Multimodal ultrasound techniques for the differential diagnosis of splenic lesions - Adiagnostic challenge

Abstract

Splenic tumors are rare and can pose adifferential diagnostic challenge, especially as an incidental imaging finding. Due to alack of large scale biopsy studies the available literature is limited with respect to clear imaging criteria for dignity. The present work is intended to show the chances of atargeted elicitation of the medical history as well as the possibilities and limitations of multimodal sonography in order to achieve the correct diagnosis of asplenic lesion using simple and gentle methods. Selective literature search and clinical case studies. In the differential diagnostics of focal splenic lesions, information about pre-existing hemato-oncological or inflammatory rheumatological diseases is essential in order to correctly classify incidental findings in particular. In addition to B‑mode ultrasound (B-US) and color-coded Doppler ultrasound (CD-US), contrast-enhanced ultrasound (CEUS) in particular provides crucial differential diagnostic information. While hyperechoic foci in B‑US or arterially hypervascularized splenic foci in CD-US/CEUS are usually benign, hypoechoic and arterially hypoperfused foci in CD-US/CEUS must be further clarified. Although the ultrasound-guided biopsy of the spleen has ahigher risk of bleeding than aliver biopsy, it is still the gentlest and most effective method for achieving the histological clarification of splenic lesions when the indications are correct. Through the combination of the medical history and multimodal ultrasound methods, if necessary supplemented by anultrasound-guided biopsy, focal splenic lesions can be successfully classified in most cases with adirect impact on further clinical procedures.