Sonografie der großen Gefäße Nebennieren und MILZ

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1 Sonografie der großen Gefäße Nebennieren und MILZ Dr. Dieter Lungenschmid/Dr. Thomas Trieb

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3 Abdomensonographie Große Gefäße Aorta Echoreiche Gefäßwand Nicht komprimierbar Darstellung der Gefäßabgänge Aorta abdominalis Tr. coeliacus (A. gastr. sinistra, A. hepatica, A. lienalis) A. mesenterica superior Aa. renales A. mesenterica inferior Iliakalgefäße

4 Abdomensonographie Große Gefäße Vena cava Echoärmere Wand, rechts der Aorta Komprimierbar Doppelschlagphänomen Zuflüsse Lebervenen

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6 Abdomensonographie Große Gefäße Vena porta Echoreiche Wand, rechts der Aorta Zuflüsse V. lienalis V.mes. sup. = Confluens V. porta

7 Aorta abdominalis V. Cava inferior

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9 MILZ

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11 Size And Location Intraperitoneal located in the Lt. hypochondrium between fundus of stomach and diaphragm Bare area anterior to Lt. kidney Ovoid in shape 11 cm in length; 7 7 cm in breadth 4 4 cm in thickness Weighs g Varies gms

12 Structure Red Pulp - Venous sinuses serving as blood reservoir, resembles a lymph gland White Pulp - Malpighian corpuscles / lymph tissue

13 Abdomensonographie Milz Indikation: Erkennen von Größen- und Formveränderungen Nebenmilz Hämatome, Abszesse, Zysten Aussage: Sehr gute Methode zur Größenbestimmung Veränderungen ab 0,5 cm erkennbar

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15 Abdomensonographie Milz Auffinden: Intercostaler Längsschnitt 10.ICR links (keine tiefe Inspiration, bei subcostaler Darstellung tiefe Insp.) Halbmondförmig Maße: 4 x 7 x 11cm, wenn max. Längsdurchmesser > 11cm dann erfolgt Bestimmung der Tiefe und Breite Echogenität: Ähnlich der Leber

16 Nebenmilz

17 Size And Location Intraperitoneal located in the Lt. hypochondrium between fundus of stomach and diaphragm Bare area anterior to Lt. kidney Ovoid in shape 11 cm in length; 7 7 cm in breadth 4 4 cm in thickness Weighs g Varies gms

18 Indications Splenomegaly Palpable splenic mass Cranial abdominal organomegaly Lethargy, collapse Anemia, abnormal RBC s

19 Ultrasound Technique Left side of body Head of spleen Under border of rib cage on left Body & tail of spleen Along left body wall Ventral or lateral to left kidney Scan sagittal & transverse

20 Anatomy Size of normal spleen variable Assessed subjectively Enlarged spleen may cross midline or extend caudally to the bladder Parenchyma Homogenous, finely textured

21 Spleen Longitudinal Spleen Lt Kidney Adrenal

22 Splenic Hilium Longitudinal Splenic hilum

23 Longitudinal Spleen Diaphragm

24 Normal Spleen

25 Anatomy Capsule Smooth, regular, VERY echogenic Splenic veins Only other structure normally visualized Poorly visualized except near hilus Whale tail Enlargement subjective Hilus Check for lymphadenopathy

26 Splenic Hilus

27 Diffuse splenomegaly Congestion Torsion Inflammation/septicemia Neoplasia Pathology Lymphosarcoma Mast cell tumor Phenothiazine tranquilizers & barbiturate anaesthetics Extramedullary hematopoesis

28 Pathology Focal or multifocal splenic lesions Hematoma Infarcts Cysts Abscess Nodular hyperplasia Neoplasia Hemangioma Hemangiosarcoma

29 Diffuse Splenomegaly Diffuse increase in echogenicity uncommon Neoplastic (mast cell or lymphosarcoma) Diffuse decrease in echogenicity more common Congestion Extra-medullary hematopoesis Lymphosarcoma Inflammation/ septicemia Torsion Normal echogenicity can occur with lymphosarcoma & mast cell tumor

30 Non Homogenous

31 Focal/Multifocal Lesions More common than diffuse Anechoic Cysts Hematoma/neoplasia Hypoechoic Neoplasia Abscess Acute infarct Nodular hyperplasia

32 Focal/Multifocal Lesions Hyperechoic Neoplasia Abscess Chronic infarct Nodular hyperplasia Mixed echogenicity Neoplasia Hematoma Abscess Nodular hyperplasia

33 Splenic Mass

34 Splenic Mass

35 Splenic Infarct

36 Torsion Definitive diagnosis by ultrasound Characteristic appearance Severe, diffuse splenomegaly Hypoechoic Coarse & lace-like Venous blood flow absent on Doppler +/- hyperechoic venous thrombi Lymphosarcoma can appear similar Normal blood flow

37 Torsion

38 Neoplasia Lymphosarcoma Diffuse or focal/multifocal Hypoechoic or hyperechoic Can appear normal Hematoma, hemangioma, hemangiosarcoma Unable to differentiate Focal Hypoechoic, hyperechoic or mixed

39 Lymphosarcoma

40 Hemangiosarcoma

41 Neoplasia Other neoplasms Mast cell tumor, leiomyoma, etc. Presence of peritoneal effusion not a good indication of malignancy Metastasis Lungs, liver, lymph nodes (splenic, hepatic, gastric)

42 Echogenic Focal Lesions Focal fat deposits Especially cats Surround hepatic veins (myelolipomas) Fibrosis & calcification Secondary to hematoma, chronic infarcts or granulomas (histoplasmosis) Primary or metastatic neoplasia

43 Definitive Diagnosis Ultrasonic appearance of most splenic diseases non-specific Consider history, signalment, clinical signs Fine needle aspirate useful Biopsy generally not performed

44 Rupture Free fluid within the abdomen Often echoic (due to blood cells) May be anechoic Most likely a tumor Cannot rule out hematoma

45 Thrombosis

46 Splenic Thrombus

47 Myelolipoma

48 Figure 7. Severe splenic laceration in a 35-year-old man after an assault. McGahan J P et al. Radiographics 2001;21:S191-S by Radiological Society of North America

49 Figure 8. Severe splenic laceration in a 29-year-old man involved in a motor vehicle accident. McGahan J P et al. Radiographics 2001;21:S191-S by Radiological Society of North America

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