Spleen Powerpoint Second 1/2

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1

Bone marrow

Hemoglobin

Polycythemia Vera:

Chronic disease of unknown cause that involves all ___ ___ elements

Characterized by an increase in RBC mass and ____ concentration

Symptoms - weakness, fatigue, vertigo, tinnitus, irritability, splenomegaly, flushing of the face, redness and pain in the extremities, and blue and black spots

2

Firm; red

Infarctions

Polycythemia Vera: Sonographic Findings

  • Spleen is variably enlarged, rather ___ and blue-___
  • ____ and thromboses (hyperviscosity) are common

Symptoms - weakness, fatigue, vertigo, tinnitus, irritability, splenomegaly, flushing of the face, redness and pain in the extremities, and blue and black spots

3

RBCs; hemoglobin

RBCs; large

Thalassemia:

Hemolytic hemoglobinopathy anemia is characterized by microcytic, hypochromic, and short-lived ___ caused by deficient synthesis of ____ polypeptide chains

Lifespan of the ___ is short because they are destroyed by the spleen in ___ numbers

4

Polypeptide; two

Large

Thalassemia:

Is classified according to the _____ chain involved, with alpha-thalassemia and beta- thalassemia being the ___ major categories

Sonographic finding is a very ____ spleen

5

Bone marrow; WBCs; hypoechoic

Leukemia; polycythemia; leukemia

Myeloproliferative Disorders: Diseases in which the ___ ___ makes too many RBCs, platelets, or certain __. Sonographic findings - isoechoic pattern because the parenchyma is ____ compared with the liver

  • Acute and chronic myelogenous ____
  • ____ vera
  • Myelofibrosis
  • Megakaryocytic ____
  • Erythroleukemia
6

Hyperplasia

Splenomegaly; shadowing; tuberculosis; sarcoidosis

Granulocytopoietic Abnormalities: Include cases of reactive ____, resulting from acute or chronic infection (ex splenic sarcoid, tuberculosis)

Sonographic findings - ____ is seen with a diffusely hypoechoic pattern; patients who have had previous granulomatous infection have bright echogenic lesions on ultrasound with or without ___; histoplasmosis and ____ are the most common causes; ___ is rare

7

Multiple

Enlarged

Abscess

Specifically

Focal Disease: May be single or ___

May be found in a normal or an ____ spleen

Major nontraumatic causes - tumor, infarction, ___ and cyst

Splenic defects may be discovered incidentally, as in another imaging study, or ____, as in the case of a splenic infarction or abscess

8

Myelogenous

Lymphocytic

Leukemia:

Chronic ____ leukemia may be responsible for more extreme splenomegaly than any other disease

Chronic ___ leukemia produces less severe splenomegaly

9

Uncommon

Endocarditis; immunologic

Splenic Abscess:

____, probably because of the phagocytic activity of the spleen and leukocytes

Reticuloendothelial system may be infected by - subacute bacterial ____, septicemia, decreased ____ states, and drug abuse

10

Foci; inflammatory

Subtle; left

Splenic Abscess: Infection is spread either from distant ____ in the abdomen or an ____ process that extends directly from adjacent organs

Clinical findings - may be ____, fever, LUQ tenderness, abdominal pain, ___ shoulder pain, flank pain, and splenomegaly

11

Mixed

Hypoechoic; foci

Anechoic; transmission

Splenic Abscess: Sonographic findings

Simple cyst to ___ echo pattern

Lesion may be ____, often with a hyperechoic ___ that represent debris or gas

Other findings: thick or shaggy walls, ____ appearance, poor definition of lesion, increased to decreased ____

12

Spleen

Splenomegaly

Immunocompromised

Splenic Infection:

Many infections can affect the ____

Most prominent feature is ____

Many ____ patients also have multiple nodules within the ____

13

Candidiasis; fibrosis; echogenic; hypoechoic

Bull's eye; hypoechoic; hyperechoic

Splenic Infection: Sonographic Findings

Patients with hepatosplenic ____ may show (1) irregular masses within spleen, (2) the "wheels-within-wheels" pattern, with the outer wheel representing the ring of ___ surrounding the inner ____ wheel of inflammatory cells, and (3) a central ____ area

Other patterns found are (1) ___ ___ (hypoechoic rim with a echogenic rim with a echogenic central core), (2), ____ nodule, or (3) ____ nodule

14

Mycobacterial; tiny

Tuberculosis; cystic; lesions

Mononucleosis

Splenic Infection: Sonographic Findings

Patients with ____ infection show ___, diffuse echogenic foci throughout the speen

Active ___ shows echo-poor or ___ masses, representing small abscess ___

Splenic enlargement from ____

15

Moderate

Focal; hypoechoic

Acquired Immunodeficiency Syndrome:

Multiorgan involvement

Sonographic findings: ____ splenomegaly

Additional findings - ____ splenic lesions displaying small round lesions that may be multiple, ____ and well-defined. Hepatomegaly with focal lesions, retroperitoneal lymphadenopathy, and ascites.

16

Occulusion

Emboli

Splenic Infarction: Most common cause - ____ of the major splenic artery or any of its branches

Are almost always the result of ___ that arise in the heart, produced either from mural thrombi or from vegetation on the valves of the left side of the heart

Other causes include septic emboli and local thrombosis in patients with ____, leukemia, lymphomatous disorders, sickle cell anemia, sarcoidosis, and polyarteritis nodosa.

17

Hypoechoic

Fresh; healed

Nodular

Splenic Infarction: Sonographic Findings

May see localized ___ area, depending on the time of onset

___ hemorrhage has a hypoechoic appearance; ____ infarctions appear as echogenic, peripheral, wedge-shaped lesions with their base toward the subcapsular surface of the spleen.

Infarction may become ___ or hyperechoic with time

18

Most commonly

LUQ; hematoma; hematoma

Spenic Trauma: The spleen is the ____ ____ commonly injured as a resutl of blunt abdominal trauma

If the patient has severe ___ pain secondary to trauma, a splenic _____ or subcapsular ___ should be considered.

The tear may result in linear or stellate lacerations or capsular tears, puncture wounds from foreign bodies or rib fractures, or subcapsular hematomas.

19

Intact; ruptures

Free fluid

Splenic Trauma: If the capsule is ___, the outcome may be intraparenchymal or subcapsular hematoma; if the capsule ____, a focal or free intraperitoneal hematoma may form. In delayed ruptures, a subcapsular hematoma may develop with subsequent rupture

Quick assessment of ___ ____ that may surround the splenic capsule in a blunt abdominal trauma can be a life-saving diagnosis for the patient

20

LUQ; hypotension; hemoglobin

Lavage; exploratory

Splenic Trauma: Patient typically has ___ pain, left shoulder pain, left flank pain and dizziness. May have tenderness of the LUQ, ___ and decreased ____, which indicates a bleed.

A timely response to this emergent situation may save the patient from having to undergo peritoneal ____ or ____ surgery.

21

5

Kidneys

Liver

Anterior; free fluid

Splenic Trauma: Sonographer should quickly examine the 4 quadrants. The entire exam should take less than ___ minutes.

  • Area surrounding the ___ (Morison's pouch)
  • Subdiaphragmatic areas
  • ___ and splenic capsule
  • Bladder and ___ rectal area to determine if ___ ___ is present
22

Blood; splenomegaly

Hematoma; pleural effusion

Splenic Trauma: If the spleen has been lacerated and ___ is contained within the splenic capsule, the most prominent sonographic finding is ____, with progressive enlargement as the bleeding continues.

Irregular splenic border, ____, contusion, subcapsular and pericapsular fluid collections, free intraperitoneal blood, or left ___ ____ may be present

23

Intrasplenic; perisplenic

Fresh; hematoma

Blood

Splenic Trauma: Focal hematoms may have ____ fluid collections. ____ fluid is seen in patients with subcapsular hematomas.

Fresh hemorrhage may appear ___ - double contour sign depicts ___ as separate from the spleen

___ exhibits various echo patterns, depending on how much time has elapsed since the trauma.

24

Parasitic; nonparasitic

Secondary

Echinococcus

Anechoic; daughter; calcification

Splenic Cysts: May be classified as ___ or ___ in origin

Most are ___ cysts caused by trauma, infection, or infarction

____ is the only parasite that forms splenic cysts; it is uncommon in the US

Parasitic cysts may appear as ___ lesions with possible ___ cysts and ___ or as solid masses with fine internal echoes and poor distal enhancement.

25

Rare

Splenomegaly; isoechoic: benign

Benign Primary Neoplasms:

Primary splenic tumors are ___; may be benign or malignant

Benign primary tumors - ____ is the first indication of an abnormality; most of these tumors appear ____ compared to the normal splenic parenchyma; ____ primary tumors include hamartoma; cavernous hemangioma, and cystic lymphangioma.

26

Asymptomatic

Solitary or multiple

Lymphoid

Solid and cystic; hyperechoic

Hamartoma: Patient is ____

Tumor may be ___ or ____ and is considered well-defined but not encapsulated

Consists of ___ tissue or a combination of sinuses and structures equivalent to pulp cords of normal splenic tissue

Sonographic findings - has both ___ and ___ components; generally ____

27

Isolated; hypoechoic

Symptomatic; rupture

Cavernous Hemangioma:

Usually an ____, inhomogeneous, echogenic mass with multiple small ____ areas

Patient becomes ______ when the size of the spleen increases and compresses other organs. Complications occur when the tumor increases in size to cause a splenic ___ with peritoneal symptoms.

28

Variable; infarction

Cavernous Hemangioma: Sonographic findings

Sonographic appearance is ___, from a well-defined echogenic appearance to a complex mixed pattern. ____ with coagulated blood or fibrin in the cavities may be seen but is unspecific.

Differential diagnosis: hydatid cyst, abscess, dermoid, and mets

29

Benign; soft tissue

Multiple

Cystic Lymphangioma:

____ malformation of lymphatic vessels, consisting of endothelium-lined cystic spaces. Lymphangiomatosis affects predominately the somatic ___ ___ (found in the neck, axilla, mediastinum, retroperitoneum, and soft tissue of the extremities)

May involve ____ organ systems or be confined to solitary organs such as the liver, spleen, kidney or colon

30

Extensive

Rare

Cystic Lymphangioma: Sonographic Appearance

Appears as a mass with ____ cystic replacement of splenic parenchyma

Splenic involvement is ___; however, when it occurs, a multicystic appearance is characteristic

31

Primary; hemangisarcoma

Mixed

Hemangiosarcoma: Primary splenic tumors are rare and may be benign or malignant

____ tumors of the spleen include lymphoma, Hodgkin tumor, or hemangiosarcoma. ____ is a malignant neoplasm arising from the vascular endothelium of the spleen

Sonographic findings - ___ cystic ultrasound pattern of hemangiosarcoma or resembles a cavernous hemangioma

32

Lymphoma

Hypoechoic; diffuse

Lymphoma: The spleen is commonly involved in ____.

Sonographic findings - typically ____; some focal areas also seen

Four different sonographic patterns have been cited in patients with malignant lymphoma - diffuse involvement, focal small nodular lesions, focal large nodular lesions, and bulky disease. ___ or small nodular pattern was seen predominantly in low-grade lymphomas and in Hodgkin lymphoma.

33

Metastases

10th

Metastatic; symptoms

Metastases:

____ are the result of a hematogenous spread from another primary site

The spleen is the ___ most common site of METS, from the breast, lung, ovary, stomach, colon, kidney, or prostate as well as from melanoma.

___ tumors may be microscopic, causing no ___

34

Abnormalities

Melanoma; lymphoma

Metastases: Sonographic Findings

Careful examination of the splenic parenchyma is necessary to look for ____

___ deposits appear hypoechoic but are higher in echo amplitude than ___; some are echodense