Questions and Answers
What structures are in contact with the spleen?
What view provides the best long axis image of the spleen?
What are some causes of mild to moderate splenomegaly?
What have you most likely detected if you find a small, rounded mass at the splenic hilum that is homogeneous and isoechoic with the spleen?
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What is the most common finding in the spleen in patients with AIDS?
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What is the typical appearance of a hypoechoic, wedge-shaped lesion within the spleen?
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What would be most helpful in improving diagnostic confidence with a finding of a hypoechoic, wedge-shaped lesion within the spleen?
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What condition do you suspect if you detect moderate splenomegaly and dilated, tortuous vessels at the splenic hilum?
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What additional evaluation should you perform if you find moderate splenomegaly and dilated tortuous vessels suggestive of portal hypertension?
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Which structure will you detect at the splenic hilum?
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What is the relationship of the pancreatic tail to the spleen?
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What term can be used to describe the normal sonographic appearance of the splenic parenchyma?
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What transducer would provide the highest resolution images of the spleen?
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What is true regarding the spleen?
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What are some pitfalls you might encounter in ultrasound scanning of the spleen?
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What findings of the spleen are commonly seen in a patient with histoplasmosis?
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The splenic vein drains into what?
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What is associated with a history of recent blunt left-sided trauma in a motor vehicle accident?
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What do multiple hyperechoic masses within the spleen most likely represent in a patient with malignant melanoma?
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What should you do if you detect a calcified ring at the splenic hilum during abdominal sonography of a patient with portal hypertension and splenomegaly?
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What are some features you would detect in a splenic cyst?
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Study Notes
Spleen Anatomy and Relationships
- Located in the left upper quadrant, significant structures in contact with the spleen include the left hemidiaphragm, stomach, pancreas, and splenic flexure of the colon.
- The splenic hilum contains the splenic vein.
Ultrasound Techniques and Findings
- The best long-axis image of the spleen is obtained using the intercostal coronal view with the patient in a supine position.
- A 5.0 MHz curved linear array transducer provides the highest resolution images of the spleen.
- Moderate splenomegaly is typically associated with portal hypertension and infections, including AIDS.
Spleen Conditions and Diagnostic Indicators
- Detection of a small, homogeneous, isoechoic mass at the splenic hilum usually indicates an accessory spleen.
- Splenic infarction presents as a hypoechoic, wedge-shaped lesion within the spleen.
- In cases of blunt left-sided trauma, associated findings may include splenic laceration, subscapular hematoma, free fluid, and perisplenic hematoma.
Disease Associations
- HIV/AIDS patients generally show moderate splenomegaly on ultrasound.
- Histoplasmosis can result in multiple focal, bright echogenic granulomatous lesions throughout the spleen.
- Multiple hyperechoic masses in patients with malignant melanoma suggest metastasis to the spleen.
Complications and Evaluation Strategies
- Portal hypertension can be assessed through the presence of moderate splenomegaly and dilated tortuous vessels at the hilum, prompting evaluation of the liver and portal vein.
- Color Doppler evaluation is critical for assessing lesions suggestive of infarction or for investigating calcified rings at the splenic hilum during ultrasound.
Normal Sonographic Characteristics
- The normal splenic parenchyma appears homogeneous with mid to low-level echogenicity and can present challenges in ultrasound due to potential pitfalls, such as:
- Rib shadows obscuring splenic parenchyma during intercostal scanning.
- Mistaking the left lobe of the liver for the spleen in hepatomegaly.
- Confusing masses in the tail of the pancreas with splenic masses.
Splenic Cyst Features
- Splenic cysts are characterized by smooth borders, posterior acoustic enhancement, an anechoic appearance, and a rounded shape.
Spleen Overview
- The average adult spleen measures approximately 12 cm in length and is classified as an intraperitoneal organ. It tends to decrease in size and weight with age.
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Description
Test your knowledge about the spleen with these flashcards. This quiz covers anatomical relationships, imaging views, and sonographic techniques associated with the spleen. Perfect for students in sonography or ultrasound training.
