Normal spleen

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Splenic variantEctopic position of the spleen-:

Left flank Pelvis Posterior to the left kidney

Splenic variantSplenunculi( accessory spleen )• Small ectopic nodule of splenic tissue usually situated near the hilum of the spleen.• Recieves its blood supply from splenic arterySonogrphically • Appears as well defined oval or rounded exceed 4 cm in diameter • Has a normal splenic acoustic characteristics • Not visible on ultrasound unless splenomegaly is present • A splenunculus may enlarge in post splenectomy patients

Pathology of the spleen

Splenomegally • Enlargement of the spleen is a highly non specific sign associatede with numerous conditions as • Infection due to rubella • Portal hypertension , • Neoplastic conditions as lymphoma • The aetiology of splenomegaly can not be usually detected on ultrasound

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Splenomegally • Enlargment of the spleen is considered when its long axis exceeds 12 cm• The spleen enlarges downwards and medially • Its inferior margin becomes rounded and may extend below the left kidney.

Benign splenic conditions

Splenic cysts Types of splenic cysts • Simple cysts• Post traumatic cysts ( liquefied haematoma )• Hydatid cyst • Cystic metastasis

Haemangioma • Rare in the spleen• Usually well defined hyperechoic focal lesion , rarely contain cystic areas

Splenic abscess • Uncommon

Causes: -• Amoebic or fungal infection• Blood born bacterial infection• Post traumatic

Splenic abscess Clinical presentation:-

upper abdominal pain and fever

Ultrasound appearance-: Similar to liver abscess

Splenic calcification• Calcifications may occur in old inactive abscess cavities• Associated with traumatic injury • In old resolving post traumatic haematoma

Splenic trauma • Splenic laceration is not usually detect by US especially in the immediate post- trauma phase• The laceration appears sonographically as hyperechoic line within the spleen • A frank area of haemorrhag may be detected

Splenic trauma

Malignant splenic diseases

Lymphoma • The most common malignant disease affecting the spleen

Clinical features-: • Anaemia • General fatigue• Weight loss• Fever • Sweating • Infection and decressed immunity

Lymphoma Ultrasound appearance :-• In many cases there is no sonographic abnormalities• Diffuse splenic enlargement with normal , hypo- or hyperechogenicity • Single or multiple and of varying sizes hypoechoic , anechoic , hyperechoic or mixed echogenicity • Lymphadenopathy may be seen elsewhere in the abdomen

Metastases Metastases occurs in the spleen much less commonly than in the liver

Sonographic appearance :-As in the liver

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