Author:
Thomas Ward
Ultrasound
CT
MRI - T1
MRI - T2
MRI - postcontrast T1
Gross
Histology
Additional comments and imaging
Benign lesions:
Hemangioma
Cystic mass (arrowheads) w/wo internal trabeculation (arrows). Smaller
hemangiomas may be echogenic
Hypo-attenuating lesion
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
progresses centrally.
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/wo contain
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 channels surrounded 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 mass with
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 .
True cysts
Fluid attenuating cystic lesion , w/wo
septations
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
hypoattenuating masses
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)
Nonenhanced: increased
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).
Malignant lesions:
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
calcifications (20%)
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 (*).
Other:
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)
Trauma
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)
