Ebook Diagnostic pediatric ultrasound: Part 2
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Ebook Diagnostic pediatric ultrasound: Part 2
Chapter 10Spleen10.1Normal Anatomy and Variants32410.2Pathology33210.3Acknowledgements35410 SpleenSomite) StofraceThe spleen is a pyramid-shaped organ Ebook Diagnostic pediatric ultrasound: Part 2n normally located in the left upper quadrant. It forms part of and is the largest organ within the lymphoproliferative system, it plays a major role in the immune system and also functions as a filter of damaged and abnormal red blood cells.Imaging of the spleen starts and often rests very much wit Ebook Diagnostic pediatric ultrasound: Part 2h ultrasound. Depending on a child's age. this organ can be imaged with transducers of different frequencies. Exquisite images can be obtained with hiEbook Diagnostic pediatric ultrasound: Part 2
gher frequency, particularly in the younger child.Requests for examining this organ are alien related to a Clin; cully palpable increase 111 its size Chapter 10Spleen10.1Normal Anatomy and Variants32410.2Pathology33210.3Acknowledgements35410 SpleenSomite) StofraceThe spleen is a pyramid-shaped organ Ebook Diagnostic pediatric ultrasound: Part 2 arc part of the normal ultrasound examination of the pediatric abdomen.This chapter describes the normal appearances, variants, and most common pathologies of the spleen as seen with lilt rasa 11 nd.10.1Normal Anatomy andVariants10.1.1Embryologylhe spleen begins to develop at the fifth week of feta Ebook Diagnostic pediatric ultrasound: Part 2l life It develops from multiple cellular nests located within the dorsal mesagas I rill in (► Fig. 10.11. Symmetrical splenic precuisoix are though',Ebook Diagnostic pediatric ultrasound: Part 2
to exist with preferential development of the left sided splenic tissue. These cellular nests eventually fuse to form a single organ The small anteriChapter 10Spleen10.1Normal Anatomy and Variants32410.2Pathology33210.3Acknowledgements35410 SpleenSomite) StofraceThe spleen is a pyramid-shaped organ Ebook Diagnostic pediatric ultrasound: Part 2nunculi), seen in about lt>‘i of normal individuals, results from incomplete fusion of all the splenic tissue into one organ.Given its embryonal development in the dorsal mesogas-trium. the final location of splenic tissue is very much dependent on noitnal situs and normal bowel rotation. At s weeks Ebook Diagnostic pediatric ultrasound: Part 2’ gestation, the liver rotates to the right, and the stomach and spleen rotate to the left. The peritoneal reflections between these organs follow theEbook Diagnostic pediatric ultrasound: Part 2
ir rotational movement.10.1.2Anatomical ConsiderationsThe final anatomical splenic position and the layout of its asso elated peritoneal reflections aChapter 10Spleen10.1Normal Anatomy and Variants32410.2Pathology33210.3Acknowledgements35410 SpleenSomite) StofraceThe spleen is a pyramid-shaped organ Ebook Diagnostic pediatric ultrasound: Part 2o splenic ligament Connects the spleen with the greatei curvature of the stomach anteriorly The licnorcnal ligament in turn connects the spleen to the retropcritoncum posteriorly. The tail of the pancreas is partly located within this lallei peritoneal reileclion and can he easily seen in close rela Ebook Diagnostic pediatric ultrasound: Part 2tion to the splenic hilum on ultrasound .he splenic hilum effectively points medially between the stomach and the left kidney, both of which leave anEbook Diagnostic pediatric ultrasound: Part 2
indents t.on. Medial to the gastrosplenic and licnorcnal ligaments is the lateral aspect of the lesser sac of the peritoneal cavity. Furl her peritoneChapter 10Spleen10.1Normal Anatomy and Variants32410.2Pathology33210.3Acknowledgements35410 SpleenSomite) StofraceThe spleen is a pyramid-shaped organ Ebook Diagnostic pediatric ultrasound: Part 2ly, the spleen is related III the diaphragm, lying in .1 concavity within the left hernidiaphragm. .Anteriorly, lhe organ is related to the stomach and left colon. Posteriorly lie the diaphragm. left pleura, lung base, and chest wall.■Arterial blood supply comes through the splenic artery, which is Ebook Diagnostic pediatric ultrasound: Part 2a branch of the celiac trunk of the aorta. This courses behind the pancreas and reaches the spleen through the lic-norenal ligament. The splenic arterEbook Diagnostic pediatric ultrasound: Part 2
y divides into a number of branches before entering the spleen. This is described to follow two main patterns. In the distributed type the primary truChapter 10Spleen10.1Normal Anatomy and Variants32410.2Pathology33210.3Acknowledgements35410 SpleenSomite) StofraceThe spleen is a pyramid-shaped organ Ebook Diagnostic pediatric ultrasound: Part 2tational age.Fig. 10.2 Anatomical drawing demonstrating the final position of the sp'ccn with the associated peritoneal reflections. AO. aorta; iVC. inferior vena cava; Fi, falciform ligament: Gf/. gastrohepatic ligament: GS. gastrosplenic ligament; IR. licrwenal ligament; IS. lesser sac: IK. left k Ebook Diagnostic pediatric ultrasound: Part 2idney. RK. fight kidney324Fig. lO.ỉa.b Normal transverse ultrasound images of die spleen, a I’osdon of die probe n the left lateral aspect b CorresponEbook Diagnostic pediatric ultrasound: Part 2
ding ultrasound image, lhe stomach (st) can be seen anterior to the spleen.Alternatively, in the magistral type (30»< I. the main till .11; .s long wiChapter 10Spleen10.1Normal Anatomy and Variants32410.2Pathology33210.3Acknowledgements35410 SpleenSomite) StofraceThe spleen is a pyramid-shaped organ Ebook Diagnostic pediatric ultrasound: Part 2m. The unified vein travels with the artery behind the pancreas to join with the superior mesenteric vein and form the portal vein.Histologically. the spleen is formed by a fibrous capsule I hat supplies a network of Irabeculatioiis veiling as a supportive framework for the functional tissue, the fu Ebook Diagnostic pediatric ultrasound: Part 2nctional tissue consists of two types, lhe white pulp I which derives its name from its appearance on gross pathology specimens) consist!: of groups oEbook Diagnostic pediatric ultrasound: Part 2
f lymphocytes and lymphoid follicles. The ted pulp comprises the remainder of the spleen (approximately ??*< of the volume) and is composed of venous Chapter 10Spleen10.1Normal Anatomy and Variants32410.2Pathology33210.3Acknowledgements35410 SpleenSomite) StofraceThe spleen is a pyramid-shaped organ Ebook Diagnostic pediatric ultrasound: Part 2ed spleen is identified in the left upper quadrant, above the left kidney and under the left hemidiaphragm, either through a window unde: I he left lower rib margin or through the lowei intercostal spaces Images should be obtained in the transverse and coronal oblique planes along the length of the Ebook Diagnostic pediatric ultrasound: Part 2organ (► Fig. 103 and ► Fig. 10.4i. These images can generally be obtained in the supine position, although rotating the child into the lateral decubiEbook Diagnostic pediatric ultrasound: Part 2
tus position t> Fig. 10.51 can assist in obtaining a suitable window when imaging in the supine position is proving difficult. Occasionally, the lung Chapter 10Spleen10.1Normal Anatomy and Variants32410.2Pathology33210.3Acknowledgements35410 SpleenSomite) StofraceThe spleen is a pyramid-shaped organ Ebook Diagnostic pediatric ultrasound: Part 2 breath briefly in expiration while be or she gently slides the probe up anddown the lower left intercostal spaces until the organ comes into view I ► Fig. 10.6 ► Video 10.6110.1.4Echogenicity and Changes in Echogenicity with AgeAs a III e of thumb, he spleen is expeeled to have echogenicity similar Ebook Diagnostic pediatric ultrasound: Part 2 to that of the liver and appear more echogenic than the adjacent kidney. Ibis is assuming that the hepatic and renal echogenicity is normal w hen theEbook Diagnostic pediatric ultrasound: Part 2
se organs are used ax a corn parison lot assessing lhe echogenic appearance oflhe spleen.Ibe spleen appears diffusely homogeneous. When it is evaluateChapter 10Spleen10.1Normal Anatomy and Variants32410.2Pathology33210.3Acknowledgements35410 SpleenSomite) StofraceThe spleen is a pyramid-shaped organ Ebook Diagnostic pediatric ultrasound: Part 20.7|. The degree of hetero geneity ranges from mild granularity to better-defined tiny areas of hypoechogcnieity throughout the organ. Some authors have clearly demons!rated that these heterogeneous appearan ces change with age and aie best identified in children between the ages of 1 and 5 years. S Ebook Diagnostic pediatric ultrasound: Part 2uch appearances arc attributed to the presence of white pulp lymphoid follicles in the spleen, which are thought to account lor the liny focal areas oEbook Diagnostic pediatric ultrasound: Part 2
f low echogenicity described.The inability to demonstrate such heterogeneity in infants is thought to result from the immaturity of the organ at this Chapter 10Spleen10.1Normal Anatomy and Variants32410.2Pathology33210.3Acknowledgements35410 SpleenSomite) StofraceThe spleen is a pyramid-shaped organ Ebook Diagnostic pediatric ultrasound: Part 2erature indicates that the chances of demonstrating such heterogeneity increases both with age and With organ Size.It is very important to become comfortable With normal splenic appearances at different frequencies and with the various probes that are part of one’s regular equipment.325 Ebook Diagnostic pediatric ultrasound: Part 2Chapter 10Spleen10.1Normal Anatomy and Variants32410.2Pathology33210.3Acknowledgements35410 SpleenSomite) StofraceThe spleen is a pyramid-shaped organGọi ngay
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