Unit 11- Focal Disease, Trauma and Cysts

A splenic abscess is _______ and typically from ______ ______

• Uncommon

• Other organs

What are the signs/symptoms of a splenic abscess?

• + blood culture

• High WBC

• Fever

• LUQ Tenderness

• Splenomegaly

US appearance of a splenic abscess:

• Splenomegaly

• Solid/Complex

• Hypoechoic, septations

• Irregular, ill-defined borders

• Low level echoes

• Hyperechoic foci

  • Debris or gas

What is this image showing?

Splenic Abscess

What are the different types of Splenic Infection?

• Hepatosplenic candidiasis

• Mycobacterial infections

• Active Tuberculosis

• Splenomegaly

US appearance of Hepatosplenic Candidiasis:

• Irregular masses within spleen

• Wheel within a wheel

• Bull’s eye

• Hypoechoic nodule

• Hyperechoic nodule

• Splenomegaly

What is this image showing?

Hepatosplenic Candidiasis

What do patients show on ultrasound with Mycobacterial infections?

Tiny diffuse echogenic foci

What do patients show on ultrasound with Active Tuberculosis?

• Echo-poor or cystic masses = small abscess lesions

What are these images showing?

Active Tuberculosis Abscess

What is the definition of AIDS?

Acquired Immunodeficiency Syndrome

With AIDS, what are the focal lesions involved with the spleen?

• Infectious processes

• Kaposi’s Sarcoma

• Lymphoma

US appearance of AIDS in the spleen:

• Splenomegaly (most common)

• Small round lesions

• Liver lesions with hepatomegaly

• Retroperitoneal lymphadenopathy

• Ascites

What is the most common cause of focal splenic lesions?

Splenic Infarction

What is a Splenic Infarction caused by?

Occlusion of splenic artery or any of its branches

What are other causes of Splenic Infarction and in what patients does this occur?

• Septic emboli

• Local thrombosis

  • Pancreatitis

  • Leukemia

  • Lymphomatous disorders

  • Sickle cell anemia

  • Sarcoidosis

  • Polyarteritis nodosa

US appearance of Splenic Infarction:

• Localized, wedge shaped, hypoechoic area

  • Dependent on time of onset

  • May become nodular or hyperechoic over time

  • Use color Doppler to evaluate lesion

What are these images showing?

Splenic Infarct

With splenic trauma, what type is it usually?

Blunt trauma

What are the effectsofh blunt trauma?

• Hematoma

• Linear or stellate lacerations

• Capsular tears

• Puncture wounds (ribs, foreign bodies)

What are the possible outcomes of splenic trauma?

• Intact capsule

• Ruptured capsule

• Delayed rupture

What are the common symptoms associated with splenic trauma?

• LUQ pain

• Left shoulder pain

• Left flank pain

• Dizziness

What are the clinical evaluation findings for a splenic trauma?

• Hypotension

• Decreased hemoglobin

• Tenderness LUQ

If a patient has a splenic trauma that is an emergent situation what must be done?

• Peritoneal lavage

• Exploratory surgery

What is a FAST scan?

• Sonographer quickly evaluates the 4 abdominopelvic quadrants (less than 5 min.)

What does the location of fluid in a FAST scan determine?

Location determines capsular or subcapsular hematoma

US findings of a Subcapsular Hematoma:

• Splenomegaly if capsule intact

• Progressively enlarges as bleeding continues

• Irregular border

• Hematoma

• Subcapsular & Pericapsular fluid

• Free intraperitoneal blood

• Possible Left Pleural Effusion

US finding of a focal hematoma:

Intrasplenic fluid collections

US findings of peri or subcapsular hematoma:

Perisplenic fluid collection

What is this image showing?

Splenic Hematoma

Pericapsular hematomas regress more than what?

Subcapsular hematomas or contusions

What is being shown in the images above?

• Top images are hematomas

• Bottom left image is a pleural effusion

What do Congenital Cysts contain of?

• Epithelial lining

• Solitary

• Unilocular

• If simple = no clinical significance

US appearance of splenic cysts:

• Anechoic - Hypoechoic

• Well-defined walls

• If complicated:

• Septations with internal echoes

• Thickened wall

• Hemorrhage may produce a fluid level

What is this image demonstrating?

A fluid filled level with a hemorrhage

What are splenic cysts secondary to?

• Trauma

• Infection

• Infarction

What is a parasitic cyst?

Echinococcus parasite only

US appearance of a parasitic cyst?

• Anechoic

• Possible daughter cysts

• Possible calcifications

• Solid masses with fine internal echoes & poor enhancement

US appearance of a splenic cyst:

• Anechoic or mixed homogeneity

• Wall may be calcified

What is this image showing?

Splenic Cysts

What are these images showing?

Splenic Cysts