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Ultrasonography. The Spleen VCA 341 Dr. LeeAnn Pack lpack@upei.ca. Indications. Splenomegaly Palpable splenic mass Cranial abdominal organomegaly Lethargy, collapse Anemia, abnormal RBC’s. Ultrasound Technique. Left side of body Head of spleen Under border of rib cage on left

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slide1

Ultrasonography

The Spleen

VCA 341

Dr. LeeAnn Pack

lpack@upei.ca

indications
Indications
  • Splenomegaly
  • Palpable splenic mass
  • Cranial abdominal organomegaly
  • Lethargy, collapse
  • Anemia, abnormal RBC’s
ultrasound technique
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
anatomy
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
anatomy6
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
pathology
Pathology
  • Diffuse splenomegaly
    • Congestion
    • Torsion
    • Inflammation/septicemia
    • Neoplasia
      • Lymphosarcoma
      • Mast cell tumor
    • Phenothiazine tranquilizers & barbiturate anaesthetics
    • Extramedullary hematopoesis
pathology9
Pathology
  • Focal or multifocal splenic lesions
    • Hematoma
    • Infarcts
    • Cysts
    • Abscess
    • Nodular hyperplasia
    • Neoplasia
      • Hemangioma
      • Hemangiosarcoma
diffuse splenomegaly
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
focal multifocal lesions
Focal/Multifocal Lesions
  • More common than diffuse
  • Anechoic
    • Cysts
      • Hematoma/neoplasia
  • Hypoechoic
    • Neoplasia
    • Abscess
    • Acute infarct
    • Nodular hyperplasia
focal multifocal lesions13
Focal/Multifocal Lesions
  • Hyperechoic
    • Neoplasia
    • Abscess
    • Chronic infarct
    • Nodular hyperplasia
  • Mixed echogenicity
    • Neoplasia
    • Hematoma
    • Abscess
    • Nodular hyperplasia
torsion
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
neoplasia
Neoplasia
  • Lymphosarcoma
    • Diffuse or focal/multifocal
    • Hypoechoic or hyperechoic
    • Can appear normal
  • Hematoma, hemangioma, hemangiosarcoma
    • Unable to differentiate
    • Focal
    • Hypoechoic, hyperechoic or mixed
neoplasia22
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)
echogenic focal lesions
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
definitive diagnosis
Definitive Diagnosis
  • Ultrasonic appearance of most splenic diseases non-specific
  • Consider history, signalment, clinical signs
  • Fine needle aspirate useful
  • Biopsy generally not performed
rupture
Rupture
  • Free fluid within the abdomen
    • Often echoic (due to  blood cells)
    • May be anechoic
  • Most likely a tumor
  • Cannot rule out hematoma