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Ultrasonography The Spleen VCA 341 Dr. LeeAnn Pack

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1 Ultrasonography The Spleen VCA 341 Dr. LeeAnn Pack

2 Spleen Indications  Splenomegaly  Palpable splenic mass  Cranial abdominal organomegaly  Lethargy, collapse  Anemia, abnormal RBC’s

3 Spleen Ultrasound Technique  Left side of body  Head of spleen –Under border of rib cage on left  Body & tail of spleen –Along left body wall –Ventral or lateral to left kidney  Scan sagittal & transverse

4 Spleen Anatomy  Size of normal spleen variable –Assessed subjectively –Enlarged spleen may cross midline or extend caudally to the bladder  Parenchyma –Homogenous, finely textured  Echogenicity –Dog:Spleen > liver > kidney –Cat:Spleen = liver > kidney

5 Spleen Normal Spleen

6 Spleen Anatomy  Capsule –Smooth, regular, VERY echogenic  Splenic veins –Only other structure normally visualized –Poorly visualized except near hilus “Whale tail” –Enlargement subjective  Hilus –Check for lymphadenopathy

7 Spleen Splenic Hilus

8 Spleen Pathology  Diffuse splenomegaly –Congestion –Torsion –Inflammation/septicemia –Neoplasia Lymphosarcoma Mast cell tumor –Phenothiazine tranquilizers & barbiturate anaesthetics –Extramedullary hematopoesis

9 Spleen Pathology  Focal or multifocal splenic lesions –Hematoma –Infarcts –Cysts –Abscess –Nodular hyperplasia –Neoplasia Hemangioma Hemangiosarcoma

10 Spleen Diffuse Splenomegaly  Diffuse increase in echogenicity uncommon –Neoplastic (mast cell or lymphosarcoma)  Diffuse decrease in echogenicity more common –Congestion –Extra-medullary hematopoesis –Lymphosarcoma –Inflammation/ septicemia –Torsion  Normal echogenicity can occur with lymphosarcoma & mast cell tumor

11 Spleen Non Homogenous

12 Spleen Focal/Multifocal Lesions  More common than diffuse  Anechoic –Cysts Hematoma/neoplasia  Hypoechoic –Neoplasia –Abscess –Acute infarct –Nodular hyperplasia

13 Spleen Focal/Multifocal Lesions  Hyperechoic –Neoplasia –Abscess –Chronic infarct –Nodular hyperplasia  Mixed echogenicity –Neoplasia –Hematoma –Abscess –Nodular hyperplasia

14 Spleen Splenic Mass

15 Spleen Splenic Mass

16 Spleen Splenic Infarct

17 Spleen Torsion  Definitive diagnosis by ultrasound  Characteristic appearance –Severe, diffuse splenomegaly –Hypoechoic –Coarse & “lace-like” –Venous blood flow absent on Doppler –+/- hyperechoic venous thrombi  Lymphosarcoma can appear similar –Normal blood flow

18 Spleen Torsion

19 Spleen Neoplasia  Lymphosarcoma –Diffuse or focal/multifocal –Hypoechoic or hyperechoic –Can appear normal  Hematoma, hemangioma, hemangiosarcoma –Unable to differentiate –Focal –Hypoechoic, hyperechoic or mixed

20 Spleen Lymphosarcoma

21 Spleen Hemangiosarcoma

22 Spleen Neoplasia  Other neoplasms –Mast cell tumor, leiomyoma, etc.  Presence of peritoneal effusion not a good indication of malignancy  Metastasis –Lungs, liver, lymph nodes (splenic, hepatic, gastric)

23 Spleen Echogenic Focal Lesions  Focal fat deposits –Especially cats –Surround hepatic veins (myelolipomas)  Fibrosis & calcification –Secondary to hematoma, chronic infarcts or granulomas (histoplasmosis)  Primary or metastatic neoplasia

24 Spleen Definitive Diagnosis  Ultrasonic appearance of most splenic diseases non-specific  Consider history, signalment, clinical signs  Fine needle aspirate useful  Biopsy generally not performed

25 Spleen Rupture  Free fluid within the abdomen –Often echoic (due to  blood cells) –May be anechoic  Most likely a tumor  Cannot rule out hematoma

26 Spleen Thrombosis

27 Spleen Splenic Thrombus

28 Spleen Myelolipoma


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