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Ultrasound ABD Spleen:
Terms in this set (85)
Inraperitoneal, ovoid organ.
Where is Spleen is located?
in LUQ (left hypochondrium) between stomach(anterior) & diaphragm(Posterior)
what are Granulomas?
Focal lesions resulting from previous infections.
How are Granulomas seen sonographically?
Focal bright echogenic lesion, with or without shadowing
What are the two most common causes of Granuloma's?
Splenic calcifications other than Granulomas, can be associated with what? PPSS
P - Pneumocystis carinii infection
P- Previous infarcts or hematoma
S - Splenic artery wall calcifications
S - Splenic artery aneurysms calcifications
Splenic Infarcts are common in patients with what 2 things? BS
Splenic artery aneurysms
Splenic infarcts sysmptoms
acute LUQ pain with fever and /or left pleural effusion.
Splenic infarcts sonographically
Hyperechioc region, wedged-shaped & no color flow.
Splenic Infarcts - Sonographically, initially ischemia(inadequate bloody supply) and edema(Excess watery fluid) will appear as what?
A hypoechoic wedge of tissue
Splenic Infarcts with necrosis and liquification the area will appear?
Anechoic and ultimately will calcify(hyperechioc)
Chronic Infarcts can lead to?
aplasia or hypoplasia
Infarcts may rupture look for....
subcapsular hemmorrage or free peritoneal blood
What is situs ambiguous or Heterotaxia?
The disruption in the development of the normal asymmetric arrangement of abdominal organs and vessels.
What are 2 classifications of Heterotaxia?
Sonographers encounter heterotaxia in which patients?
What is the initial presentation of Heterotaxia?
Symptoms of congenital heart disease or jaundice due to billiary tract abnormalities
What is a generic term defining the misarrangement of abdominal structures?
What is the most common cause of congestive Splenomegaly in adults?
Portal Hypertension(due to Cirhossis,-Nodular parenchyma, reduction of blood flow through portal vein)
What are some other causes, besides portal hypertension, of Splenomegaly? B CHLL RSSV
B - Bacterial infections
C - Congestive heart failure(CHF)
H - Hemolytic anemia
L - Leukemia
L - Lymphoma(Hodkin & non Hodgkin)
R - Rheumatoid arthritis
S - Schistosomiasis
S - Sickle cell anemia
V - Viral infections
The spleen is located in the LUQ, so when it enlarges it extends where?
In the anterior, medial, and inferior direction
Splenomegaly indicated with a longitudinal measurement of?
>12cm or if spleen is inferior to lower pole of left kidney
Splenic Trauma - What results when the splenic capsule remains intact?
Subcapsular or Intraparenchynmal hematomas
Splenic Trauma - What results with capsule rupture?
Perisplenic(around) or Intraperitoneal(within) hematomas
Splenic Trauma - What happens after capsule rupture?
Fluid is typically demonstrated to be loculated around the spleen, although blood may spread within the peritoneal cavity. Check the pelvis, morrisons pouch and flanks for free blood.
Splenic Trauma - The ultrasound appearance of intraperitoneal blood depends on what?
Age, amount, & physical state of the clot
In a patient with a history of splenic rupture or surgery, splenic cells may implant throughout the peritoneal cavity (autotransplantation) resulting in what?
What is Post-traumatic Splenosis?
Splenic cells may implant throughout the peritoneal cavity (autotransplantation) resulting in an ectopic spleen.
What are the symptoms of Post-traumatic Splenosis?
(may mimic other pathologies)
Spenic Trauma: The spleen is the organ most frequently damaged in?
blunt abdominal trauma
Splenic Trauma: Associated with mortality rate due to ?
liver, spleen, & major blood vessel injury
Splenic Trauma: Injury Bowel and Pancreas can lead to what?
Splenic Trauma: The timing of blood cogulation is not fully understood and acute bleeds, may have various ultrasound appearances. Most medical professionals assume the hemoperitoneum(presence of blood in peritoneal cavity) will appear anechoic although, one may see what?
irregulary marginated, echogenic mass, that may mimic that of an enlarged spleen.
What is Polysplenia?
What is Polysplenia associated with? IC BM
I - Intestinal malrotation
C - Cardiac defects
B - Biliary atresia / absent GB
M - Multiple LUQ spleens
What Is Splenic Ptosis?
Ectopic (wandering) spleen. Drooping, sagging of supporting ligament.
What is Splenic Ptosis (wandering) spleen prone to?
torsion & infarction
What surgery is needed for a splenic ptosis to reposition spleen back in its place (LUQ)
What is utilized in the emergency department to document the presence of free fluid in the peritoneal cavity?
Focused Assessment with Sonography for Trauma (FAST)
What does FAST stand for?
Focused Assessment with Sonography for Trauma
The FAST exam also allows analysis for possible what? SHHR
S - Solid organ damage
H - Hemopericardium
H - Hemothroax
R - Retroperitoneal injury
What is a normal variant of the spleen that is commonly found?
What can a Accessory Spleen be confused with?
Enlarged lymph node around the spleen
A mass in the tail of the pancreas
How does an Accessory Spleen appear sonographically?
Small rounded mass, 1.5-2cm in diameter.
Where are Accessory Spleens located?
Near the splenic hilum
(have identical echogenicity to the adjacent spleen)
Rare location of accessory spleen?
Pelvis or Scrotum
Following splenectomy, the accessory spleen may assume?
Function & size of the removed organ.
What are the Function of the spleen?
1. Blood Reservior( RBC's & Platelets)
2. Filter peripheral blood- removal of macrophages of ruptures, worn out, or defected blood cells
3. Erythropoises ( produced of red blood cells throughout life)
4. Defense against disease ( lymphoid organ)
What is Polycythemia Vera?
Blood disorder resulting in uncontrolled RBC production causing hyperviscosity and hypercoagulation. May cause splenomegaly
Splenic Cysts: What are the congenital PRIMARY cysts?
Autosomal polycystic disease
Epithelial, endothethial cysts, & epidermiod cyst
Splenic Cysts - What are Epidermoid cysts?
cysts lined by squamous epithelium
Epidermoid cysts typically appear as a solitary cyst averaging how many cm in size?
How can Epidermoid cysts appear sonographically?
The wall may be calcified & the internal contents may appear echogenic
What are the SECONDARY cysts resulting from trauma, infection, or degeneration?
-Echhincoccal (hydatid) cysts
-Liquified infarcts or hematoma
What can erode into the spleen due to their proximity?
What happens with Pancreatic Pseudocysts?
The Pseudocyst may weaken vessels causing pseudoaneurysms and bleeding into the Pseudocyst
Abscesses: What is associated with general abdominal sepsis?
Abscesses: What is a good culture medium, susceptible to infection, with filtered bacteria available in the spleen?
damaged splenic tissue
Sonographically, how are Splenic Abscesses seen?
Complex cystic lesions
Splenic Abscesses - When gas is present in lesion how does it look sonographically?
High-level echoes & ring down shadowing (dirty shadow) or reverberation (comet tail) artifact
Splenic Abscesses: Which patients are susceptible to fungal and microbacterial microabcesses, which presents as target lesions or small hyperechioc masses?
Splenic Abscesses: What are ruptured abscesses associated with?
High mortality rate.
What are the most common benign primary neoplasm of the spleen?
(primary neoplasms of the spleen are rare)
Although metastases to the spleen are relatively uncommon, what more frequently metastasizes to the spleen?
(followed by breast & lung cancer)
How do metastatic lesions appear sonographically?
(appearance may vary)
If a Patient has malignant melanoma and you see a mass in the spleen, what should you suspect?
What is the most frequent metastatic lesion of the spleen?
METS spread from melanoma
Portal Hypertension (HTN): What happens as pressure increases?
-increases pressure(portal HTN)-reverse normal flow through portal splenic veins.
-Pressure increases and portal vein enlarges and tortous-collaterals open(collateral vesicles appear in splenic hilium)
-See splenorenal collateral, recannalized umbilical vein in the ligamentum teres within liver.
When is the left lobe of the liver seen anteriorly to the Spleen?
During a 3rd trimester pregnancy
If the left lobe is enlarged
What is seen on x-ray that typically makes a Splenic Artery Aneurysm suspected?
A calcified circle is seen in the LUQ
How can a Splenic Artery Aneurysm appear sonographically?
A cystic mass
If calcified, a hyperechoic shadowing foci in the area of the splenic artery
Splenic Artery Aneurysm - What should be traced from the celiac axis along the anterior aspect of the pancreatic tail to the splenic hilum?
What is Asplenia?
What is Asplenia associated with? IC RAM
I - Intestinal malrotation
C - Cardiac defects
R - Reversed positons of the aorta and IVC
A - Absent spleen
M - Midline liver and GB
Ischemia to the spleen
Trauma, Rupture, and hematoma: Spleen may appear normal if there is a small, fresh
hematoma or it may present as a heterogenous mass if there is extensive parenchymal injuries (appearance varies with age)
-Mets to spleen uncommon despite rich blood supply
-Mets spread from melanoma is the most frequent metastatic lesion of the spleen
-usually hypoechoic, but may be hyperechioc or complex
Malignant neoplasms: Vascular Neoplasms of the spleen are (rare):
-littoral cell angiomas
Acquired aplasia or hypoplasia:
small nonfunctional spleen associated with repeat infarction(obstruction of blood supply)(sickle cell anemia)
-spleen is small, fibrotic, and calcified
what hemangioma/neoplasms appearance is variable but has similar appearance as liver hemangioma
Benign neoplasm of the spleen
-opportunistic infectons and lymphoma can affect the spleen
-most commonly, an enlarged spleen
Associated with AIDS patients:
AIDS: Patients with P.Carini or mycobacterium avium may demonstrate
numerous punctuate nonshadowing calcifications typical of granulomatous disease within the spleen, liver, kidneys, and adrenal glands.
Primary congenital splenic cysts arise from
epithelial or endothelial lining
Secondary cyst result from
trauma, infection, or degeneration
THIS SET IS OFTEN IN FOLDERS WITH...
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Abd Ultrasound - Liver Pathology
ABD Board Exam - Ultrasound 3 - Pancreas
ABD Board Exam - Ultrasound 5 - Testicle
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