Medica_Montag

DIAGNOSTICS ON THE MOVEON THE MOVEON THE MOVEON THE MOVEON THE MOVEON THE MOVEON THE MOVEON THE MOVEON THE MOVEON THE MOVEON THE MOVEON THE MOVEON THE MOVEON THE MOVEON THE MOVEON THE MOVEON THE MOVEON THE MOVE Halle 9 Stand A14 MONDAY @ MEDICA8 EH @ MEDICA No 1 2015 is a particularly suitable procedure to detect haematoma in the spleen because it does not accumulate the contrast agent. Subcapsular bleed- ing shows on the contrast enhanced image as cap-shaped. Bleeding in the spleen without trauma being present frequently occurs in oncologi- cal patients with a severely impaired immune system. Patients with acute or chronic leukaemia also frequently suffer splenomegaly, which can rup- ture spontaneously (Image 5a). An intralienal pseudo aneurysm, which entails arterial blood flooding the spleen, is life-threatening (Image 5b) and requires fast intervention or sur- gical procedures. The focal round lesion A biopsy is only rarely carried out in these cases, for example if an iso- lated splenic metastasis is suspected. Because the risk of secondary bleed- ing following puncture of the spleen is too high, the preferred option is to rely on the clinical anamnesis. In malignant lymphoma patients who have round lesions in the spleen, it Christian Görg MD studied medicine, church music and protestant theology at the Justus-Liebig University Giessen. In 1992 he wrote his habilitation treatise on internal medicine at the Medical Faculty of the Philipps University in Marburg. From 1995 the professor has also served as a consultant in the Department of Haematology and Oncology at the Centre for Internal Medicine, in Giessen and Marburg University Hospitals and has also been head of the ultrasound department since 1996. Spleen – the forgotten organ Perineal lesions ‘Small lesions near the spleen are often detected during routine exami- nations. The objective then is to find out whether there is a serious pathol- ogy, or whether they may be just anatomic variations. Around 15% of the population have a so-called accessory spleen (see Image), which is a harmless nodule of splenic tissue located away from the main body of the spleen.’ The small spleen A small spleen initially does not pre- sent as an actual clinical picture, but: ‘We need to check whether the tissue is perfused normally or whether there is a functional asplenia/hyposplenia, that is, whether or not the spleen may have shrunk due to recurring infarc- tions (See image). This can be deter- mined easily with the help of contrast enhanced ultrasound (image).’ The use of echo enhancers works so well with the spleen because the tissue not only accumulates the contrast agent intensely in the arterial phase, but also retains it for a long time dur- ing the parenchymal phase. Large spleen Possible causes for such a spleno- megaly can be an infection such as glandular fever (Image 3), cirrhosis of the lever which leads to blood stasis in the splenic vein, or certain malig- nant lymphoma which go hand in hand with an enlarged spleen. Inhomogeneous spleen ‘Normally, parenchymatous organs, such as the liver and spleen, display an evenly homogeneous echotex- ture,’ Görg points out. ‘Occasionally this echo-texture may appear coars- er (Image 4). Such inhomogeneous spleens are frequently found when infectious diseases are present, but they can also be caused by vascular pathologies. When the inhomogene- ity is focal this can often be caused by splenic infarction. Again, this type of vascular pathology can be visualised with the help of contrast enhanced ultrasound. Pain in left upper abdomen The spleen is one of the organs most frequently affected by abdomi- nal injuries. The initial question that needs to be answered is whether or not trauma is present. Is there fluid in the abdomen, or not? Is the spleen the cause of this bleeding, or not? Contrast enhanced ultrasound Below: Accessory spleen Large spleen in patient with glandular fever Diffuse parenchymal inhomogeneity as an incidental finding Spontaneous splenic rupture with liquid mass Confirmation of an Reduced enhancement in the contrast enhanced ultrasound Small spleen after radiation therapy of the spleen Hypoechoic round lesion as an incidental finding LEADING EXPERT POINTS TO SIX IMPORTANT INDICATIONS FOR AN ULTRASOUND EXAMINATION Although a small organ, the spleen can cause a considerable concern once it makes itself noticeable. Because this organ is rarely the cause of problems in the upper abdomen, most doctors tend not to pay it much attention. Professor Christian Görg, Consultant at the Department of Haematology/ Oncology and head of the Ultrasound Department at the Centre for Internal Medicine, University Hospital Giessen and Marburg, is an exception. Through his background in oncology he has developed a well-trained eye for problems affecting the spleen, which, being the largest lymph node in the body, is particularly prone to cancerous diseases. When should an ultrasound of the spleen be carried out? Here Görg provides an overview EH @ MEDICA No 12015

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