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Corvino A, Granata V, Tafuri D, Cocco G, Catalano O. Incidental Focal Spleen Lesions: Integrated Imaging and Pattern Recognition Approach to the Differential Diagnosis. Diagnostics (Basel) 2023; 13:2536. [PMID: 37568899 PMCID: PMC10416953 DOI: 10.3390/diagnostics13152536] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/16/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
Spleen lesions and pseudolesions, detected incidentally in imaging, are not uncommon and may require further work-up. The imaging appearance of focal splenic lesions (FSLs) may not be pathognomonic, because of considerably overlapping features. Consequently, all imaging techniques lack specificity to fully characterize FSLs. Clinical correlation is mandatory, so as, first of all, to categorize the patient as having or not having a history of solid or hematologic malignancy. Nowadays, many patients have old imaging studies available for comparison and, consequently, it is important to understand if the lesion was previously present or not, and if the size is the same or has changed. In the absence of comparison studies, and with a lack of imaging features of benignity, further investigation may be necessary, using PET, biopsy, or short-term follow-up. Some algorithms have been proposed to manage incidental FSLs; however, none of these strategies has been validated by prospective studies to date. In this review we illustrate the topic of incidental FSLs and we analyze a number of published algorithms.
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Affiliation(s)
- Antonio Corvino
- Movement Sciences and Wellbeing Department, University of Naples “Parthenope”, Via Medina 40, I-80133 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, I-80131 Naples, Italy
| | - Domenico Tafuri
- Movement Sciences and Wellbeing Department, University of Naples “Parthenope”, Via Medina 40, I-80133 Naples, Italy
| | - Giulio Cocco
- Department of Neuroscience, Imaging and Clinical Sciences, University “G. d’Annunzio”, I-66100 Chieti, Italy
| | - Orlando Catalano
- Radiology Unit, Varelli Diagnostic Institute, I-80126 Naples, Italy
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Tan M, Low HM, Shelat V, Tan CH. Imaging patterns in non-traumatic spleen lesions in adults-a review. Jpn J Radiol 2022; 40:664-677. [PMID: 35099683 DOI: 10.1007/s11604-022-01250-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/17/2022] [Indexed: 02/05/2023]
Abstract
The spleen is a complex organ involved in multiple physiological processes in the human body. Elective splenectomy is an uncommon operation, and the precise characterization of the lesion should be achieved to determine the risks and benefits of this operation accurately. Given the significant role of the spleen in homeostasis and the potential risks of the surgery itself and following sequelae such as infection susceptibility, accurate recognition, and classification of splenic lesions is required before surgery. This review provides an overview of malignant (e.g., lymphoma, angiosarcoma) and benign (e.g., cysts, hemangioma, hamartoma) splenic lesions that may warrant an elective splenectomy. Images from a cohort of adult patients undergoing isolated splenectomy for non-traumatic indications in a single center are provided. This review highlights the considerable overlap in imaging patterns between splenic lesions, splenic lesions masquerading as lesions in other organs, increased detection of asymptomatic splenic incidentalomas due to improvements in imaging modalities. This review also provides clinical correlations for each lesion, providing additional information to help clinicians differentiate between lesions and accurately identify diseases amenable to surgical management.
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Affiliation(s)
| | - Hsien Min Low
- Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vishalkumar Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Cher Heng Tan
- Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
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Pavan H, Garcia TS, Torres FS, Gazzoni FF, Folador L, Ghezzi CLA. Focal incidental upper abdominal findings on unenhanced chest computed tomography that do not require further imaging: a roadmap for the thoracic radiologist. Radiol Bras 2022; 55:173-180. [PMID: 35795597 PMCID: PMC9254702 DOI: 10.1590/0100-3984.2021.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/18/2021] [Indexed: 11/21/2022] Open
Abstract
Abstract Chest scans usually include the upper abdomen, leading radiologists to evaluate the upper abdominal structures. The aim of this article is to summarize the most common incidental upper abdominal findings that do not require further imaging or management in patients undergoing unenhanced computed tomography of the chest for the investigation of thoracic symptoms or diseases. We review common incidental findings of the liver, gallbladder, spleen, adrenal glands, kidney, and retroperitoneum, as well as findings that mimic other lesions. Thoracic radiologists should be aware of such typical findings and report when no further investigation is needed, thus avoiding unnecessary imaging examinations, protecting patients from additional medical interventions, and allaying patient concerns.
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Trenker C, Görg C, Freeman S, Jenssen C, Dong Y, Caraiani C, Ioanițescu ES, Dietrich CF. WFUMB Position Paper-Incidental Findings, How to Manage: Spleen. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2017-2032. [PMID: 34052061 DOI: 10.1016/j.ultrasmedbio.2021.03.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental Imaging Findings-The Role of Medical Ultrasound." IFs are less commonly encountered in the spleen than in many other abdominal organs but remain a frequent dilemma in clinical practice. A histological diagnosis is rarely necessary for patient management. Many IFs, such as secondary spleens and splenic cysts, are harmless and do not require any further investigation. The diagnosis of many other focal splenic lesions is, however, often problematic. The following overview is intended to illustrate a variety of incidentally detected spleen pathologies such as size variants, shape variants, secondary spleens, focal splenic lesions and splenic calcifications. It should aid the examiner in establishing the diagnosis. Moreover, it should help the ultrasound practitioner decide which pathologies need no further investigation, those requiring interval imaging and cases in which immediate further diagnostic procedures are required.
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Affiliation(s)
- Corinna Trenker
- Department of Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstrasse, Marburg, Germany
| | - Christian Görg
- Department of gastroenterology, Interdisciplinary Center of Ultrasound, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstrasse Marburg, Germany
| | - Simon Freeman
- University Hospitals Plymouth, Imaging Directorate, Derriford Hospital, Plymouth, United Kingdom
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland GmbH Strausberg/Wriezen, Akademisches Lehrkrankenhaus Medizinische Hochschule Brandenburg "Theodor Fontane", Germany; Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg "Theodor Fontane", Neuruppin, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cosmin Caraiani
- Department of Medical Imaging, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Elena Simona Ioanițescu
- Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Center of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.
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Fujikawa H, Kokita A, Watanabe K, Saito M. Primary Splenic Lymphoma: An Uncommon Cause of Persistent Fever Diagnosed by Examining the "Forgotten Organ". JMA J 2021; 4:171-173. [PMID: 33997453 PMCID: PMC8119175 DOI: 10.31662/jmaj.2020-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/12/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Hirohisa Fujikawa
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Internal Medicine, Suwa Central Hospital, Nagano, Japan
| | - Ayaka Kokita
- Department of Endocrinology, Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Keisuke Watanabe
- Department of Internal Medicine, Suwa Central Hospital, Nagano, Japan
| | - Minoru Saito
- Department of Internal Medicine, Suwa Central Hospital, Nagano, Japan
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Ladumor H, Al-Mohannadi S, Ameerudeen FS, Ladumor S, Fadl S. TB or not TB: A comprehensive review of imaging manifestations of abdominal tuberculosis and its mimics. Clin Imaging 2021; 76:130-143. [PMID: 33596517 DOI: 10.1016/j.clinimag.2021.02.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/21/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
The ever-growing prevalence of tuberculosis is a cause for concern among both developing and developed countries. Abdominal tuberculosis is the most common site of extrapulmonary tuberculosis and involves almost all of the visceral organs. Clinical presentation of abdominal tuberculosis is often non-specific. Thus, having a high index of clinical suspicion is necessary to aide early diagnosis and guide prompt initiation of appropriate treatment. In this review, we focus on the entire spectrum of abdominal tuberculosis and other diseases mimicking it with an emphasis on their imaging findings.
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Affiliation(s)
- Heta Ladumor
- Weill Cornell Medicine - Qatar, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar.
| | - Salma Al-Mohannadi
- Weill Cornell Medicine - Qatar, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar
| | | | - Sushila Ladumor
- Department of Radiology, Hamad General Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Shaimaa Fadl
- Department of Radiology, Virginia Commonwealth University, West Hospital, 1200 East Broad Street, Room 2-013, Box 984070, Richmond, VA, 23298, United States of America
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Abrishami A, Khalili N, Kooraki S, Abrishami Y, Grenacher L, Kauczor HU. Evaluation of cross-sectional imaging features that aid in the differentiation of benign and malignant splenic lesions. Eur J Radiol 2021; 136:109549. [PMID: 33465552 DOI: 10.1016/j.ejrad.2021.109549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE This study aimed to investigate the role of cross-sectional imaging in differentiating between benign and malignant splenic lesions based on various imaging features. METHODS Database of imaging reports from January 2015 to December 2017 were searched dedicatedly for "spleen" or "splenic" terms to identify patients with splenic lesions found either on CT or MRI. The study cohort consisted of patients who had available histological reports or had follow-up imaging for a minimum of one year. Patients were categorized into the benign subcohort if they did not have a history of extra-splenic malignancy, and had a splenic lesion(s) falling into one of these categories: benign histopathology on biopsy, stable size and enhancement, or decreased size on follow-up imaging. Those who had malignant histopathology on biopsy were included in the malignant subcohort. Various morphologic features and enhancement patterns of these lesions were carefully reviewed by two radiologists who were blinded to the final histopathologic diagnosis. RESULTS We identified 161 patients (54 % males, mean age ± SD = 59.7 ± 15.4) including 124 (77 %) in the benign and 37 (23 %) in the malignant subcohort. Benign lesions were more likely to be cystic (21.7 % vs 2.7 %, p < 0.001), homogenous (59.7 % vs. 29.7 %, p = 0.001) and to demonstrate well-defined borders (69.3 % vs. 29.7 % p= <0.001). Malignant lesions had significantly larger diameter (median size: 15 vs 11 mm, p = 0.03). Restricted diffusion was not seen in any of the benign lesions; however, 50 % of malignant lesions demonstrated restricted diffusion (p = 0.003). Features such as lesion distribution, presence of calcification, splenomegaly and number of lesions were not significantly different between benign and malignant lesions. CONCLUSION Smaller lesion diameter, well-defined border and homogeneity favor benign nature of splenic lesions while restricted diffusion should raise suspicion for malignancy.
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Affiliation(s)
- Alireza Abrishami
- Department of Radiology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Nastaran Khalili
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Cancer Immunology Project, Universal Scientific Education and Research Network, Tehran, Iran
| | - Soheil Kooraki
- Department of Nuclear Medicine, University of California, Los Angeles, CA, USA
| | - Yalda Abrishami
- Department of Radiation Oncology, University Hospital of Augsburg, Augsburg, Germany
| | - Lars Grenacher
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Conradia Radiologie München, Department of Radiology, Munich, Germany.
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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Patel N, Evans AG, Rothberg PG, Gonzalez RS. Incidental splenic findings in pancreatosplenectomy specimens resected for primary pancreatic lesions. Histopathology 2019; 75:746-754. [PMID: 31269535 DOI: 10.1111/his.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/28/2019] [Indexed: 12/01/2022]
Abstract
AIMS Little has been written on the frequency and nature of incidental splenic lesions diagnosed on histopathological examination of pancreatosplenectomy specimens. METHODS AND RESULTS For 191 such specimens, incidental histological findings after haematopathologist re-review were tabulated. Cases suspicious for lymphoid malignancy underwent molecular analysis for immunoglobulin heavy and kappa light chain rearrangement. Follow-up was obtained on selected cases. In five cases (3%), the spleen was sampled but not mentioned in the original microscopic report; all were normal on re-review. Otherwise, most (171 of 186, 92%) were initially diagnosed as normal, with 160 (94%) remaining so on re-review. Findings on re-review not initially described (n = 11, 6%) included four cases with splenic morphology suspicious for possible leukaemia/lymphoma involvement. Additional findings included abscess formation, foamy macrophages, necrotising granulomas and simple cysts. Fifteen spleens were initially diagnosed as abnormal; the histopathological process was confirmed in all, including non-necrotising granulomas, cysts, Gamna-Gandy bodies, foamy macrophages, involvement by pancreatic neoplasm and involvement by known chronic lymphocytic leukaemia (CLL). Molecular analysis was performed on the five cases of known/suspected lymphoma and two were positive for monoclonal gene rearrangement, including the known CLL and a previously undiagnosed case with similar immunophenotype. CONCLUSIONS Incidental splenic findings are not uncommon in pancreatosplenectomy specimens. While most are of limited clinical significance, low-grade lymphoproliferative disorders may go undetected if the spleen is overlooked. We recommend careful observation of splenic findings in these specimens, with a low threshold for haematopathological consultation when in doubt.
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Affiliation(s)
- Nisha Patel
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Andrew G Evans
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Paul G Rothberg
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Raul S Gonzalez
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
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Siewert B, Millo NZ, Sahi K, Sheiman RG, Brook OR, Sun MRM, Kane RA. The Incidental Splenic Mass at CT: Does It Need Further Work-up? An Observational Study. Radiology 2018; 287:156-166. [PMID: 29369753 DOI: 10.1148/radiol.2017170293] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose To evaluate whether an incidentally noted splenic mass at abdominal computed tomography (CT) requires further imaging work-up. Materials and Methods In this institutional review board-approved HIPAA-compliant retrospective study, a search of a CT database was performed for patients with splenic masses at CT examinations of the abdomen and chest from 2002 to 2008. Patients were divided into three groups: group 1, patients with a history of malignancy; group 2, patients with symptoms such as weight loss, fever, or pain related to the left upper quadrant and epigastrium; and group 3, patients with incidental findings. Patients' CT scans, follow-up examinations, and electronic medical records were reviewed. Final diagnoses of the causes of the masses were confirmed with imaging follow-up (83.9%), clinical follow-up (13.7%), and pathologic examination (2.4%). Results This study included 379 patients, 214 (56.5%) women and 165 (43.5%) men, with a mean age ± standard deviation of 59.3 years ± 15.3 (range, 21-97 years). There were 145 (38.3%) patients in the malignancy group, 29 (7.6%) patients in the symptomatic group, and 205 (54.1%) patients in the incidental group. The incidence of malignant splenic masses was 49 of 145 (33.8%) in the malignancy group, eight of 29 (27.6%) in the symptomatic group, and two of 205 (1.0%) in the incidental group (P < .0001). The incidental group consisted of new diagnoses of lymphoma in one (50%) patient and metastases from ovarian carcinoma in one (50%) patient. Malignant splenic masses in the incidental group were not indeterminate, because synchronous tumors in other organs were diagnostic of malignancy. Conclusion In an incidental splenic mass, the likelihood of malignancy is very low (1.0%). Therefore, follow-up of incidental splenic masses may not be indicated. © RSNA, 2018.
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Affiliation(s)
- Bettina Siewert
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115
| | - Noam Z Millo
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115
| | - Kamaldeep Sahi
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115
| | - Robert G Sheiman
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115
| | - Olga R Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115
| | - Maryellen R M Sun
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115
| | - Robert A Kane
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115
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Sahovaler A, Yeh DH, Morrison D, de Ribaupierre S, Izawa J, Power A, Inculet R, Parry N, Palma DA, Landis M, Leung A, Fung K, MacNeil SD, Yoo J, Nichols AC. The incidence and management of non-head and neck incidentalomas for the head and neck surgeon. Oral Oncol 2017; 74:98-104. [PMID: 29103759 DOI: 10.1016/j.oraloncology.2017.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/16/2017] [Accepted: 09/02/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - David H Yeh
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Deric Morrison
- Department of Medicine, Division of Endocrinology, Western University, London Ontario, Canada
| | - Sandrine de Ribaupierre
- Department of Clinical Neurological Science, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jonathan Izawa
- Department of Surgery, Divisions of Urology and Surgical Oncology, Schulich School of Medicine & Dentistry Western University, Canada
| | - Adam Power
- Department of Surgery, Division of Vascular Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Richard Inculet
- Division of Thoracic Surgery, Department of Surgery, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Neil Parry
- Divisions of General Surgery and Critical Care, Departments of Surgery and Medicine, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - David A Palma
- Department of Radiation Oncology, London Regional Cancer Program, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Mark Landis
- Department of Radiology, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Andrew Leung
- Department of Radiology, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
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Scharitzer M, Tamandl D, Ba-Ssalamah A. Zufallsbefunde von Leber, Gallensystem, Pankreas und Milz bei asymptomatischen Patienten. Radiologe 2017; 57:270-278. [DOI: 10.1007/s00117-017-0235-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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de Azevedo OS, do Nascimento Santos B, de Souza Liboni N, da Costa JF, de Campos OD. Splenic Angiosarcoma: A Diagnostic Splenectomy Finding. Case Rep Oncol 2016; 9:733-737. [PMID: 27920710 PMCID: PMC5126591 DOI: 10.1159/000452619] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 12/29/2022] Open
Abstract
Splenic tumors are not frequent. Blood vessel neoplasms are a rare category of tumors and have an extremely low incidence in the spleen. This case report aims to describe a 57-year-old woman in whom a routine imaging examination had shown splenic cysts. During her follow-up, the cysts became larger and increased in number. A diagnostic splenectomy was performed and its analysis showed a rare splenic angiosarcoma.
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Gore RM, Ecanow JS. Management of splenic “incidentalomas” found on ultrasound and computed tomography. Cancer Imaging 2015. [PMCID: PMC4601538 DOI: 10.1186/1470-7330-15-s1-o11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Llewellyn ME, Jeffrey RB, DiMaio MA, Olcott EW. The sonographic "bright band sign" of splenic infarction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:929-938. [PMID: 24866600 DOI: 10.7863/ultra.33.6.929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To evaluate the frequency of the "bright band sign" in patients with splenic infarcts as well as control patients and to thereby assess whether the bright band sign has potential utility as a sonographic sign of splenic infarction. METHODS Using an electronic search engine and image review, 37 patients were retrospectively identified with noncystic parenchymal splenic infarcts on sonography. Nineteen abnormal control patients with noninfarcted splenic lesions on sonography and 100 normal control patients with sonographically normal spleens were also identified. The sonographic appearance of each splenic lesion was evaluated by 2 reviewers and assessed for the bright band sign, defined as thin specular reflectors perpendicular to the sound beam within hypoechoic parenchymal lesions, and for the presence or absence of the classic sonographic appearance of splenic infarction. Possible histologic counterparts of the bright band sign were assessed in archival infarct specimens. RESULTS The bright band sign was present in 34 (91.9%; 95% confidence interval [CI], 78.1%-98.3%) of 37 patients with splenic infarcts on sonography, including 12 (85.7%; 95% CI, 57.2%-98.2%) of 14 with classic and 22 (95.7%; 95% CI, 78.1%-99.9%) of 23 with nonclassic infarct appearances. No normal or abnormal control patients had the bright band sign. Histologic sections suggested that preserved splenic trabeculae within infarcts may generate the bright band sign. CONCLUSIONS The bright band sign is a potentially useful sonographic sign of splenic infarction, which may confer additional sensitivity and specificity and may be particularly helpful with infarcts having nonclassic appearances.
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Affiliation(s)
- Michael E Llewellyn
- Departments of Radiology (M.E.L., R.B.J., E.W.O.) and Pathology (M.A.D.), Stanford University School of Medicine, Stanford, California USA; and Radiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California USA (E.W.O.)
| | - R Brooke Jeffrey
- Departments of Radiology (M.E.L., R.B.J., E.W.O.) and Pathology (M.A.D.), Stanford University School of Medicine, Stanford, California USA; and Radiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California USA (E.W.O.)
| | - Michael A DiMaio
- Departments of Radiology (M.E.L., R.B.J., E.W.O.) and Pathology (M.A.D.), Stanford University School of Medicine, Stanford, California USA; and Radiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California USA (E.W.O.)
| | - Eric W Olcott
- Departments of Radiology (M.E.L., R.B.J., E.W.O.) and Pathology (M.A.D.), Stanford University School of Medicine, Stanford, California USA; and Radiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California USA (E.W.O.)
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Defining an Imaging Algorithm for Noncystic Splenic Lesions Identified in Young Patients. AJR Am J Roentgenol 2013; 201:W893-9. [DOI: 10.2214/ajr.12.10105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Heller MT, Harisinghani M, Neitlich JD, Yeghiayan P, Berland LL. Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 3: White Paper of the ACR Incidental Findings Committee II on Splenic and Nodal Findings. J Am Coll Radiol 2013; 10:833-9. [DOI: 10.1016/j.jacr.2013.05.020] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 05/24/2013] [Indexed: 12/27/2022]
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Abstract
Background As the largest single lymphatic organ in the human body, the spleen is responsible for central immunological and haematological tasks. Therefore, the spleen can be subject to a wide range of pathologic disorders. Computed tomography (CT) represents the most widely applied cross-sectional abdominal imaging technique and is considered the imaging modality of choice for the evaluation of numerous abdominal pathological conditions. Hypodense splenic lesions are frequently encountered on abdominal CT images. Although most hypodense lesions of the spleen can be considered benign, some findings and clinical conditions warrant closer attention to the lesion. CT offers a number of morphological criteria that can be applied to differentiate hypodense lesions of the spleen, such as a the appearance of a lesion’s borders, its attenuation, as well as the presence of calcifications or solid components. Methods This article reviews the most common splenic pathologies leading to hypodense appearances on CT images and illustrates the key CT imaging findings in the context of the clinical history of the patients. Conclusion The key imaging findings of hypodense splenic lesions are presented in order to aid interpretation during routine evaluation of abdominal CT images. Teaching Points • Haemangiomas, congenital in origin, represent the most common benign lesions of the spleen. • Lymphoma represents the most common malignant tumour of the, usually secondarily involved, spleen. • Most hypodense splenic lesions on CT represent benign lesions that require no further work-up. • For correct interpretation, hypodense splenic lesions need to be evaluated in the clinical context.
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