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Pathology of Spleen, Adrenal, Peritoneum and Retroperitoneum
ultrasound, Rumack
65
Medical
11/28/2010

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Term
splenomegaly
Definition
Most common cause in adults is portal hypertension due to alcoholic cirrhosis
also caused by polycythemia vera
seen universally with schistosomiasis infections.
Term
1.hematologic disorders (leukemia, lymphoma)
2.infectious mononucleosis
Definition
Marked splenomegaly is caused by:
Term
1.infection
2.portal hypertension (also associated with varices and ascites)
3.AIDS
Definition
Mild to moderate splenomegaly is caused by:
Term
1.lymphomatous involvement
2.metastatic disease
3.cysts
4.hematomas
Definition
Focal lesions of splenomegaly is caused by:
Term
myelofibrosis
Definition
Massive splenomegaly is caused by:
Term
echinococcus
Definition
This parasite causes infectious cysts that may have an 'eggshell calcification,' and the patient may present with LUQ pain, elevated WBCs, and fever.
Term
posttraumatic cysts/pseudocysts
Definition
These splenic cysts have no cellular lining, and may contain low-level echoes from cholesterol crystals or debris.
Term
true primary congenital/epidermoid cysts
Definition
These rare cysts, including lymphangiomas and cystic hemangiomas, are typically solitary and 10cm.
Term
granuloma
Definition
This pathology appears as focal, echogenic lesions with or without shadowing, and is caused by histoplasmosis, tuberculosis, and sarcoidosis
Term
lymphoma and angiosarcoma
Definition
types of primary malignancy of the spleen
Term
1.melanoma
2.lymphoma
3.leukemia
4.carcinoma of ovary, breast, lung, or stomach
Definition
types of metastasis to the spleen
Term
hemangioma
Definition
Most common benign primary neoplasm of the spleen.
Term
hemangioma
Definition
This pathology of the spleen affects males 20-50, and is associated with Klippel-Trenaunay-Weber syndrome.
Term
splenic infarction
Definition
cause: occlusion of a segment of splenic artery or branch
prevalence: common in patients with bacterial endocarditis and splenic artery aneurysms
Term
Gaucher's disease
Definition
This is a familial disorder of fat metabolism caused by an enzyme deficiency affecting the spleen; 50% are <8yrs.
Term
candidiasis
Definition
This splenic pathology, common in immunocompromised patients, appears as wheel-within-wheel or bull's eye nodules.
Term
miliary tuberculosis
Definition
prevalence: common in immunocompromised patients
cause: mycobacterial infection
sonographic appearance: innumerable tiny echogenic foci seen diffusely throughout the spleen
Term
subcapsular/intraparenchymal hematoma
Definition
Sonographic appearance is crescent-shaped fluid collection conforming to splenic contour.
Term
Accessory Spleen/Splenunculi/Supernumerary Spleen
Definition
This common congenital anomaly (30%) may present with acute abdominal pain if there is torsion.
Term
situs solitus
Definition
the normal arrangement of asymmetric body parts
Term
situs inversus
Definition
the mirror image arrangement of body parts
Term
situs ambiguous
Definition
the wide spectrum of abnormalities between situs solitus and situs inversus
Term
polysplenia
Definition
prevalence: males
sonographic appearance:
1.two left lungs
2.absent gallbladder
3.cardiovascular abnormalities
Term
asplenia
Definition
prevalence: females
sonographic appearance:
1.two right lungs
2.reversed aorta and IVC
3.horseshoe kidneys
4.midline liver and gallbladder
Term
lymphadenopathy
Definition
prevalence: most commonly seen in lymphoma (50% of patients with non-Hodgkin's lymphoma;25% of patients with Hodgkin's disease)
2.criteria for assessment:
abdomen - <1cm = normal
>1cm, single = suspicious
>1.5cm, single = abnormal
>1cm, multiple = abnormal
retrocrural - >0.6cm = abnormal
pelvic - >1.5cm = abnormal
Term
lymphadenopathy
Definition
sonographic appearance: variable
1.round or oval, with a longitudinal/transverse ratio of less than 2
2.discrete hypoechoic or anechoic masses seen anterior and posterior to the great vessels with no enhancement
1.may fuse to form a hypoechoic mantle of tissue surrounding the aorta and elevating it from the spine ('floating aorta' sign)
3.echogenic cortical widening, and narrow or absent echogenic hilus suggest malignancy
4.color Doppler may show avascular intranodal regions or displaced/distorted intranodal vessels
Term
testicular, pelvic
Definition
Metastatic disease of the retroperitoneum is typically from _____ or ______ tumors, and is through lymphatic or hematogenous spread.
Term
primary retroperitoneal tumor
Definition
prevalence: rare
1.3:1 men
malignancy: 70-90% in adults are malignant
prognosis: 5-year survival is 22-50%
1.fixation of tumor and invasion of adjacent structures are worst prognostic features
Term
1.liposarcoma – embryonic lipoblasto cells
2.leiomyosarcoma – contains smooth muscle
3.malignant fibrous histiocytoma
Definition
types of primary retroperitoneal tumors
Term
retroperitoneal fibrosis/Ormond's disease
Definition
This pathology is a dense fibrous tissue proliferation confined to the paravertebral region; seen as a hypoechoic, homogenous 2-6cm mass that appears midline as plaque around the distal aorta, without displacing it from the spine; associated with bilateral ureteral obstruction, malignancy, and methysergide use.
Term
psoas muscle and perinephric space
Definition
Common sites for retroperitoneal hemorrhage include _____ and _______.
Term
lymphocele
Definition
This retroperitoneal pathology typically occurs 10-21 days after surgery; most are anechoic, resembling simple cysts, though 20-50% present as complex masses with septations.
Term
adrenal cysts
Definition
This benign asymptomatic pathology of the adrenal glands is rare, affecting females 3:1, commonly in the 3rd - 5th decades.
Term
1.endothelial
2.pseudocyst
3.epithelial
4.parasitic
Definition
types of adrenal cysts
Term
right
Definition
Post-traumatic hemorrhage affects the _(right/left)___ adrenal gland more commonly.
Term
adenoma
Definition
This neoplasm of glandular epithelium occurs in 3% of autopsies, and incidence increases with age;associated with hypertension, diabetes, hyperthyroidism, renal cell carcinoma, and hereditary adenomatosis of colon and rectum
Term
hyperfunctioning
Definition
______ adenoma's give rise to Cushing's syndrome or Conn's disease.
Term
Cushing's syndrome
Definition
This adrenal pathology results from excessive cortisol secretion from adrenal hyperplasia (70%), adenoma (20%), carcinoma (10%), or exogenous corticosteroid administration
Term
Cushing's disease
Definition
This adrenal pathology results from excessive cortisol excretion due to elevated ACTH production from a pituitary adenoma
Term
Conn's disease
Definition
This adrenal pathology results from excessive excretion of aldosterone from adrenal adenoma (70%), adrenal hyperplasia (30%), or rarely adrenal carcinoma
Term
pheochromocytoma
Definition
This hyperfunctioning tumor, more common on the right adrenal gland, increases epinephrine and norepinephrine secretion; more common in the 2nd-5th decades.
Term
pheochromocytoma
Definition
This rare, usually benign pathology typically arises from neuroectodermal tissue of adrenal medulla; patients may present with intermittent hypertension, pounding or severe headache, palpitations with tachycardia, or excessive perspiration; associated with von Hippel-Lindau and MEN
Term
adrenal cortical carcinoma
Definition
This rare, malignant adrenal pathology has two types - hyperfunctioning (more common in female), and nonfunctioning (more common in men); most common in the 4th decade; sonographic appearance is variable based on size, though all typically have a well-defined lobulated border
Term
myelolipoma
Definition
This benign fatty nonfunctioning tumor is hyperechoic, and may show a propagation speed artifact.
Term
lung, liver, bone
Definition
The adrenal gland is 4th most common site for metastasis after ___, ___, and ____.
Term
1.Morrison's Pouch – between kidney and liver (right subhepatic space)
2.Pouch of Douglas – between rectum and uterus
3.paracolic gutters – lateral to ascending and descending colon in pelvis
Definition
dependent areas of the abdomen and pelvis
Term
1.cirrhosis
2.neoplasm
3.congestive heart failure
4.tuberculosis
Definition
causes of ascites
Term
hemoperitoneum
Definition
Effusion of blood in the peritoneal cavity caused by:
1.trauma
2.ruptured aneurysm, ectopic pregnancy, or liver mass
3.postsurgical bleeding
4.spontaneous hemorrhage in patients on anticoagulants
Term
chylous ascites
Definition
Lymph accumulation within the peritoneal cavity caused by:
1.trauma
2.surgery
3.lymphangioma
4.lymphoma
Term
pseudomyoxoma peritonei
Definition
Rare, often fatal intra-abdominal disease where columnar epithelium secrete copious globules of extracellular mucin, with dissecting gelatinous ascites; seen as a 'starburst appearance' or scalloping of the liver
Term
FAST - Focused Assessment with Sonography for Trauma
Definition
Screen for intra-abdominal injury in trauma patients, where the primary focus is to detect free intraperitoneal fluid, which would suggest significant intra-abdominal injury requiring urgent laparotomy
Term
inclusion cyst
Definition
This peritoneal pathology is caused by fluid produced by the ovaries that may encase the ovaries
symptoms: pelvic pain and pressure
sonographic appearance: vary in size and echogenicity
Term
mesenteric cyst
Definition
These rare intra-abdominal masses are usually asymptomatic, and vary in size (<1cm - >25cm) and echogenicity
Term
peritonitis
Definition
diffuse inflammation of the parietal and visceral peritoneum
Term
splenunculi
Definition

This is a benign anatomical variant.

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Term
METS to spleen
Definition

This rare pathology is typically asymptomatic.

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Term
splenic infarct
Definition

This splenic pathology is common in patients with bacterial endocarditis and splenic artery aneurysms.

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Term
splenic hemangioma
Definition

Most common benign neoplasm of the spleen.

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Term
pseudomyoxoma peritonei
Definition

This rare, often fatal disease may cause abdominal pain and distention or bowel obstruction.

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Term
pheochromocytoma
Definition

This adrenal pathology has symptoms of a pounding or severe headache or palpitations with tachycardia.

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Term
retroperitoneal fibrosis/Ormond's disease
Definition

What is surrounding the aorta?

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Term
myelolipoma
Definition

This is a benign fatty nonfunctioning tumor of the adrenal gland.

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Term
ascites
Definition

Majority is caused by cirrhosis, neoplasm, congestive heart failure, or tuberculosis.

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Term
adrenal carcinoma
Definition

This adrenal disease occurs most commonly in the 4th decade, and is overall more common in females.

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Term
adrenal adenoma
Definition

May give rise to Cushing's syndrome or Conn's disease.

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