Gi -- Spleen

Front 1

What are the differential possiblities of cystic splenic mass/es?

Back 1

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

Front 2

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?

Back 2

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

Front 3

What is polysplenia associated with?

Back 3

Polysplenia is often part of multisystem congenital anomalies including,
1. situs inversus
2. severe cardiovascular anomalies

Front 4

Grading system for splenic laceration:

Back 4

- 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

Front 5

Splenic infection and abscess

Back 5

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.

Front 6

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.

Back 6

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

Front 7

Splenic hamartoma

Back 7

Also called splenomas, or nodular hyperplasia of the spleen
Benign, associated with tuberous sclerosis