بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم

2. Imaging of splenic masses

3. Splenic focal lesions: • Congenital: accessory spleen,epidermoid cyst 2.Inflammatory : abscess, TB, hydatid disease 3.Vascular : infarction 4.Neoplastic hemangioma,lymphangioma,lymphoma,metastasis 5.Posttraumatic hematoma, false cyst

4. Congenital: • Accessory spleen: • Results from failure of fusion • Found in 10% of general population • may be solitary or multiple and usually measure no more than 4 cm in diameter. • The most common location is the splenic hilum or anywhere in the intraperitoneal space • Can grow after splenectomy

5. Epidermoid cyst: • represent about 10% of benign non parasitic splenic cysts. • In 80% of cases, lesions are solitary and unilocular,occusionally internal septations are seen. • 10% of cases showing wall calcification. • Differentiation between true and false splenic cyst: Cyst wall trabiculation or peripheral septation (86% and 17%) • Cyst wall calcification ( 14% and 50%) • High attenuation cyst occurs in 33% of false cysts

7. inflammatory • Abscess: • Multiple: 75% • Hematogenous spread Fungal or granulomatous infections • Solitary: 25% • Secondary infection of infarction or hematoma Direct extension from adjacent infection Bacterial infection

8. vascular • Infarction: • Either arterial or venous, arterial infarction occurs secondary to occlusion of the splenic artery or its branches and the venous infarction is caused by thrombosis of the splenic sinusoids. • Initially the area of infarction is hypoechoic and usually wedge-shaped, solitary and extending to the periphery of the spleen . • The lesion may decrease in time, and gradually fibrose, becoming hyperechoic. It demonstrates a lack of Doppler perfusion compared with the normal splenic tissue. In rare cases of total splenic infarction due to occlusion of the proximal main splenic artery, greyscale sonographic appearances may be normal in the early stages.

9. Neoplastic • Hemangioma; • The most common benign primary splenic tumor. • hemangiomas are found most often in adults from mid-30s to mid-50s years of age. • Most hemangiomas are small lesions that are found incidentally and patients usually have no symptoms. • Complications include rupture, hypersplenism.

10. Hamartoma: • Non-neoplastic mass of a mixture of normal elements of splenic tissue, usually solid • Rare, incidental lesion in adults • CT: hypodense or isodense . • MR T1WI; isointense T2WI; hyperintense • The typical hypervascularity seen with both color Doppler imaging and angiography is thought to reflect the hypervascularity of the red pulp within the hamartoma.

11. Lymphoma: • The most common malignant tumor of the spleen • 25%-40% of lymphoma involves spleen • Primary splenic lymphoma: rare, 1%, NHL • AIDS: 10% HD, 26% NHL • Splenic size is not an indicator: 1/3 splenomegly ….no lymphoma 1/3 lymphoma…….no splenomegly

12. Detection rate: 60% ,Three patterns of involvement : a- Solitary or multiple masses b- Numerous tiny nodules c- Diffuse low attenuation Hypodense lesions on CT without contrast enhancement Lymphadenopathy: > 50%

13. Metastasis : • Uncommon, occur late, 7% autopsy • Spreading route: Hematogeneous, via lymphatics, direct • Solitary 30% , multiple 60% • Primary sites: breast, lung, ovary, stomach, melanoma. • Cystic metastases: ovary, breast, endometrium

14. Posttraumatic: • Hematoma: • Intrasplenic hematoma is diagnosed when extravasated blood is present in splenic bulb. • Occurring after blunt or penetrating abdominal trauma, splenic biopsy or anticoagulation therapy

15. Conclusion: • Many diseases affecting the spleen have a similar appearance on cross sectional imaging, therefore clinical history is often important in helping narrow DD of suspected splenic disease. • If uncertainly of a diagnosis persists, percutaneous biopsy may be useful. • Because of its cross sectional imaging capability and short imaging times, CT is currently the image of choice for evaluation of the spleen.

16. Thank you