Incidental Focal Spleen Lesions: Integrated Imaging and Pattern Recognition Approach to the Differential Diagnosis

Abstract

Spleen lesions and pseudolesions, detected incidentally in imaging, are not uncommon and may require further work-up. The imaging appearance of focal splenic lesions (FSLs) may not be pathognomonic, because of considerably overlapping features. Consequently, all imaging techniques lack specificity to fully characterize FSLs. Clinical correlation is mandatory, so as, first of all, to categorize the patient as having or not having a history of solid or hematologic malignancy. Nowadays, many patients have old imaging studies available for comparison and, consequently, it is important to understand if the lesion was previously present or not, and if the size is the same or has changed. In the absence of comparison studies, and with a lack of imaging features of benignity, further investigation may be necessary, using PET, biopsy, or short-term follow-up. Some algorithms have been proposed to manage incidental FSLs; however, none of these strategies has been validated by prospective studies to date. In this review we illustrate the topic of incidental FSLs and we analyze a number of published algorithms.

Urgent Rare Surgical Complication Assessment of Intestinal Gastrointestinal Stromal Tumors

“…GISTs are rare tumors originating from the interstitial cells of Cajal in the muscularis propria, although they are considered the most common mesenchymal tumor of the GI tract (incidence worldwide of 1-2 per 100,000). They arise from abnormal proliferation of interstitial cells of Cajal that are electrical pacemakers and mediators of enteric neurotransmission in the muscularis propria of the GI tract, with 95% of the tumors staining positive for CD117 (c-KIT) and 70% for CD34 [14], in most cases caused by oncogenic activating mutation of the receptor tyrosineproteinkinase [1][2][3]. Their incidence is very uncommon when compared to GI carcinoma [15] and they usually occur after 40 years of age, most commonly in older patients (median age 60-65 years) with a slight male predilection [9,10].…”

Breast ultrasound: An opportunity to detect unsuspected pleural and pulmonary abnormalities

“…In comparison with other methods, US can highlight small effusions <15 mL unlike chest x‐ray, which requires a minimum of 150 mL 33 . US is comparable to computed tomography (CT), even if CT itself has some limitations; indeed, it is a method compulsorily performed in the supine position, unlike US, and it is not able to optimally differentiate the consolidation portion from the liquid portion in cases where it is performed without a contrast medium 43–45 . Therefore, US is a method capable of early detecting the formation of a pleural effusion, which can be extremely useful in patients with suspected extension of neoplastic disease of the breast both in the primary form and as a relapse of the disease 46,47 …”

Noninfectious Granulomatous Lung Disease: Radiological Findings and Differential Diagnosis

“…Early PLCH can have the same features as RB-ILD, presenting as bronchiolocentric ill-defined micronodules generally associated with mild centrilobular emphysema [32]. Differential diagnosis with GPA can be challenging due to the bronchiolocentric distribution of micronodules, often cavitated [102][103][104][105].…”