Diseases of the Spleen

Diseases of the Spleen, Enlargement of the Spleen, Rupture of the spleen, hematologic disorders for which splenectomy is potentially therapeutic, heroditary spherocytosis, thalassemia, sickle cell anemia, idiopathic thrombocytopenic purpura, secondary hypersplenism, myeloid metaplasia, lymphoma, accessory spleen, splenic artery aneurysm, splenic cysts and tumors, splenic abscess



Splenic Abscess

Splenic abscesses may be due to trauma, thrombotic or embolic infarction, or the hematogenous spread of in¬fection. Multiple abscesses most frequently represent fungal infections in patients with immune deficiencies. Although most patients have fever, leukocytosis, and usually a mass or tenderness in the left upper quadrant, the clinical diagnosis of a splenic abscess may be very difficult, and a missed diagnosis can have fatal consequences. The plain radiographic findings of splenic abscess are variable and nonspecific, and include elevation of the left hemidiaphragm with sympathetic changes at the base of the left lung, splenomegaly, and extraluminal gas collections in the […]

Splenic Cysts and Tumors

Splenic cysts may be congenital, parasitic (primarily echinococcal), or post-traumatic, reflecting the final stage in the evolution of a splenic hematoma. Splenic cysts are variable in size and, when large, can produce discrete soft tissue densities in the left upper quadrant and displace adjacent contrast-filled organs. Calcification most frequently occurs in echinococcal cysts, which are often multiple and tend to have thicker and coarser rims of peripheral calcification than congenital or post-traumatic cysts. Because of its noninvasive nature, ultrasound is often the initial modality in evaluating a splenic cyst presenting as gross splenomegaly or a left upper quadrant mass. A splenic […]

Splenic Artery Aneurysm

Calcification within the media of the splenic artery is extremely common and produces a characteristic tortuous, corkscrew appearance. When viewed end-on, splenic artery calcification appears as a thin-walled ring. A similar, though larger circular pattern or bizarre configuration of calcification in the left upper quadrant can be due to a saccular aneurysm of the splenic artery. A definitive diagnosis of splenic artery aneurysm can be made by arteriography. splenic artery aneurysm · saccular aneurysm in spleen · splenic artery aneurysms ·

Accessory Spleen

Accessory spleens occur in 10 to 30 percent of the population as a result of the failure of fusion during embryonic life of some of the multiple buds of splenic tissue in the dorsal mesogastrium. Most accessory spleens are found in the hilar region, where they may be completely isolated from the spleen or connected to it by thin bands of tissue. These nodules of normal splenic tissue are often multiple and vary from a few millimeters to several centimeters in diameter. Most are small, are of no clinical significance, and are only detected on CT performed for an unrelated […]

Lymphoma

Lymphoma arises in the lymph nodes or in the lymphoid tissue of parenchymal organs such as the gastrointestinal tract, spleen, lung, or skin. Ninety percent of cases of Hodgkin’s disease originate in the lymph nodes; 10 percent are of extranodal origin. In contrast parenchymal organs are more often involved in non-Hodgkin’s lymphomas; about 40 percent of these lymphomas are of extranodal origin. The spleen is often affected in patients with lymphoma of both the Hodgkin’s and non-Hodgkin’s types. The best imaging modality is CT, which most commonly demonstrates splenomegaly with or without focal low-density nodules in the parenchyma. However, if […]

Myeloid Metaplasia

Myeloid metaplasia (myelofibrosis) is a hematologic disorder in which gradual replacement of the marrow by fibrosis produces a varying degree of anemia, and a leu-k’emoid blood picture. Exframedullary hematopoiesis causes massive splenomegaly and often hepatomegaly and may form tumorlike posterior mediastinal masses that can be seen on plain chest radiographs. Although the disease is most commonly idiopathic, a large percentage of patients have antecedent polycythemia vera. Myelofibrosis has also been reported in association with metastatic carcinoma, chemical poisoning, chronic infection, leukemia, and histiocytosis X. About halfjhe patients with myelofibrosis have radiographic evidence of osteosclerosis. This primarily affects the/spine, ribs, and […]

Idiopathic Thrombocytopenic Purpura Idiopathic Thrombocytopenic Purpura

Acute idiopathic thrombocytopenic purpura typically presents with the sudden onset of severe purpura 1 to 2 weeks after a sore throat or upper respiratory infection in an otherwise healthy child. In most patients, the disorder is self-limited and clears spontaneously within a few weeks. Unlike the acute form, chronic idiopathic thrombocytopenic purpura occurs primarily in young women and has an insidious onset with a relatively long history of easy bruising and menorrhagia. Because most patients with this condition have a circulating platelet autoantibody that develops without underlying disease or significant exposure to drugs, chronic idiopathic thrombocytopenic purpura is generally considered […]

Sickle Cell Anemia

n sickle cell anemia, secondary bone marrow hyperplasia is accompanied by focal ischemia and infarction in multiple tissues due to sludging of the abnormally shaped red blood cells. The findings are similar to those in thalassemia, though in sickle cell disease the radio-graphic changes are less frequent and tend to be less severe. In the spine, expansile pressure of the adjacent in-tervertebral disk produces characteristic biconcave indentations on both the superior and the inferior margins of the osteoporotic vertebral bodies (“fish” vertebrae). Another typical appearance is the development of localized steplike central depressions of multiple vertebral end plates. This is […]

Thalassemia

Thalassemia is a hereditary disorder of hemoglobin synthesis that causes a severe anemia and occurs predominantly in persons living about the Mediterranean, especially those of Italian or Greek descent. Thalassemia major (Cooley’s anemia) is a severe anemia of infants and children that produces more dramatic radiographic findings than any of the other childhood hemolytic anemias. Extensive marrow hyperplasia, the result of ineffective erythropoiesis and rapid destruction of newly formed red blood cells, causes pronounced widening of the medullary spaces and thinning of the cortices. As the fine secondary trabeculae are resorbed, new bone is laid down on the surviving trabeculae, […]

Hereditary Spherocytosis

Hereditary spherocytosis is transmitted as an autosomal dominant trait and is the most common of the symptomatic familial hemolytic anemias. Because the anemia of hereditary spherocytosis is usually mild, bone changes are infrequent. With severe anemia, marrow hyperplasia can cause radiographic abnormalities that resemble those seen in thalassemia, except that they are of lesser degree and are usually limited to the skull (widening of the diploe, displacement and thinning of the outer table, hair-on-end appearance). Extramedullary erythropoiesis may produce paravertebral masses visible on chest radiographs. Excessive red blood cell destruction may lead to the formation of bilirubin stones that appear as […]

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