconnected fragments
Splenic infection and abscess
Microabscesses are usually due to Candida albicans; immunocompromised patients. A pyogenic abscess is uncommon and often results from an infection of infarcted splenic tissue. Hydatid abscesses are rare.
1. What is the ddx of diffuse hypodense micronodules in the spleen?
2. What are the different patterns of lymphomatous involvement of the liver and spleen.
1.
- Lyphoma/Leukemia
- Fungal infections -- Candida and Histo
- TB
- Sarcoidosis
- Mets = usually larger
- Pyogenic abscess = usually larger and less numerous
2. Lymphoma of hte spleen and liver cna present as focal masses, diffusely scattered nodules, or diffuse infiltration resulting in hepatosplenic enlargement without nodularity
Splenic hamartoma
Also called splenomas, or nodular hyperplasia of the spleen
Benign, associated with tuberous sclerosis