spleen pathology

splenomegaly

the upper limit of normal for an adult spleen is 14cm.


splenomegaly can have many causes including:

  • masses (for example lymphoma)
  • infective (for example glandular fever)
  • haemolytic (for example leukaemia)
  • congestive (for example portal
  • hypertension)

ultrasound image- an 18cm long spleen.

note the rounded ends and lobulated undersurface

ascites and splenic varices

  • varices are often secondary to portal hypertension.

ultrasound image- ascites.

lymphoma

lymphoma will generally cause splenomegaly.

only some instances of foacl metastatic lymphomatous masses will occur within the spleen.

note: not all splenic masses are lymphomas.

ultrasound image- multiple rounded hypoechoic lesions in the spleen.

ultrasound image- a hypoechoic mass abutting the splenic hilum.  differential diagnosis included splenic vein thrombosis, however the separate splenic vessels are visible on power doppler.

splenic calcifications

indicates chronic or past infective processes.

multiple punctate calcifications can be present from chronic infections such as tb or brucellosis, or from sickle cell disease.

ultrasound image- this patient had splenomegaly secondary to haemolytic disease.

the micro-calcification was idiopathic.

ultrasound image- this was an instance of histoplasmosis (a fungal disease from guano).

splenic mass

rarely, a primary mass will develop in the spleen.

ultrasound image-  primary splenic mass.

splenic trauma

  • haematomas: subcapsular and extra-capsular
  • splenic infarcts – clinically it varies, patients may have no symptoms , diffuse abdominal pain or luq pain. an acute splenic infarction will appear as a hypoechoic , wedge shaped parenchymal lesion. it extends to the splenic margin. the apex of the wedge will point towards the hilum and the base at the outer edge. this will help distinguish it from an abscess or splenic neoplastic mass.

splenic infarct

ultrasound image- splenic infarct.
there is a typical wedge shaped appearance with the base at the outer edge and the apex towards the hilum.
to prove this was an infarct a ct was performed.

ct of the previously shown ultrasound.

splenic haematoma

ultrasound image- power doppler used to check for uniform perfusion of the spleen, and no active flow into the hematoma.

ultrasound progress views of a splenic haematoma.

by increasing the gain settings, the complexity of the organising haematoma is evident.

this is important in any fluid collection, particularly prior to attempted aspiration.

ultrasound image- a post traumatic haematoma of the spleen.
the complex subcapsular collection is seen to compress the spleen where-as an extra-capsular rupture is more likely to be free fluid with less mass effect.
ensure there is uniform perfusion of the spleen using power doppler.

splenic metastases

“the most common primary sources of splenic metastasis are breast, lung, colorectal, and ovarian carcinomas and melanoma in cases of multivisceral cancer and colorectal and ovarian carcinomas in cases of solitary splenic lesion.” [ref:arch pathol lab med. 2007 jun;131(6):965-9.
splenic metastases: clinicopathologic presentation, differential diagnosis, and pathogenesis.]

ultrasound image- splenomegaly with metastases.

ultrasound image- multiple echogenic lesions in the spleen consistent with metastases.