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. 935
Focal Splenic Lesion Differential Diagnoses: Spleen (Left) A single lesion ſt in the mid spleen is shown, predominately hypoechoic with some internal peripheral vascularity. This was confirmed to be lymphomatous involvement of the spleen. (Right) Longitudinal US shows an exophytic gastric MALT lymphoma with direct invasion into the spleen. Portions of the mass are cystic (due to internal necrosis). Solid components range from hyperechoic ſt to hypoechoic . Lymphoma Lymphoma (Left) Power Doppler US show a heterogeneously hyperechoic mass representing secondary lymphoma involvement. Note that the absence of internal Doppler signal does not always exclude solid nature. (Right) Transverse US shows lymphomatous deposits ſt in the spleen. The markedly hypoechoic appearance may be confused with cystic lesions (in the left kidney ). Lymphoma Lymphoma (Left) Color Doppler US shows a similar heterogeneously hyperechoic mass with hypoechoic rim, here representing a metastasis from conjunctival melanoma. Hyperechoic mets may be from melanoma (hemorrhage) or mucinous adenocarcinomas (calcification). (Right) Longitudinal US shows irregular, echogenic nodules ſt of varying sizes (mets from hepatocellular carcinoma), hypodense on CECT. Echogenic appearance may represent coagulative necrosis. Mimics include granulomas, hemangiomatosis. Metastasis Metastasis 936
- Page 906 and 907: Target Lesions in Liver Hepatic Met
- Page 908 and 909: Multiple Hepatic Masses ○ Cluster
- Page 910 and 911: Multiple Hepatic Masses Cirrhosis W
- Page 912 and 913: Hepatic Mass With Central Scar Foca
- Page 914 and 915: Periportal Lesion Helpful Clues for
- Page 916 and 917: Periportal Lesion Peribiliary Cyst
- Page 918 and 919: Irregular Hepatic Surface Subcapsul
- Page 920 and 921: Portal Vein Abnormality Bland Porta
- Page 922 and 923: PART III SECTION 2 Biliary System
- Page 924 and 925: Diffuse Gallbladder Wall Thickening
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- Page 928 and 929: Hyperechoic Gallbladder Wall Porcel
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- Page 940 and 941: PART III SECTION 3 Pancreas Cystic
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- Page 952 and 953: PART III SECTION 4 Spleen Focal Spl
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- Page 958 and 959: Focal Splenic Lesion Splenic Infarc
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Focal Splenic Lesion<br />
Differential Diagnoses: Spleen<br />
(Left) A single lesion ſt in the<br />
mid spleen is shown,<br />
predominately hypoechoic<br />
with some internal peripheral<br />
vascularity. This was<br />
confirmed to be<br />
lymphomatous involvement of<br />
the spleen. (Right)<br />
Longitudinal US shows an<br />
exophytic gastric MALT<br />
lymphoma with direct invasion<br />
into the spleen. Portions of<br />
the mass are cystic (due to<br />
internal necrosis). Solid<br />
components range from<br />
hyperechoic ſt to hypoechoic<br />
.<br />
Lymphoma<br />
Lymphoma<br />
(Left) Power Doppler US show<br />
a heterogeneously<br />
hyperechoic mass representing<br />
secondary lymphoma<br />
involvement. Note that the<br />
absence of internal Doppler<br />
signal does not always exclude<br />
solid nature. (Right)<br />
Transverse US shows<br />
lymphomatous deposits ſt in<br />
the spleen. The markedly<br />
hypoechoic appearance may<br />
be confused with cystic lesions<br />
(in the left kidney ).<br />
Lymphoma<br />
Lymphoma<br />
(Left) Color Doppler US shows<br />
a similar heterogeneously<br />
hyperechoic mass with<br />
hypoechoic rim, here<br />
representing a metastasis<br />
from conjunctival melanoma.<br />
Hyperechoic mets may be from<br />
melanoma (hemorrhage) or<br />
mucinous adenocarcinomas<br />
(calcification). (Right)<br />
Longitudinal US shows<br />
irregular, echogenic nodules<br />
ſt of varying sizes (mets from<br />
hepatocellular carcinoma),<br />
hypodense on CECT. Echogenic<br />
appearance may represent<br />
coagulative necrosis. Mimics<br />
include granulomas,<br />
hemangiomatosis.<br />
Metastasis<br />
Metastasis<br />
936
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