Diagnostic ultrasound ( PDFDrive )

162 PART II Abdominal and Pelvic Sonography
tail. Identifying the splenic artery and vein may be helpful in
conirming the normal tail of the pancreas.
Similarly, the fundus of the stomach may nestle in the hilum
of the spleen. An oblique plane during scanning may pass through
the spleen and include the hilum, with an echogenic portion of
the stomach simulating an intrasplenic lesion. In some patients,
this is just the fat around the stomach. Occasionally, luid in the
fundus of the stomach can simulate a perisplenic luid collection.
his can usually be resolved by scanning transversely or by letting
the patient drink some water during the scan.
An occasional anatomic variant can occur if the inferior
portion of the spleen is located posterolateral to the upper pole
of the let kidney. his variant has been called the retrorenal
spleen. Awareness of its existence can prevent the misdiagnosis
of an abnormal mass. If visualized sonographically, it should be
avoided in any interventional procedure performed on the let
kidney. 103
It can be very diicult to determine the site of origin of large,
LUQ masses arising from the spleen, let adrenal gland, let kidney,
tail of the pancreas, stomach, or retroperitoneum. Diferential
motion observed during shallow respiration may be helpful.
Additionally, the identiication of the splenic vein entering the
splenic hilum can be deinitive. CT or MRI should be used to
clarify challenging cases.
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