Diagnostic Ultrasound - Abdomen and Pelvis

Focal Splenic Lesion
Pyogenic Abscess
Parasitic Abscess (Hydatid Cyst)
(Left) Longitudinal
transabdominal US of the
spleen shows multifocal
splenic abscesses ſt. They are
irregular, some with
surrounding hypoechoic areas
(inflammatory edema).
Multifocal fungal or
granulomatous abscesses are
typically smaller than
pyogenic types. (Right)
Transverse US of the spleen
shows a multiloculated, thinwalled,
anechoic cyst with a
"cyst-within-cyst" appearance.
Curvilinear calcification ſt is
seen in the cyst wall. This
represents a chronic, healed
hydatid cyst.
Differential Diagnoses: Spleen
Granulomatous Abscess
Hemangioma
(Left) Transverse splenic US
shows a small echogenic focus
with posterior acoustic
shadowing st, consistent with
a healed calcified granuloma
(typically due to prior TB,
MAC, histoplasmosis, or
sarcoidosis). Mimics may
include vascular calcifications
or Gamna-Gandy bodies of
portal hypertension. (Right)
Longitudinal US shows a large
hemangioma ſt with
hyperechoic solid and anechoic
cystic components . On
occasion, cystic areas may be
as large as entire lesion, giving
the lesion a predominantly
cystic appearance.
Hemangioma
Lymphoma
(Left) Color Doppler US in the
same patient shows prominent
internal vascularity ſt in the
solid portion of the splenic
hemangioma. (Right)
Longitudinal US shows
multiple hypoechoic lesions ſt
in a patient with multifocal
lymphomatous involvement of
the spleen. The differential
would also include metastasis
and granulomatous diseases.
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