Diffuse and focal abnormalities of the spleen

Most frequent LUQ mass

Splenomegaly

Most common splenic abnormality

Splenomegaly

Splenomegaly is most commonly caused by

Portal HTN

Splenomegaly

Enlarged spleen >13cm in length

Usually caused by portal HTN with cirrhosis

Asher sign - In supine in trans, upper border of spleen extends across the anterior aorta by more than 2cm = splenomegaly

Causes of splenomegaly

Congestive vascular disorder, lymphoma, schistosomiasis, leukemia, infection (AIDS, epstein-Barr) Hemolytic anemia, sickle cell anemia, mets, collagen disease, polycythemia

USA splenomegaly

Length >13cm

Thickness >5cm

Hypoechoic with malignant processes

Hyperechoic with inflammatory processes and in radiation therapy

Enlarges inferiorly and medially

Mild to moderate = infection, portal hypertension and AIDS
Massive = >20cm

Focal lesions may cause splenomegaly

Splenomegaly

Sarcoidosis

Inflammatory disease that causes all clumping in certain organs

The immune system is overactive nodules called granulomas

Multiple hypoechoic nodules throughout the spleen

When granulomas heal, they become calcified

Leads to multiple echogenic foci throughout the spleen, some may cause shadowing

Infections in spleen

Spleen function includes WBC production and filtration

Infection of the spleen may be localized or imported from other areas

Mononucleosis

Mononucleosis

Causes significant increase in spleen sixe

Associated with Epstien Barr infection → FF seen and splenomegaly

Epstein-Barr infection

AIDS

Moderate splenomegaly in 50-70% of pys

Splenomegaly is noted more in pts with sexually transmitted HIV than in those acquiring the disease through IV use

AIDS is associated with

Hepatomegaly, hepatitis, splenomegaly, candidiasis, pneumocystis carinii (MOST COMMON INFECTION OF AIDS), fatty infiltration of liver, kaposi sarcoma, cholangitis, acalculous cholecystitis, non-hodgkin lymphoma, anemia

Granulomatous infections

Systemic fungal respiratory disease caused by bird, bat and other animal droppings

Associated with splenomegaly, sarcoidosis and brucellosis infections

Granulomatous infections are most commonly caused by

Histoplasmosis and tuberculosis

Granulomatous infections USA

Multiple hypoechoic nodules <1cm in size

• When nodules heal, multiple echogenic foci form in the spleen and liver

Portal HTN Calcifications

Increased blood volume in the spleen

Gamma-Gandy bodies are caused by microhemorrhaging and infarction

Organized foci of hemorrhage in the spleen most commonly seen with portal HTN

Contains hemosiderin, fibrous tissue and calcium

Vascular calcifications

Linear calcs that follow course of vessel

USA splenic calcifications

Diffuse echogenic foci within splenic tissue

With or without shadowing

May see twinkle with color

What causes splenic calcs

Granulomatous infections

Portal HTN

Vascular calcs

Granulomas

Splenic abscess

Rare

May see them post-splenectomy

Decreased hematocrit, fever, increased WBCs and possible septicemia

Splenic abscess is most commonly associated with

Endocarditis, septicemia, and trauma

Splenic abscess USA

Complex fluid collection with internal echoes

Irregular borders

May see septations and pleural effusion

Dirty shadowing from gas

Splenic abscess

Benign neoplasms of spleen are very _____

Rare

Most common benign tumor of spleen

Cystic cavernous hemangioma

Cystic cavernous hemangioma

Composed of high concentration of vascular tissues

Associated with Kasabach - Merritt syndrome and Klippel-Trenaunay-Weber syndrome

Hamartoma

Most commonly INCIDENTAL

Solitary mass but can cause formation of multiple nodules in pts with tuberous sclerosis

Compresses and displaces normal splenic tissue

Hamartoma USA

Round, well-circumscribed, unencapsulated bulging nodules

Hypoechoic or homogeneous

Hypervascular on color

Gaucher disease

Massive splenomegaly due to hypertension

Can see multiple well defined, hypoechoic nodules

Requires splenectomy

Osteoma

Comes from bone

Fibroma

Fibrous tissues

Chondroma

Cartilaginous tumor

Cystic hemangioma

Congenital defect in lymphatic vessels in spleen

Granulomas

Calcifications

Most common splenic malignancy

Lymphoma

Lymphoma

Tumor of lymphatic system

Commonly involves spleen

Marked splenomegaly

• Hodgkin

• Non-Hodgkin

Hodgkin lymphoma

Most commonly occurs in pts age 15-24 yrs and over 60 yrs

Marked by mature, malignant B cells called Reed-Sternberg cells

Leukocytosis, anemia

More commonly affects lymphnodes in arms, upper chest and neck

Considered one of the most treatable cancers

Non-Hodgkins lymphoma

MOST COMMON TYPE

Average pt age 60 yrs

Elevated lactate dehydrogenase, anemia, leukopenia

No pattern for lymph node involvement; occurs in any lymph nodes throughout body

Much less responsive to treatment than Hodgkin’s

USA lymphoma (4 patterns)

Diffuse, marked splenomegaly, patchy inhomogeneity

Multiple small hypoechoic lesions, miliary nodules

Multiple large lesions 1-10cm

Single bulky mass

Lymphoma (Hodgkins)

Lymphoma

Leukemia

Cancer of WBCs

Night sweats, fatigue, weakness, unintentional weight loss, painless, swollen lymphnodes, enlargement of liver or spleen, fever, chills

• Lymphocytic

• Myelogenous

Myelogenous leukemia

Cancer of myeloid cells

Acute or chronic

Acute form is most common leukemia

Lymphocytic leukemia

Cancer of the lymphocytes

Acute or chronic

leukemia Labs

Complete blood count used to eval leukemia

Low platelet count

Low RBC

High WBC

Low sedimentation rate

Leukemia

Angiosarcoma

Primary malignant neoplasm of the spleen

Very rare aggressive malignancy

High rate of mets and poor prognosis

Arises from the vascular endothelium

Anemia, LUQ pain, malaise, fever weight loss

High incidence of splenic rupture

Angiosarcoma USA

Splenomegaly

Heterogeneous echotexture

Complex mass with cystic and solid components

Increased vascularity

Most likely primary cancer to spread to spleen

Melanoma

Most common primary cancers seen with splenic mets

Mets from lung or breast

USA mets to spleen

Hypoechoic most common, Bulls eye appearance

Cystic or hyperechoic

Splenic mets

Perisplenic abnormalities

Lesions of pancreas, left kidney, left adrenal and left lobe of the liver may impinge upon spleen and mimic primary splenic disease

Pancreas

Lesions of body or tail mat mimic primary splenic process

Renal

Upper pole of left kidney impinges on splenic hilum

Renal cyst may indent the splenic parenchyma

Adrenal

Left adrenal gland may be source of tumor or cyst that intrinsically compresses the spleen

A hypoechoic enlarged spleen is typically caused by ______________, while a hyperechoic enlarged spleen is typically caused by_______

Malignancy, infection

Massive splenomegaly (>20cm) can be caused by

Thalassemia major

Lymphoma

Gaucher disease

The most common splenic infection in an AIDS pt is ___________ and the most common malignancy of the spleen in an AIDS pt is ___________

Pneumocystis carinii; Kaposi sarcoma

Gamna Gandy bodies are most commonly seen with

Portal HTN

What splenic abnormality is associated with tuberous sclerosis or Wiskott-Aldrich syndrome

Hamartoma

Hodgkin lymphoma typically causes lymphadenopathy in the ________, while non H lymphoma typically causes lymphadenopathy in the _______

Upper body; Whole body

Pts with angiosarcoma have an increased risk of:

Splenic rupture