Diagnostic ultrasound ( PDFDrive )

CHAPTER 5 The Spleen 159
H
A
B
FIG. 5.30 Subcapsular Hematoma. (A) Transverse scan shows a luid- and debris-illed crescentic hematoma (H) in the lateral aspect of the
spleen. (B) Thin, brightly echogenic crescentic line (arrow) represents the splenic capsule.
A
B
FIG. 5.31 Perisplenic Hematoma. (A) Coronal scan shows a hematoma (arrows) lateral to the spleen (S). (B) Corresponding contrast-enhanced
computed tomography image shows the splenic laceration (arrows) and large, perisplenic hematoma. Free luid is also seen in the right upper
abdomen.
of accessory spleens, however, are easy to recognize sonographically
as small, rounded masses, usually less than 5 cm in diameter,
with the same echogenicity as the spleen (Fig. 5.33). CT, MRI,
or, in challenging cases, scintigraphy with technetium-labeled
heat-damaged red blood cells, can conirm the diagnosis. 87
A “wandering spleen” (or mobile spleen) can be found in
unusual locations and may be mistaken for a mass (Fig. 5.34).
It is caused by absence or extreme laxity of the supporting ligaments
and a long, mobile mesentery (see Fig. 5.1B). he mobile
spleen may undergo torsion, resulting in acute or chronic
abdominal pain. 88,89 If the diagnosis of a wandering spleen is
made in a patient with acute abdominal pain, the diagnosis of
torsion is supported by color low Doppler imaging showing
absence of blood low. 90
he other two major congenital splenic anomalies are the
asplenia and polysplenia syndromes. hese conditions are best
understood if viewed as part of the spectrum of visceral heterotaxy.
A normal arrangement of asymmetrical body parts is