SPLEEN PATHOLOGIES 😮🥳🤨

Hematopoiesis

Granulocytopoiesis

• Reactive hyperplasia to acute and chronic infection (Low sonodensity)

• Noncaseous Granulomatous inflammation

• Myeloproliferative syndromes (normal)

• Chronic myelogenous Leukemia

• Acute myelogenous leukemia

• Lymphopoiesis (low sonodensity or focal sonolucent)

• Chronic lymphocytic leukemia

Lymphoma

Hodgkin disease.

Erythropoiesis (normal)

• sickle cell disease

• Hereditary spherocytosis

• Hemolytic, anemia

• Chronic anemia

  other

• Multiple Myeloma (low sonodensity) myleoproliferative syndrome

Reticuloendothelial hyperactivity (normal)

• still disease

• Wilson disease

• Felty Syndrome

• Reticulum cell Sarcoma

Congestion (normal or low sonodensity)

Hepatocellular disease

Non specific

Neoplasm-metastasis (Focal sonodense)

Cyst (focal sonolucent)

Abscess (Focal sonolucent)

Malignant neoplasm (Focal sonolucent)

• Hodgkin disease

• Lymphoma

Benign neoplasm (focal sonolucent)

Hematoma (perisenic)

Splenomegaly

As the largest unit of the Reticuloendothelial System, the spleen is involved in all systemic inflammation and generalized hematopoietic Disorders in much metabolic disturbance Whenever the spleen is involved in systemic disease, splenic enlargement, or splenomegaly, usually develops.

Causes of splenomegaly:

• Collagen-vascular disease

• Congestion

• Extramedullary hematopoiesis

• Hemolytic anemia

• Infection

• Neoplasm

• Storage disease

• Trauma

Clinical signs of splenomegaly may include LUQ Pain (Secondary to stretching of the splenic capsule or Ligaments) Or fullness

Enlargement of the spleen may encroach upon surrounding Organs, such as the left kidney, pancreas, stomach and intestines.

Congestion of the spleen

Two types known as acute and chronic

In acute congestion, Active hyperemia accompanies the reaction in The moderately Enlarged spleen

In chronic venous congestion, diffuse enlargement of the spleen occurs.

The Venus congestion maybe of systemic Origin, caused by intrahepatic obstruction to portal, venous, drainage, or obstructive venous disorders in the portal or splenic veins.

Systemic venous congestion is found in cardiac decompensation involving the right side of the heart.

It is particularly severe in tricuspid or pulmonary valvular disease and chronic cor pulmonale.

Most common causes of striking congestive splenomegaly are the various forms of cirrhosis of the liver Also caused by obstruction to the extra hepatic portal or splenic vein.

Wandering spleen

(here out from video, yes there will be repeats perhaps)

• Abnormal migration during developmental stages of embryology

• Positioned outside of normal LUQ location

• Clinically; Asymptomatic, tenderness torsion is possible

• Sonographic: Abdominal/pelvic mass, Decreased color, Doppler velocity in complete torsion.

Splenic agenesis

• AKA asplenia

• Complete embryologic absence of spleen

• Occurs with additional major congenital abnormalities

• Rare, benign

• Clinically: Increased risk of infectious disease

• Sonographic: No splenic tissue visualized in LUQ or abdominal/pelvic region

Accessory spleen

• AKA splenule

• Collection of normal splenic tissue separate from the spleen

• Common congenital, anomaly, 30% of population

• Clinically; Asymptomatic, palpable lump depending on size/location

• Sonographic: Homogeneous, isoechoic to Spleen near hilum or superior border

Atrophy

• AKA autosplenectomy

• Decrease in splenic tissue volume

• Technically benign disorder, but associated with “ Wasting” Diseases

• Clinically: Asymptomatic, symptoms associated with causative disease

• Sonographic: Small spleen, non-visualized due to lack of tissue

Splenomegaly

• Splenic enlargement

• Caused by systemic disease

• Clinically: Infectious pts, Metabolic disturbances, hematopoietic disorders

• Sonographic: changes in size texture and vascularity, Increased volume

Amyloidosis

• Excessive production of amyloid Proteins in organs

• Spleen is the most commonly effected organ

• Clinically: Systemic diseases, fatigue/weakness, joint pain, weight loss, skin changes

• Sonographic: Enlarged, size depends on the amount of buildup

Gaucher’s disease

• Rare metabolic disorder

• Abnormal accumulation of specific lipid cells in specific organs → Mainly spleen and liver

• Clinically: All ages, 50% younger than eight years old, 17% younger than one years old

• Sonographic: Splenomegaly, heterogeneous, spleen, multiple hyperechoic nodules

Neimann-pick disease

• Metabolic disorder

• Unable to metabolize lipid cells → Sales malfunction, and lead o apoptosis

• Clinically: Female infants, rapidly progresses, fatal

• Sonographic: Hepatomegaly, lymphadenopathy, Digestive complications

Sickle cell anemia

• Irregularly shaped RBC; Difficult to travel

• Inadequate healthy RBC

• Slow flow and lack of oxygen to organs

• Clinically: Inherited, geographic locations; 8% of African-Americans, Fatigue/weakness, infections, joint pain, dizziness

• Sonographic: Variable due to severity, early: Enlarged, late: Infarction, fibrosis, atrophy

Hemolytic anemia

• Inadequate healthy RBC

• Decrease lifespan of erythrocytes

• Rate of destruction is higher than bone marrow can compensate for

Autoimmune hemolytic anemia

• Anemic caused by auto immune response or disease

• Primary: Without disease

• Secondary: With disease

• Clinically: Occurs with underlying disease, Lymphoma/leukemia, infectious mono

• Sonographic: Splenomegaly

Polycythemia Vera

• Excess of RBC

• Unknown cause that involves all bone marrow elements

• Clinically: Weakness/fatigue, vertigo, tinnitus, irritability, erythema, painful extremities, contusion

• Sonographic: Splenomegaly, infarction, thrombosis

Thalassemia

• Inadequate amount of hemoglobin

• Leads to anemia

• Destruction of healthy RBC

• Clinically: Inherited

• Sonographic: Splenomegaly

Mononucleosis

• Viral infection that severely affects the Spleen

• Kissing disease

• Associated with EBV

• Clinically: Teens and adolescence, tenderness and swelling in LUQ, Swollen, lymph nodes, fever, sore throat

• Sonographic: Splenomegaly

Trauma

• Blood abdominal force; MC injury

• FAST exam : Focused assessment with sonography for drama. Check 4 quads, Morrisons pouch, subdiaphragm, liver and splenic capsules, bladder and rectal regions

• Clinically: Decreased hematocrit, Shock

• Sonographic: eval for eternal hemorrhage, eval for FF

Abscess

• Collection of pus

• Infection from abdominal organ

• Inflammation from direct adjacent organ

• Clinically: Increased risk for pts, Drug use, endocarditis, decreased immunity, trauma

• Sonographic: Focal collection of purulent material w/i splenic parenchyma, Target or Bullseye appearance, splenomegaly

Infarction

• Death of focal splenic tissue: May affect a segment or entire organ

• MC cause of focal splenic lesions

• Caused by occlusion of splenic arteries/Branches: Result of embolus from heart

• Clinically: Pancreatitis, leukemia, lymph disorders, SCA

• Sonographic: NO Splenomegaly, acute: Hypoechoic wedge, Chronic: echogenic Wedge

Hemangioma

• Proliferation of vascular channels: cluster of blood vessels

• MC, benign splenic tumor

• Clinically: Asymptomatic

• Sonographic: Isolated, Heterogeneous echogenic mass with multiple hypoechoic areas, Heterogeneity Caused by areas of cystic changes or hemorrhage

Hemangiosarcoma

• Rare, malignant neoplasm rising from vascular endothelium of spleen

• Clinically: Weakness/fatigue, loss of appetite/weight loss, tumor rupture, hemorrhage

• Sonographic: Cystic and solid components, hyperechoic

Hamartoma

• Abnormal mixture of cells and tissues: Mainly lymphoid tissues

• Rare, Benign

• Clinically: Asymptomatic

• Sonographic: Cystic and solid components, isoechoic / hyperechoic

Lymphangioma

• Malformation of Lymphatics

• Consists of cystic spaces that vary in size

• May involve other organs

• Rare, benign

• Clinically: Spleen- Asymptomatic, possible tenderness. Variable symptoms due to additional organs

• Sonographic: Multiple cysts, solitary or grounded

Lymphoma

• Spleen is most commonly involved organ

• MC malignant tumor is Hodgkin and non-Hodgkin’s

• Clinically: history of ca

• Sonographic: Difficult to visualize on ultrasound, bulky disease, focal or diffuse lesions, splenomegaly may occur, AIDS Lymphoma: Uniform decreased echogenicity or focal hyperechoic lesions

Metastatic disease

• Hematogenous spread from primary site

• Spleen is 10th MC site of mets

• Clinically: history of ca

• Sonographic: Multiple or solitary, nodularity, diffuse lesions, target or halo lesions