Ultrasonography

The Spleen
VCA 341 Dr. LeeAnn Pack lpack@upei.ca

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Indications

Splenomegaly Palpable splenic mass Cranial abdominal organomegaly Lethargy, collapse Anemia, abnormal RBCs

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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

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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: Cat: Spleen > liver > kidney Spleen = liver > kidney

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Normal Spleen

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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

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Splenic Hilus

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Pathology

Diffuse splenomegaly
Congestion Torsion Inflammation/septicemia Neoplasia
Lymphosarcoma Mast cell tumor

Phenothiazine tranquilizers & barbiturate anaesthetics Extramedullary hematopoesis

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Pathology

Focal or multifocal splenic lesions

Hematoma Infarcts Cysts Abscess Nodular hyperplasia Neoplasia
Hemangioma Hemangiosarcoma

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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

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Non Homogenous

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Focal/Multifocal Lesions

More common than diffuse Anechoic

Cysts
Hematoma/neoplasia

Hypoechoic
Neoplasia Abscess Acute infarct Nodular hyperplasia

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Focal/Multifocal Lesions

Hyperechoic
Neoplasia Abscess Chronic infarct Nodular hyperplasia

Mixed echogenicity
Neoplasia Hematoma Abscess Nodular hyperplasia

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Splenic Mass

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Splenic Mass

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Splenic Infarct

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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

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Torsion

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Neoplasia

Lymphosarcoma
Diffuse or focal/multifocal Hypoechoic or hyperechoic Can appear normal

Hematoma, hemangioma, hemangiosarcoma

Unable to differentiate Focal Hypoechoic, hyperechoic or mixed

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Lymphosarcoma

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Hemangiosarcoma

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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)

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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

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Definitive Diagnosis

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

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Rupture

Free fluid within the abdomen

Often echoic (due to blood cells) May be anechoic

Most likely a tumor Cannot rule out hematoma

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Thrombosis

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Splenic Thrombus

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Myelolipoma