Ultrasonography of splenic abnormalities

Abstract

Aim: This report gives a comprehensive overview of ultrasonography of splenic abnormalities. Certain ultrasonic features are also discussed with pathologic correlation.

Methods: We review the typical ultrasonic characteristics of a wide range of splenic lesions, illustrating them with images obtained in our institution from 2000 to 2003. One hundred and three patients (47 men, 56 women), with a mean age of 54 years (range 9-92 years), were found to have an abnormal ultrasonic pattern of spleen.

Results: We describe the ultrasonic features of various splenic lesions such as accessory spleen, splenomegaly, cysts, cavernous hemangiomas, lymphomas, abscesses, metastatic tumors, splenic infarctions, hematomas, and rupture, based on traditional gray-scale and color Doppler sonography.

Conclusion: Ultrasound is a widely available, noninvasive, and useful means of diagnosing splenic abnormalities. A combination of ultrasonic characteristics and clinical data may provide an accurate diagnosis. If the US appearance alone is not enough, US may also be used to guide biopsy of suspicious lesions.

Figure 1

There is a homogenous, round contour near the hilum, identified as an accessory spleen (AS) in a 62-year-old female. One anechoic cyst is noted within the accessory spleen. The pathologic process affecting the spleen (small cyst) also affects the accessory spleen (large cyst).

Figure 2

Multiple tiny calcified spots involving almost the entire spleen are found in a 58-year-old female with liver cirrhosis, called Gamna-Gandy bodies.

Figure 3

A pseudocyst cyst of the spleen after trauma reveals debris or echogenic contents within the thick wall (arrows) in a 60-year-old female.

Figure 4

Pancreatic pseudocyst eroding into the adjacent spleen and mimicking a huge splenic simple cyst was noted after an episode of acute alcoholic pancreatitis in a 32-year-old male patient.

Figure 5

An atypical hemangioma can have mixed echogenicity with a dominant cystic portion. Mild through transmission points to the cystic nature of the hemangioma.

Figure 6

Large and multiple hemangiomas occupy the entire spleen. The hypoechoic areas shown in Figure 5 are filled with blood clots and thrombosis. The 48-year-old male received splenectomy due to LUQ pain caused by venous thrombosis in spleen.

Figure 7

An enlarged spleen (A) demonstrates a diffusely coarse echotexture with several mixed echoic lesions (B) in a 58-year-old male patient.

Figure 8

Splenic metastasis from a lung carcinoma in a 68-year-old male is seen as a hypoechoic mass with a target sign.

Figure 9

A peripheral wedge-shaped hypoechoic region (arrows) was noted at the upper pole of spleen from an infarction after transcatheter arterial embolization in a 45-year-old male with hepatoma.

Figure 10

A subcapsular crescent-shaped hypoechoic lesion is noted at the upper pole of spleen.

Figure 11

Several linear hypoechoic foci and a subcapsular fluid accumulation are noted in a spleen. Loss of the normal architecture was seen after a traffic accident in a 38-year-old male.

Figure 12

A splenic laceration and rupture (in Figure 11) is identified as a blood-filled cleft (lower arrow) and capsular rupture (upper arrow) on contrast CT.