Sonographic patterns in splenic infarct

Abstract

The sonographic findings in eight cases of splenic infarct at their onset and at different phases of their development have been retrospectively analyzed. A wide range of appearances was seen (single or multiple, rounded or wedge-shaped, echo-free, hypoechoic, and hyperechoic lesions). In our opinion, such variable appearances are related to the age of the infarct (hypoechoic or echo-free in the earlier stages, hyperechoic in healed infarcts). A presumptive diagnosis is possible in the earlier stages since the detection of changes (in echogenicity and/or in size) over a period of time strongly suggests an infarct. On the other hand, a hyperechoic wedge-shaped lesion is fairly typical of healed infarcts.

Chronic Recurring Infarction of the Spleen: Sonographic Patterns and Complications

“…The underlying pathological processes for this sonographic pattern include inflammation, oedema and necrosis [7]. In the second healing phase shrinking and fibrosis occur with an echogenic enhancement as demonstrated by sonography [4,6]. As a final state usually a completely homogeneous splenic texture is found and less frequently a slightly inhomogeneous structure of the splenic parenchyma characterized as a state of scarring [6,8].…”

“…Acute infarctions of the spleen have been described by sonography as triangular lesions with extensions to the periphery of the splenic parenchyma and variations in size and echomorphology [3,4]. Due to a high tendency of spontaneous healing of processes in the spleen, splenic infarctions heal in most cases [5,6].…”

The Sonographic “Bright Band Sign” of Splenic Infarction

“…Among the risk factors sought were malignancy, severe liver disease, history of hypotension, autoimmune disorders, wandering spleen, endocarditis, thromboembolic disease, trauma, collagen vascular disease, portal hypertension, and sickle cell disease. [2][3][4][5][6][7][8][9][10]12 Imaging Technique All sonographic examinations were performed by 1 of 6 licensed sonographers, each with 5 or more years of clinical experience, working under the supervision of radiology residents, body imaging fellows, and attending radiologists. Scanners included the Acuson Sequoia System 512 (Siemens Medical Solutions, Mountain View, CA) and the LOGIQ 9 system (GE Healthcare, Milwaukee, WI).…”

“…1 In other patients, splenic infarction may be an important clue to serious underlying diseases such as embolic, thrombotic, and hematologic disorders. [2][3][4][5][6][7][8][9][10] However, the sonographic diagnosis of splenic infarction may not be straightforward. Although the classic sonographic appearance of an acute splenic infarct is a peripheral wedge-shaped hypoechoic lesion showing diminished flow on Doppler interrogation, infarcts often do not show this classic appearance; they may be indistinguishable from other focal splenic lesions that also appear peripheral, Abbreviations CI, confidence interval; CT, computed tomography T ©2014 by the American Institute of Ultrasound in Medicine | J Ultrasound Med 2014; 33:929-938 | 0278-4297 | www.aium.org…”

“…hypoechoic, and hypovascular. [2][3][4][5][6][7][8][9] As a result, in many instances attempts are then made to confirm the diagnosis with either contrast-enhanced sonography or computed tomography (CT). However, contrast-enhanced sonography is not universally available, and CT may not be advisable, owing to radiation concerns, cost, renal insufficiency, a contrast agent allergy, or an unstable medical condition.…”