Ultrasonographic atlas of splenic lesions

Abstract

Ultrasonography (US) is widely used for abdominal imaging. Its noninvasiveness, extensive range of application, and low cost make US a useful and valuable tool for the detection, diagnosis, and follow-up of splenic abnormalities. As more splenic lesions are discovered with increasing imaging, the requirements for differential diagnosis are also rising. In this pictorial essay, we introduce representative US findings of many different splenic lesions including normal sonographic findings, normal variants and congenital anomalies, infectious conditions, benign and malignant neoplasms, and non-neoplastic lesions. Knowledge of the US features of various splenic lesions will help narrow the differential diagnosis and guide clinical decision-making.

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

“…Abscesses may contain echogenic components, due to debris, or hyperechoic foci, due to air bubbles. Doppler techniques and CEUS may demonstrate hypervascularity within the thick wall but always show absence of internal flows [15,28]. Candida infections show a "bulls-eye" or a "wheel within a wheel" pattern, consisting of different layers of necrosis, inflammation, and fibrosis [28].…”

“…Doppler techniques and CEUS may demonstrate hypervascularity within the thick wall but always show absence of internal flows [15,28]. Candida infections show a "bulls-eye" or a "wheel within a wheel" pattern, consisting of different layers of necrosis, inflammation, and fibrosis [28]. On CT, abscesses are hypo-attenuating and hypo-enhancing.…”

“…At US, hemangiomas may appear as hyper-echoic or, less frequently, as hypo-echoic. Smaller hemangiomas are usually homogeneous, while larger ones may show a complex solid and cystic appearance [28]. Punctate or curvilinear peripheral calcification is possible [21].…”

“…Punctate or curvilinear peripheral calcification is possible [21]. On Doppler imaging there may be peripheral vascularity or absent vascularity [28]. At unenhanced CT, the lesion is iso-attenuating or, more frequently, hypo-attenuating [29].…”

“…At imaging assessment, these lesions appear thin walled and sharply marginated, without any significant contrast enhancement. Vascularity along the walls in Doppler imaging is helpful for the diagnosis [28]. Intervening fibrous stroma can appear as septa, with calcifications or progressive enhancement [19].…”