||Ultrasound||CT||MRI - T1||MRI - T2||MRI - postcontrast T1||Gross||Histology||Additional comments and imaging|
|Hemangioma||Cystic mass (arrowheads) w/wo internal trabeculation (arrows). Smaller hemangiomas may be echogenic||
on non-contrast enhanced images, w/wo calcifications.
Progressive enhancement is characteristic.
Delayed images demonstrate a nearly isoattenuating mass, w/wo calcification
|Hypointense mass. High signal intensity (arrow) may represent hemorrhage.||Variable signal intensity, depending on presence and stage of hemorrhage (arrow).||
Early post-contrast:peripheral nodular enhancement that
Delayed post-contrast: uniform (arrow) or progressive internal enhancement.
|Hemangioma can be seen to contain a large cystic space (arrows) filled with hemorrhagic debris.||H and E stain shows the characteristic multiple blood-filled vascular channels. Cystic areas that were filled with serous material (*) instead of blood. Architectural distortion is noted(arrowheads).|
|Hamartoma||Heterogeneous grey-scale echotexture. Hypervascular on color Doppler.||Heterogeneous enhancement||Well-defined lesion (arrows), isointense. Areas of hemorrhage (arrowheads) may be present.||Irregular, heterogeneously low signal intensity||
Early post-contrast: mild, diffuse, heterogenous enhancement.
Early post-contrast: mild, diffuse, heterogenous enhancement.
Delayed contrast-enhanced: relative uniform enhancement
|Spherical, well-circumscribed, diffusely hemorrhagic mass (arrows) without necrosis.||H-E stain: disorganized sinuses and splenic red pulp elements|
|Lymphatic malformation||Multiple, multi-loculated hypo-echoic, rounded lesions. Low-level echoes (arrows) represent proteinaceous fluid.||
Nonenhancing lesions. May nearly completely replace normal
spleen, w/wo calcifications.
Delayed phase: low-attenuation, non-enhancing lesions, w/wocontain calcifications.
|Variably sized, low signal intensity. High signal intensity (arrow), indicates proteinaceous material||Relatively homogenous hyper-intense signal.||Cystic spaces (arrows) containing clear, yellowish fluid consistent with lymph. Septations (arrowheads) can be seen||H and E stain: multiple lymph filled channelssurrounded by normal splenic tissue (*)|
|False Cyst||Well-defined, hypoechoic, rounded lesion with a thick wall, possibly calcified (arrowheads). Reverberation artifact is noted (asterisk)||Uniform, well-rounded, low attenuation masswith or without a calcified wall||Thick fibrous wall outlining a large cyst, variable cyst contents||H and E stain: thick wall (double-headed arrow) surrounded by compressed splenic parenchyma (arrow- heads). No epithelial lining.|
Fluid attenuating cystic lesion, w/wo
Well-defined, low attenuation mass, w/wo septations
|Well defined rounded mass, homogeneous high signal||Well-defined, rounded, homogeneously low-signal, non-enhancing lesion (arrow)||Large cyst, w/wo thin trabeculae (arrows)||H and E stain: trueendotheial lining (arrows)|
|Peliosis||Multiple low-attenuation, lesions of different sizes||Multiple low-intensity, rounded lesions of different sizes throughout the splenic and liver parenchyma||Diffuse, multiple cystic cavities of variable size with clotted blood||H and E stain: hemorrhage within vascular cavities (arrows)|
|Littoral cell angioma||Heterogeneous splenic echotexture, multiple hyperechoic lesions and a focal hyperechoic mass (arrow).||
Early portal venous phase: multiple, partially confluent
Delayed phase: homogeneously enhance, nearly imperceptible.
|Multiple subtle hypointense splenic lesions (arrow).||Hypointense (arrow), adjacent to the normally bright splenic parenchyma.||Multiple blood-filled spaces (arrow).||H and E stain: multiple blood-filled spaces (*) within a focus of littoral cell angioma|
|Granulomatous disease (Histo, Wegener, Sarcoid)||Large necrotic splenic lesions or infiltration with multiple nodules, w/wo scattered calcifications (arrows)||Foci of low-signal-intensity may represent calcified granulomatous disease||Text soon coming||
Arterial phase: multiple small, hypointense, lesions. Non-
enhancing on the early phase
Delayed phase: Multiple small, hypointense lesions, enhance on delayed phase image
|Abscess||Heterogeneously hypoechoic mass, internal low-level echoes and irregular borders(arrowheads)||
Nonenhanced CT: hypoattenuating mass (large arrow), may see
adjacent inflammatory changes (small arrow)
Low-attenuation mass, irregular borders(arrows). Extra-splenic spread may be seen
|Cystic mass, may demonstrate irregular or thick wall, heterogeneously intermediate signal intensity.||Heterogeneous, hyperintense signal intensity||Cystic mass, enhancing irregular wall, heterogeneously intermediate signal intensity internally||Irregular nodular borders||H and E stain: shows severe inflammatory infiltrate and hemorrhage (arrows), destruction of normal splenic tissue|
|Hematoma||Heterogeneous spleen, with multiple hypoechoic collections of blood (arrows)||
attenuation compatible with acute or subacute.Chronic
may be fluid-attenuating
Contrast-enhanced: single or multiple scattered well-defined low-attenuation.
|Depends on hematoma age. Heterogeneous T1 iso- to hyper- intense lesion represents acute/subacute hematoma||Depends on hematoma age. Heterogeneous T2 hyper-intense lesion represents acute/subacute hematoma||H and E stain: fragments of normal spenic parenchyma (*) and large collections of blood (arrows).|
|Lymphoma||Complex mass, variable echotexture. Ill-defined, central hypoechoic area (*) corresponding to cystic region. Acoustic enhancement accounts for some of the increased echogenicity within this lesion.||
Venous phase: large, ill-defined
mass with low attenuation.
Delayed phase: homogeneously attenuating spleen with a wedge-shaped area of low attenuation (arrow) corresponding to area of infarct.
|Delayed phase: homogeneously attenuating spleen with a wedge-shaped area of low attenuation (arrow) corresponding to area of infarct.||Variable, hyperintense component secondary to the proteinaceous nature of the necrotic material. In this case, heterogeneously increased signal is secondary to diffuse involvement.||Hypovascular, irregular, infiltrative lesion||Infiltrating lymphorna (*) with a central cystic/necrotic area (arrowheads).||H and E stain: diffuse infiltration (*). A small amount of normal splenic parenchyma (double-headed arrow).|
|Metastases||Hyperechoic mass (arrowheads), depends on primary. Doppler examination may show internal vascular flow.||
Penitoneal implants from mucinous adenocarcinoma scallop
the surface of the liver and spleen.
Contrast-enhanced: large, ill-defined, low-attenuation lesion. Metastatic disease may present as single or multiple splenic lesions
|Usually T2-hyperintense, as in this case (renal cell carcinoma, arrows).||Large, metastatic foci, ranging from cystic (*) to solid (arrows)||Histology depends on primary tumor. H and E stain: neoplastic tissue composed of mucous glands (*), primary colonic adenocarcinoma.|
|Angiosarcoma||Heterogeneous echotexture, echogenic rim (arrow) and a hypoechoic center (arrowhead) compatible with necrosis. Doppler: hypervascular rim||
Non-enhanced: vague hypo-attenuating lesion (arrow), w/wo
Early portal-venous:heterogeneous enhancement, decreased attenuation (arrowhead) corresponds to necrosis. Two enhancing masses (black arrows) are seen in the liver.
Delayed: low attenuation, focal central high attenuation correspons to hemorrhage, w/wo calcifications
|Low signal intensity in the periphery (arrows), high signal intensity in the center (hemorrhage). Liver lesions compatible with metastasis||High signal intensity in the periphery, inhomogeneity in the center is compatible with necrosis. Liver lesions compatible with metastasis||Intense contrast enhancement, w/wo metastasis.||Multiple tumor nodules in the periphery of the rim (white arrows) and a central necrosis and fibrosis (black arrows).||H and E stain:diffusely infiltrating purple masses (arrowheads) and areas of focal hemorrhage (*).|
|Infarction||Scattered heterogeneous wedge-shaped and rounded hypoechoic areas with hemorrhagic debris (arrows)||
Hyperacute infarct: enlarged spleen with generalized
decreased attenuation, w/wo hemorrhage
Chronic infarct: small spleen, possibly calcified
Incomplete infarct: focal wedge-shaped lesion
Chronic, incomplete: wedge-shaped, hypoattenuating lesion, w/wo subcapsular splenic calcification
|Peripheral area of increased signal intensity with a dark rim, compatible with an infarct.||Nonenhancing wedge-shaped area(arrow)||Variable, multiple cystic areas with irregular borders||Liver-spleen scan: acute sequestration shows only a thin rim of activity (arrowhead)|
Grade 1: Subcapsular hematoma <10% surface area Laceration:
Capsular tear, <1 cm parenchymal depth
Grade 2: Subcapsular hematoma 10%–50% surface area; intraparenchymal hematoma <5 cm in diameter Laceration 1–3 cm parenchymal depth; does not involve a trabecular vessel
Grade 3: Subcapsular hematoma >50% surface area or expanding; ruptured subcapsular or parenchymal hematoma Laceration: >3 cm parenchymal depth or involved trabecular vessels
Grade 4: Laceration involving segmental or hilar vessels and producing major devascularization (>25% of spleen)
Grade 5: Laceration completely shattered spleen. Hilar vascular injury, devascularizes spleen, active bleeding (arrows) and extravasation (arrowhead)