Abstract
The characterization of focal splenic lesions by ultrasound can be quite challenging. The recent introduction of contrast-enhanced ultrasound (CEUS) has come to play a valuable role in the field of imaging splenic pathologies, offering the possibility of an ionizing radiation-free investigation. Because CEUS has been incorporated into everyday clinical practice, malignant diseases such as focal lymphomatous infiltration, metastatic deposits, benign cysts, traumatic fractures, and hemangiomas can now be accurately depicted and characterized without the need for further imaging. More specifically, splenic traumatic fractures do not require additional imaging by computed tomography (with ionizing radiation exposure) for follow-up, because splenic fractures and their complications are safely imaged with CEUS. In the new era of CEUS, more patients benefit from radiation-free investigation of splenic pathologies with high diagnostic accuracy.
Highlights
The search for efficient and less expensive imaging techniques is an ongoing challenge worldwide, ultrasound being ideally positioned to provide comprehensive imaging in a cost-effective manner
Study conducted in the Department of Radiology, King’s College Hospital, Denmark Hill, London, United Kingdom
contrast-enhanced ultrasound (CEUS) showed a focus of hyperenhancement within the fracture plane, consistent with a pseudoaneurysm
Summary
The search for efficient and less expensive imaging techniques is an ongoing challenge worldwide, ultrasound being ideally positioned to provide comprehensive imaging in a cost-effective manner. As with a cyst, there should be no enhancement of the debris or fluid/necrotic areas, the wall irregularity and enhancement distinguishing an abscess from a cyst Granulomatous diseases such as sarcoidosis and tuberculosis can involve the spleen; for example, 60% of sarcoidosis patients have splenic involvement[10]. It is challenging to diagnose traumatic splenic injury solely on the basis of B-mode ultrasound images, and contrast-enhanced CT is often the modality of choice for the assessment of the spleen after blunt abdominal trauma. CEUS can be used at the bedside to delineate splenic injury in a trauma patient and is useful in the follow-up imaging evaluation of such patients, to avoid the ionizing radiation exposure of repeated CT examinations (Figure 6). A distinct form of low-grade non-Hodgkin lymphoma is hairy-cell leukemia (Figure 9), which accounts for approximately 2% of all cases of leukemia[14]
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