Sonography of the Spleen

Abstract

This pictorial essay will review and discuss the aspects of differential diagnosis with splenic sonography, including recent literature and exemplary pictorial sonographic cases. Although the spleen is well evaluated by computed tomography and magnetic resonance imaging, sonography has certain advantages, including its ubiquitous availability, lack of ionizing radiation, and low cost. Sonography of the spleen plays an important role in emergency diagnosis of splenic rupture and hemorrhage. The additional use of contrast-enhanced sonography can improve the diagnostic validity. Depending on the indication, sonography of the spleen is especially important for oncologic differential diagnosis of focal lesions, follow-up examinations, and image guidance of therapeutic interventions.

Focal splenic lesions: US findings

“…The incidence of angioma ranges from 10 to 14.56 % and prevalence at autopsy is 0.3-14 % [2,18,19]. This benign tumor derives from the sinusoidal epithelium and is characterized by proliferation of spaces containing blood and covered with endothelium, it may contain capillaries and/or cavernous vascular channels, and may be prone to thrombosis and hemorrhage [8]. Angioma is usually asymptomatic and it is often an incidental finding, but large peripheral angiomas may rupture and cause bleeding.…”

“…In HIV infected patients, histoplasmosis, Pneumocystis carinii and Mycobacterium avium intracellulare are common causes of splenic calcifications. US shows multiple, disseminated, hyperechoic lesions in some cases with a small shadow cone [8]. Focal accumulation of hemosiderin and calcium deposition in the splenic parenchyma secondary to hemorrhage are called Gamna-Gandy bodies which are common in patients with cirrhosis and portal hypertension as well as in patients with schistosomiasis, splenic vein thrombosis, hemolytic anemia, hemochromatosis and secondary to trauma [2].…”

“…World population incidence of focal splenic lesions ranges from 0.103 to 0.20 %; of these lesions true cysts account for 21.35 %, angiomas 14.56 %, calcification and infarctions 9.7 %, pseudocysts, also referred to as false cysts, 8.73 %, lymphomas and abscesses 7.76 %, and metastases 4.85 % [2,3]. Unlike liver lesions, focal lesions of the spleen have so far received little attention and they have often been considered to be poorly specific findings.…”

“…Currently the indications for US imaging of the spleen are the following: measurement of splenic dimensions, evaluation of changes in splenic volume in patients with hematologic diseases, diagnosis of focal lesions (cyst, tumor, infarction, abscess, calcification), evaluation of splenic vessels, portal hypertension and US-guided interventional procedures involving the spleen [1,[6][7][8].…”

Nonalcoholic fatty liver disease (NAFLD) and Portal Hypertension in Egyptian Patients

“…Abdominal ultrasound imaging using Toshiba "Just Vision" real-time scannerinstrument with a 3.5 MHz convex transducer was performed to all participants. Thepatients were scanned in the supine position with comment on: liver size, echogenicity,splenic size according to its longest axis (normally it is up to 12-13cm (7) , and PVdiameter and patency. Measurement of the portal vein diameter was taken in quietrespiration at the hilum of the liver just before bifurcation into right and left.…”