Ultrasound images of Vascular abnormalities of the spleen

Ultrasound images Splenic infarct Splenic infarction is most commonly associated with endocarditis, sickle cell disease and myeloproliferative disorders11 and also with lymphoma andcancers. It usually results from thrombosis of one or more of the splenic artery branches. Because the spleen is supplied by both the splenic and gastric arteries, infarction tends to be segmental rather than global. Patients may present with LUQ pain, but not invariably. Initially the area of infarction is hypoechoic and usually wedge-shaped, solitary and extending to the periphery of the spleen (Fig. A and B). 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 (Fig.C), due to occlusion of the proximal main splenic artery, greyscale sonographic appearances may be normal in the early stages. Although the lack of colour Doppler flow may assist in the diagnosis, CT is the method of choice. Occasionally infarcts may become infected or may haemorrhage. Sonography can successfully document such complications and is used to monitor their resolution serially. In patients with multiple infarcts, such as those with sickle-cell disease, the spleen may become scarred, giving rise to a patchy, heterogeneous texture.
The most common of these are pancreatitis and tumour thrombus. Colour and spectral Doppler are an invaluable aid to the diagnosis, particularly when the thrombus is fresh and therefore echopoor. Contrast agents may be administered if doubt exists over vessel patency. Splenic vein occlusion causes splenomegaly and varices may be identified around the splenic hilum.
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fig.A
ultrasound images Splenic infarct due to an embolus following recent liver resection
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fig. B
Ultrasound images of Colour Doppler of the same
patient demonstrates a lack of perfusion in the infarcted area
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CT scan of the same patient above.

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