Diagnostic Ultrasound - Abdomen and Pelvis

Splenic Infarct
Diagnoses: Spleen
IMAGING
• Variable sonographic appearance of acute splenic infarction
○ Classic
– Hypoechoic, peripheral, wedge shaped, and avascular
○ Non-classic
– Rounded or peripheral band morphology
– Global infarction
– Isoechoic to hyperechoic
○ Bright band sign
– Thin, parallel echogenic lines within the hypoechoic
infarcted area
– Thought to represent preserved fibrous trabeculae
within infarcted tissue
• Chronic infarction
○ Atrophic, scarred spleen, ± calcification
• Associated findings
○ Splenomegaly, splenic vein occlusion (with large
perisplenic varices), splenic artery thrombosis
KEY FACTS
TOP DIFFERENTIAL DIAGNOSES
• Splenic laceration
• Splenic hematoma
• Splenic cyst
• Splenic mass
• Splenic metastases
• Splenic lymphoma
DIAGNOSTIC CHECKLIST
• Color and power Doppler are critical components of
ultrasound evaluation of splenic infarct
• Grayscale appearance can be variable depending on
morphology, evolution of the infarct
• Clinical history is very helpful
○ Multitude of underlying disorders can predispose to
splenic infarction
(Left) Transverse US of the
spleen demonstrates
inhomogeneity of the splenic
echotexture, with geographic
areas of hypoechogenicity
containing parallel echogenic
bands; these regions represent
infarct. Compare this to
normal parenchyma . Note
also the presence of
perisplenic fluid . (Right)
Corresponding color Doppler
US shows absent vascularity in
the infarcted parenchyma
and normal vascularity within
the uninvolved parenchyma
.
(Left) Longitudinal splenic
view is shown in the same
patient. In this plane of view,
the extent of the infarct can
be appreciated. The infarcted
tissue is hypoechoic with
numerous thin, parallel
echogenic bands (the bright
band sign). Note again the
free fluid . (Right)
Corresponding coronal CECT
image clearly shows areas of
nonenhancement within
the inferior 2/3 of the
enlarged spleen
(splenomegaly). Normal tissue
shows enhancement . Fluid
surrounding the spleen
indicates rupture.
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