Diagnostic Ultrasound - Abdomen and Pelvis

Approach to Splenic Sonography
(Left) A large left pleural
effusion is shown in
conventional longitudinal view
from an intercostal approach,
nicely delineating the
relationship between the
spleen and the left
hemidiaphragm. The aorta is
partially visualized st. (Right)
A large left pleural effusion
is shown in conventional
transverse view from an
intercostal approach, in right
lateral decubitus position.
Note the spleen ſt, left kidney
st, and vertebral body .
Diagnoses: Spleen
(Left) Here, the spleen is used
as an acoustic window to
visualize the pancreatic tail. At
the splenic hilum, there is a
splenule as well as a
heterogeneous pancreatic tail
mass immediately adjacent
. (Right) Corresponding
axial CT through the spleen
also shows the splenule
adjacent to a large pancreatic
tail mass , proven to
represent a neuroendocrine
tumor.
(Left) Transverse US in a 44-
year-old man with fever and
pancytopenia is shown. The
spleen is enlarged with a focal,
ill-defined hypoechoic lesion
ſt, a nonspecific US finding
with a broad differential
diagnosis. (Right) PET/CT
showed ↑ avidity of the focal
splenic lesion ſt and ↑
background uptake in the
spleen and liver . Final
diagnosis was hemophagocytic
lymphohistiocytosis, a rare
entity. Splenic US is a good
initial test, but abnormal
findings may often require
further imaging or histologic
work-up.
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