Contrast-Enhanced Sonography of the Spleen
Orlando Catalano,
Fabio Sandomenico1,
Iolanda Matarazzo1 and
Alfredo Siani2
1 Department of Radiology, S. Maria delle Grazie Hospital, Via Domitiana
Località La Schiana, Pozzuoli (Na) I-80078, Italy.
2 Department of Radiology, I.N.T. "Fondazione Pascale," via
M.Semmola, Naples I-80131, Italy.
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Fig. 1A. —37-year-old healthy male volunteer. S = Spleen, K = Left
kidney, D = Left hemidiaphragm. Contrast-enhanced sonogram (obtained 34 sec
after injection) shows slightly inhomogeneous enhancement of spleen
parenchyma.
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Fig. 1B. —37-year-old healthy male volunteer. S = Spleen, K = Left
kidney, D = Left hemidiaphragm. Contrast-enhanced sonogram (obtained 123 sec
after injection) shows homogeneously hyperechoic splenic texture. Note
opacified hyperechoic splenic artery (short arrow) and unopacified
hypoechoic splenic vein (long arrow).
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Fig. 2. —71-year-old man with chronic lymphatic leukemia and nonfocal
splenic involvement. Contrast-enhanced sonogram (obtained 125 sec after
injection) shows markedly enlarged spleen with subtle inhomogeneity. Note that
echogenicity of spleen parenchyma is lower than that in
Figure 1B. S = spleen.
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Fig. 3. —69-year-old woman with atrial fibrillation and splenic
embolism. Contrast-enhanced sonogram (obtained 57 sec after injection) shows
wedge-shaped hypoechoic (avascular) area (arrows) pointing toward
splenic hilum (infarction).
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Fig. 4A. —50-year-old man with chronic liver disease and portal
hypertension. Contrast-enhanced sonogram (obtained 50 sec after injection)
shows splenic deeper pole hypoechoic area (straight arrows) with
slightly echoic rim and incompletely opacified afferent artery (curved
arrow). S = spleen.
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Fig. 4B. —50-year-old man with chronic liver disease and portal
hypertension. Contrast-enhanced CT scan correlates optimally with
contrast-enhanced sonography in showing infarction (arrows).
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Fig. 5. —49-year-old man with oral floor infection and hematogenous
sepsis. Contrast-enhanced sonogram (obtained 111 sec after injection) shows
subcapsular anechoic (avascular) partially loculated homogeneous fluid
collection (arrows) of spleen (proven to be abscess at aspiration). S
= spleen.
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Fig. 6A. —22-year-old woman with vague abdominal pain and incidental
detection of spleen hemangioma. S = spleen. Baseline sonogram shows small
hyperechoic nodule (arrow) of spleen.
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Fig. 6B. —22-year-old woman with vague abdominal pain and incidental
detection of spleen hemangioma. S = spleen. Contrast-enhanced sonogram
(obtained 62 sec after injection) fails to recognize any splenic focal
lesion.
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Fig. 7A. —54-year-old man with previous colonic carcinoma and increased
tumor markers. Baseline sonogram detects splenic solitary hypoechoic lesion
(arrow). Hypoechoic splenic nodules are usually malignant
[4,
5].
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Fig. 7B. —54-year-old man with previous colonic carcinoma and increased
tumor markers. Contrast-enhanced sonogram (obtained 21 sec after injection)
shows hypoechoic nodule with thick regular enhancing rim (arrow).
Disregard black sector-shaped artifact covering middle third of spleen.
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Fig. 7C. —54-year-old man with previous colonic carcinoma and increased
tumor markers. Contrast-enhanced sonogram (obtained 133 sec after injection)
shows centripetal filling of lesion (arrow), diagnostic for
hemangioma. Disregard artifact mentioned in B.
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Fig. 7D. —54-year-old man with previous colonic carcinoma and increased
tumor markers. Contrast-enhanced CT scan correlates well with
contrast-enhanced sonogram (B) in showing lesion (arrow).
Nodule was unchanged on sonography (not shown) performed 6 months later.
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Fig. 8A. —63-year-old woman with uterine carcinoma. Baseline sonogram
shows perisplenic fluid (arrow) but fails to show any defined splenic
abnormality.
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Fig. 8B. —63-year-old woman with uterine carcinoma. Contrast-enhanced
sonogram (obtained 101 sec after injection) confirms perisplenic effusion
(short arrow) but in addition shows hypoechoic defect (long
arrow) due to metastasis. Liver metastases (not shown) were also
found.
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Fig. 9A. —31-year-old man with Hodgkin's disease involving spleen.
Baseline sonogram identifies subtle hypoechoic nodules (arrows).
Spleen has normal size.
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Fig. 9B. —31-year-old man with Hodgkin's disease involving spleen.
Contrast-enhanced sonogram (obtained 53 sec after injection) clearly shows two
hypoechoic lesions (arrows). Small echoic dots within nodules appear
on real-time videos as moving pollution (microcirculation).
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Fig. 10A. —21-year-old man with blunt trauma. Baseline sonogram shows
small perisplenic fluid (arrow) without any defined parenchymal
abnormality.
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Fig. 10B. —21-year-old man with blunt trauma. Contrast-enhanced sonogram
(obtained 78 sec after injection) shows multiple hypoechoic areas
(arrows) due to spleen contusion and laceration.
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Fig. 11A. —31-year-old man with blunt trauma. No defined change is
recognizable on baseline spleen sonogram. S = spleen, K = left kidney.
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Fig. 11B. —31-year-old man with blunt trauma. Contrast-enhanced sonogram
(obtained 177 sec after injection) shows hypoechoic band (arrows) due
to transverse complete laceration of spleen. S = spleen. K = left kidney.
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Fig. 11C. —31-year-old man with blunt trauma. Contrast-enhanced CT scan
correlates well with contrast-enhanced sonography, showing linear spleen
injury (arrows).
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Fig. 12. —40-year-old woman with blunt trauma. Contrast-enhanced
sonogram (obtained 44 sec after injection) shows hyperechoic pooling
(arrow) of extravasated contrast medium pointing toward spleen
surface. F = perisplenic fluid, S = spleen.
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Fig. 13A. —39-year-old man with lymphoma and nonfocal spleen
enlargement. S = spleen. Contrast-enhanced sonogram (obtained 15 sec after
injection) shows feeding pedicle (long arrow) entering enlarged
accessory spleen (short arrow).
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Fig. 13B. —39-year-old man with lymphoma and nonfocal spleen
enlargement. S = spleen. Contrast-enhanced sonogram (obtained 134 sec after
injection) shows identical texture between spleen and accessory spleen
(arrow).
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Fig. 14A. —23-year-old woman with acute anemia 12 hr after splenectomy
for spleen injury. Baseline sonogram shows ill-defined and inhomogeneous left
subphrenic pseudomass (arrows). K = left kidney.
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Fig. 14B. —23-year-old woman with acute anemia 12 hr after splenectomy
for spleen injury. Contrast-enhanced sonogram (obtained 28 sec after
injection) shows contrast pooling (curved arrow) adjacent to large
hematoma (straight arrows). Active bleeding from splenic pedicle was
found at surgery.
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Copyright © 2005 by the American Roentgen Ray Society.
