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LIEN/SPLEN/LIMPA

Oleh:
Naomi R. Claudya Napitupulu
213210169
FK UMI 2013

SMF RADIOLOGI
RSUD DR PIRNGADI MEDAN
SPLEN
The spleen is an organ of the haematological system and has a role in
immune response, storage of red blood cells and hematopoiesis.

The spleen is a wedge-shaped organ lying mainly in the left upper


quadrant (left hypochondrium and partly in the epigastrium) and is
protected by the left 9th to 11th ribs. It is soft, highly vascular and
dark purple in colour.
GROSS ANATOMY
Size and weight vary from person-to-
person but on average is around 2.5 cm
thick, 7.5 cm broad and 12.5 cm in
length.

The spleen has two poles (superior and inferior),


three borders and two surfaces (diaphragmatic
and visceral). It is enclosed by a thin capsule,
which is easily ruptured.

The spleen is completely covered by peritoneum, except at the hilum, and


forms a number of ligaments :
gastrosplenic ligament
attaches the spleen to the greater curvature of the stomach
contains short gastric and left gastroepiploic arteries
splenorenal ligament
attaches the spleen to the left kidney
contains splenic artery and vein and the pancreatic tail
PELVIC
FOTO ABDOMINAL SPLEN NORMAL
POSISI AP SUPINE
SAGITTAL ABDOMEN
CT SCAN ABDOMEN SAGITTAL
POSITION
ABDOMINAL SPACE ANATOMY
CT-SCAN ABDOMEN NORMAL
ABDOMINAL ANATOMY
CT-SCAN ABDOMEN NORMAL
NORMAL SPLEN IN ULTRASONOGRAPHY
DISEASE OR MEDICAL CONDITIONS

 SPLENOMEGALI
 CONGENITAL ANOMALIES
1. Wandering Spleen
2. Polysplenia
3. Asplenia
4. Spleen Accessories
 MASS LESIONS
1. SPLENIC HEMANGIOMA
2. SPLENIC LYMPHANGIOMAS
3. SPLENIC EPIDERMOID CYST
 SPLENIC INJURY
 SPLENIC DISEASE
1. Splenic Regeneration
2. Splenic Infarction
3. Splenic Abcess
4. Splenic Siderotic Nodules
SPLENOMEGALY
 Splenomegaly is a term which refers to enlargement of the
spleen. The normal adult splenic length upper limit is usually
around 12-15 cm.
SPLENOMEGALY

Splenomegaly in ultrasound
Splenomegaly with cirrhotic liver
Splenomegaly in ultrasound
S

Computed to tomographic section of abdomen


Splenic involvement in
Non-Hodgkin Lymphoma

S
 Any situations of splenomegaly:

AIDS
Splenomegaly associated with generalized lymphoid hyperplasia is the most
common finding in patients with AIDS.
Focal lesions in the spleen are usually caused by opportunistic infections such
as pneumocytes, pneumocytis jiroveci, atypical mycobacterium, or Candida.
AIDS-associated lymphoma and Kaposi sarcoma may also cause single or
multiple solid-appearing lesions in the spleen.

Fetal splenomegaly
(or simply an enlarged fetal spleen) can arise from a number of situations. It
can occur with or without fetal hepatomegaly.
CONGENITAL ANOMALIES
1. Wandering Spleen
2. Polysplenia
3. Asplenia
4. Spleen Accesories
1. WANDERING SPLEEN
Wandering spleen is a rare condition in which the spleen migrates from
its usual anatomical position, commonly to the lower abdomen or pelvis.

CT images show the abnormal location of the spleen at the pelvic


cavity above the urinary bladder, anterior and superior to the uterus
with stretched splenic artery and vein
abnormal location of the spleen at the pelvic
2. POLYSPLENIA
Polysplenia syndrome, also known as left isomerism, is a type
of heterotaxy syndrome where there are multiple spleens congenitally
as part of left-sided isomerism.
Axial
Coronal

Multiple spleens of variable size


3. ASPLENIA
Asplenia can be classified into two types:
1. Anatomical asplenia:
Absence of splenic tissue (can be congenitial, acquired or iatrogenic)
2. Functional asplenia:
Splenic tissue present, however it is non-functioning
4. ACCESORY SPLEEN
ACCESORY SPLEEN IN
ULTRASOUND
MASS LESIONS
1. SPLENIC HEMANGIOMA
2. SPLENIC LYMPHANGIOMAS
3. SPLENIC EPIDERMOID CYST
1. SPLENIC HEMANGIOMA
Splenic haemangiomas (also known as splenic venous
malformations) while being rare lesions, are considered the second
commonest focal lesion involving the spleen after simple splenic cysts
Splenic nodule showing small calcifications and slow progressive
contrast enhancement that tends to homogenize on delayed aquisition
2. SPLENIC LYMPHANGIOMAS

Spleen is replaced by multiple cystic structures of varying size.


Spleen is replaced by multiple cystic lesion of
varying size. Some showed septa and mural
calcifications.
3. SPLENIC EPIDERMOID CYST
Splenic epidermoid cysts are a type of non-parasitic primary splenic cyst.

Cystic mass (through transmission) with internal debris that was


quite mobile during prolonged scanning much like a hydrocoele (as
evidenced by internal "colour" on the duplex scanning).
The spleen is enlarged ( 16.5 cm ).
There is a 4.8 cm cystic lesion with
mobile echogenic debris and no
increased vascularity in the lower
aspect of the spleen. Adjacent to
this is a smaller 1.7 cm simple cyst.

Lobulated splenic lesion with rim


calcification and internal round
calcifications.
SPLENIC INJURY
GRADING SPLEN INJURY
SPLENIC DISEASE
1. SPLENIC REGENERATION
2. SPLENIC INFARCTION
3. SPLENIC ABCESS
4. SPLENIC SIDEROTIC NODULES
1. SPLENIC REGENERATION
2. SPLENIC INFARCTION
Splenic infarction with a wedge shape non vascularized splenic lession
Splenic infarct with a non vascularized wedge shaped
hypoechoic area
SPLEEN INFARCTION IN CT-SCAN
3. SPLENIC ABCESS
Splenic abscesses, like abscesses elsewhere, are localised collections of
necrotic inflammatory tissue caused by bacterial, parasitic or fungal agents.

Hypoechoic to anechoic region towards the periphery of the spleen


- Extensive areas of confluent non-
enhancing hypodensity (mainly fluid
density) in the spleen, mostly reaching
the periphery of the organ, with no gas
locules seen in them. The spleen is
moderately enlarged and surrounded by
inflammatory stranding, with several
prominent lymph nodes near the splenic
hilum, thought to be reactive.

- The splenic vein appears patent


(although it's faintly doing so, but
thought it is due to the phase of the
study as the portal vein is faintly
enhancing too).

- Abdominal solid viscera appear


unremarkable.
4. SPLENIC SIDEROTIC NODULES
Splenic siderotic nodules, also known as Gamna-Gandy bodies, of the
spleen, are most commonly encountered in portal hypertension. The
pathophysiological process is the result of microhaemorrhage resulting in
haemosiderin and calcium deposition followed by fibroblastic reaction
Ultrasound study of the abdomen demonstrates heterogenous echogenicity of the liver
with nodularity of the liver surface. There is moderate amount of ascities in the
abdomen. The hepatic vein and IVC is massively dilated. The portal vein demonstrate
antegrade flow and is of normal calibre. Multiple tiny echogenic foci are present in the
spleen indicative of Gamna-Gandy bodies. The spleen is not enlarged.
Marked splenomegaly with multiple
splenic foci of low signal, they are tiny
innumerable (Gamma gandy bodies).