Traditional medicine

Classification of changes in the spleen. Diffuse changes in the spleen

Like lymph nodes, the spleen functions as a kind of biological filter. However, unlike the lymph nodes, the spleen filters not lymph, but peripheral blood, as a result of which antigens, old and damaged cells are removed from the blood, and red blood cells and platelets are preserved. It is because of this that during intravenous immunization, the main role in the development of the immune response and antibody production belongs to the spleen. The spleen also functions as a blood depot. Erythropoietin is produced in the spleen, erythropoiesis develops, and hemolysis processes occur - the physiological breakdown of old red blood cells of post-day life.

The parenchyma of the spleen is divided into two main regions called the red and white pulp. The structure of the spleen largely corresponds to the functions of this organ (Fig. 1.9). Functionally active erythrocytes, granulocytes, platelets are deposited in the red pulp, antigens are captured and absorbed, old and damaged cells are eliminated. In the white pulp, rich in lymphocytes, the processes of antibody production develop. The stroma of both red and white pulp is made up of reticular cells and reticular fibers.

The outside of the spleen is covered with a fibrous capsule, from which connective tissue septa (trabeculae) extend into the organ. The arteries entering the spleen are located along the trabeculae, continue in the form of arterioles and branch in the form of capillaries.

From the capillaries, blood enters through the venous sinuses into the pulpal and trabecular veins and then into the splenic vein. The venous depot of the spleen is approximately 11 times larger than the arterial depot. The spleen does not have afferent, but there are efferent lymphatic vessels. They are located at the gate of the organ, next to the splenic vein and artery.

Localization of cells of the immune system in the spleen and its features in different species of animals and birds

Arterioles, capillaries, and venous sinuses are located in the red pulp, consisting of splenic or pulpal cords (they are also called pulpal cords), localized between the venous sinuses. The strands are represented by a reticular stroma filled with erythrocytes, in the loops of which there are also platelets, granulocytes, T- and B-lymphocytes, resident macrophages and numerous plasma cells. Despite the fact that in the spleen, as in other peripheral organs of the immune system, cells with helper (auxiliary) activity are predominantly identified among T-lymphocytes, its red pulp predominantly contains T-suppressors, the main function of which is the negative regulation of the immune response, In the red pulp of the spleen, numerous cells with natural killer activity (NK lymphocytes) and lymphoid cells that do not have specific markers of T- and B-lymphocytes on the membrane are also detected. Plasma cells of the spleen reflect the natural antibody-forming background of the immune system, which responds to individual antigenic molecules entering the spleen through the bloodstream. Capillaries open freely in the pulp cords. Therefore, the cells, having reached the cords, are retained in them, absorbed by macrophages, or returned to the bloodstream through the venous sinuses.

White pulp is a collection of lymphoid cells in the form of periarterial sleeves enveloping arterioles. Therefore, on sections of the spleen, the parenchyma appears as a red pulp, interspersed with areas of white pulp with arterioles surrounded by periarterial couplings. The muffs are formed mainly by T lymphocytes and form the thymus-dependent zone of the spleen. This area of the spleen contains a large number of interdigital dendritic cells. The white pulp is separated from the red pulp by the mantle (marginal zone), which is a mixture of lymphoid cells with a predominance of B lymphocytes over T cells. Above the mantle, directly separating it from the red pulp, is the marginal zone. According to I. Roitt et al., specialized macrophages and B-lymphocytes are localized in this area, ensuring the production of antibodies to the second type of thymus-independent antigens - TI-2 (T-independent antigens-2). In the mantle, B cells are localized in lymphoid follicles, primary (unstimulated) and secondary (stimulated), similar to the follicles of the lymph nodes, which form the thymus-independent or B-dependent zone of the spleen. B-lymphocytes of primary follicles are “naive”, they have not previously been in contact with the antigen. Antigenic stimulation and the development of an immune response are accompanied by the formation of secondary follicles with reproduction centers containing immunological memory cells. As in lymph nodes, follicular structures contain follicular dendritic cells. Sapin M.R. at the ends of the branching of arterioles, he notes the presence of ellipsoidal macrophage-lymphoid couplings, consisting of a dense framework of reticular cells and fibers, in the loops of which macrophages and lymphocytes participating in the immune response of the spleen are localized.

Starting from the marginal sinus of the white pulp and up to its border with the red pulp of the spleen, the marginal zone (Marginal Zone - Mz) extends. Many subtypes of dendritic cells and macrophages are localized in this area. Among them, a specialized subpopulation of non-recirculating mature B cells, called MzB, stands out, i.e. Marginal zone B lymphocytes. MzB lymphocytes carry high levels of slgM, CDl, CD9 and CD21 on the membrane and do not have or express low levels of slgD, CD5, CD23 and CD11b antigens, which phenotypically distinguishes them from B1 cells (carry slgD, CD5, CD23 and CD11b on the membrane ). MzB lymphocytes, like B1 cells, are quickly involved in the T-independent adaptive immune response, representing the first line of defense against antigens circulating in the blood that enter the spleen with the blood.

The marginal zone in the spleen is well defined in rodents and humans. In birds, dogs, and cats, the equivalent of the marginal zone is the B-dependent peri-ellipsoidal white pulp (PWP), composed of ellipsoidal muff reticular cells, muff B lymphocytes, and rounded surrounding macrophages. PWP B cells are thought to be similar to MzB B cells and are responsible for the production of antibodies against bacterial capsular antigens such as pneumococci. A feature of another B-dependent zone of the avian spleen is that the germinal centers of chickens, in particular, are divided into two types. One of them is partially encapsulated, and the other is completely encapsulated. These differences are thought to be a consequence of their functional differences. Another hypothesis is that these differences reflect distinct stages of germinal center maturation.

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What is splenic parenchyma?

Ultrasound examination of the spleen is carried out using linear, convex and sector probes, the latter is used when the diaphragm is high and in those who have undergone pneumonectomy on the left, with strong filling of the stomach and transverse colon. Echolocation of the spleen is carried out from the back, through the left side, and with magnification it is clearly visible from the abdomen. Good echolocation is also possible with the patient in an upright position.

This is apparently due to some descent of the stomach and transverse colon, which facilitates its release. However, it should be noted that obtaining a complete spleen on one scan is not always possible; it is especially difficult to locate the upper border of the outer surface, facing the left lung. Sometimes good visualization of the upper pole is interfered with by gases in the transverse colon. In these cases, body position and scanning methods should be changed.

Normally, on an echogram, the spleen is a highly homogeneous parenchymal organ that has a granular structure and is slightly more echogenic than the normal echogenicity of the liver. It should be noted that there is no strict version of the normal echogenicity of the spleen structure; in addition, much depends on its reaction to various pathological conditions of the body. Apparently, echogenicity also depends on the individual characteristics of the development of reticular parenchyma tissue. More often, the spleen normally has a crescent shape. Its size and shape vary significantly, so there are no uniform anatomical sizes and shapes. In practice, average sizes are used: length cm. width 3-5 cm.

The spleen can be located horizontally, obliquely and vertically. The outer convex side is adjacent to the costal part of the diaphragm, and the inner, concave side is facing the abdominal organs. The anterior end is pointed and adjacent to the stomach, the posterior, more rounded, adjacent to the upper pole of the kidney and adrenal gland. On the inner surface, approximately in the middle, there are its gates, which consist of vessels: the splenic vein and artery, nerves. Almost always, regardless of its caliber, the splenic vein is detected under the body and tail of the pancreas; the artery is rarely detected.

The position of the spleen depends entirely on the constitutional characteristics of the person. Thus, in people with a high and narrow chest the spleen is located almost vertically, and in people with a wide chest it is slightly higher and horizontal. The position of the spleen is significantly influenced by the location and degree of filling of the stomach and transverse colon.

Pathology

The main echographic signs of splenic pathology are absence, decrease, increase, change in contours, specificity of structure and echogenicity towards increasing or decreasing, changes in the caliber of the splenic veins and arteries, the presence of echogenic or anechoic space-occupying formations.

Developmental defects

Anomalies in the development of the spleen are extremely rare, these include: aplasia, hypoplasia, rudimentary, the presence of an additional spleen, lobules or accumulation of splenic tissue, dystopia (wandering spleen), congenital single or multiple cysts, etc.

Aplasia

Absence of the spleen in an anatomical location or possible sites of dystopia.

This anomaly is extremely rare, since in these cases, a detailed examination may reveal an accumulation of specific splenic tissue in the tail of the pancreas, the left adrenal gland, or in the retroperitoneal region closer to the anatomical location of the spleen. These formations should be differentiated from possible pathological structural formations located identically.

Hypoplasia

A fairly common anomaly, which is characterized by a decrease in all sizes of the spleen while maintaining clear contours and the specificity of the structure of the parenchyma. Its length is 5-6 cm, width 2-3 cm.

Vestigial spleen

The spleen is significantly reduced in size (length 2-3 cm, width 1.5-2 cm), there is no specific structure, so it can easily be mistaken for a structural pathological process in this area.

Accessory spleen

This anomaly is very rare and is presented in the form of two spleens, paired side to side or poles, otherwise the echographic picture is the same as that of a normal spleen. It should be clearly differentiated from possible tumor formations.

Lobulated spleen

This anomaly in our practice was detected by chance twice: one case was a side-to-side fusion, the other was a pole-to-side fusion. Additional lobules are often identified as oval structures with a structure similar to splenic tissue and are located at the poles or hilum.

Multilobular spleen

It is extremely rare; on the echogram it is a normal spleen, consisting of several well-defined round formations or segments located in the same capsule and having a single gate.

Dystopia

It is extremely rare and can be located in the abdominal cavity, in the small pelvis near the uterus and bladder. It should be differentiated from structural tumor-like formations of the intestine, left ovary and high-pedunculated fibroids.

Right-handed location

It occurs only with transposition of the abdominal organs; echographic differentiation from the liver does not present echographic difficulties.

Pathology of the splenic artery and veins

Among the pathologies of the splenic artery, aneurysms in the form of sac-like pulsating protrusions of different sizes, which are especially clearly visible using Doppler Color, are very rare. In our practice, a large (6-8 cm) aneurysm of the splenic artery was accidentally discovered. At the same time, the splenic artery was slightly dilated, and a sac-like pulsating expansion protruded from it. Thromboembolism may occur more often in its branches.

On the echogram, this is a narrow echo-negative strip of the artery, cut off by an echo-positive inclusion. There are single and multiple.

The most common lesion of the main trunk of the splenic vein is thrombosis, which can be a continuation of the portal vein or intrasplenic branches. The echogram shows the dilated tortuous splenic vein at the hilum of the spleen, in the cavity of which echogenic thrombi of varying lengths are located. There are also varicose dilatations of the branches of the splenic vein with echogenic small thrombi and phleboliths (a weakly echogenic or almost anechoic perifocal zone around the thrombi).

Spleen damage

Injuries to the spleen occupy one of the leading places in trauma to the abdominal cavity and retroperitoneal space; they can be open or closed.

For closed injuries, echography is a highly informative and indispensable technique for obtaining quick and fairly accurate information about the presence and extent of damage.

Closed injuries of the spleen are divided into supracapsular, subcapsular, and intraparenchymal.

Supracapsular

With this injury, a rounded-elongated, narrow or wide echo-negative formation in the form of an echo-negative strip is located along the outer capsule, while maintaining a somewhat thickened capsule.

Subcapsular

A hematoma in the form of an anechoic or low-echoic formation of various sizes and shapes is located between the capsule and the parenchyma. The detached solid capsule is clearly visible.

Intraparenchymal ruptures

Can be single or multiple. They are located as shapeless, sometimes round, poorly contoured, anechoic formations (hematomas).

After an hour, echo-positive inclusions (clots) may appear. With intraparenchymal tears, subcapsular tears are always present.

After an hour, when small hematomas are being organized, the echo picture resembles a heart attack, abscess or other structural tumors. A history of trauma helps in differentiation. When the capsule ruptures, a dip in the contour of the spleen is visible, the latter seems to be divided into two parts of different acoustic densities, depending on the amount of blood with which the spleen is saturated.

In case of large ruptures, free fluid is located in the left lateral canal of the abdominal cavity - blood, which can flow into the pouch of Douglas or retrovesically in men. Small collections of blood can be found anywhere in the retroperitoneal area, their location depending on the position at the time of examination. Echography allows for effective dynamic monitoring of the rupture site and makes recommendations on the method of treatment. Of the 273 cases of splenic injuries with multiple ruptures that we identified, only 53% of patients underwent splenectomy; in the remaining cases, treatment was carried out conservatively.

Involutive stages of traumatic hematomas of the spleen

Resorption stage

If the hematoma is not infected, then the resorption process can proceed quickly, after two weeks only faintly noticeable echo traces remain.

Stage of suppuration

When suppuration occurs, the hematoma begins to contour due to a circular echogenic strip (perifocal inflammation), the contents are divided into liquid and dense parts, which form the effect of reflection from the sediment and the thickened posterior wall. If the process lasts for a long time, a thick capsule can form and then the echo picture of a chronic abscess is evident.

Proliferation stage

In rare cases, a hematoma may undergo active proliferative processes, that is, proliferation of connective tissue, and be discovered by chance. Old proliferated hematomas have rounded, well-defined contours with a rather thick capsule with a mixed echostructure, identical to the structure of fibroids. Such, usually asymptomatic, old hematomas can easily be perceived as structural tumor formations. In our practice, there was a case when the splenic fibroma we diagnosed during surgery turned out to be an old hematoma overgrown with connective tissue.

True (innate)

Congenital cystic formations of the spleen are very rare and can be single, multiple, or in the form of polycystic disease; are considered congenital if detected in early childhood. Usually they are located as round or slightly elongated, clearly contoured formations of various sizes (but not more than 10 cm) with a thin capsule and pure anechoic content, sometimes with the effect of reflection from the posterior wall.

Dermoid cysts

They are quite rare. Usually these are round, well-contoured, rather large formations with a thickened capsule, sometimes replacing the entire spleen.

The contents of the cyst are liquid or in the form of a fine-grained floating mass that changes its position depending on the position of the body. Sometimes delicate echogenic septa can be located against the background of fluid. It should be differentiated from a hydration cyst or a cyst with internal bleeding; with the latter, the contents are always divided into two levels: blood (liquid) and solid (clots).

Pseudocysts

These formations, often small in size, with uneven contours, without a capsule (the edges of the parenchyma serve as the capsule), containing a small amount of fluid, are the result of traumatic hematomas and surgical interventions. They usually resolve, but if they become infected they can cause secondary abscesses.

The latter usually grow over time or the echogenicity of their contents changes. Immunological testing and puncture biopsy help.

Splenic calcifications

These are highly echogenic single or multiple formations of various sizes, rarely leaving an acoustic shadow. Calcifications are usually found in persons who have had malaria, miliary tuberculosis, typhoid fever, sepsis, as well as heart attacks, abscesses and echinococcosis. These formations can be detected both against the background of normal spleen sizes and with splenomegaly.

Hypersplenism

Primary hypersplenism can be congenital with congenital hemolytic anemia, thalassemia, hemoglobinopathy and acquired with thrombocytopenic purpura, primary neutropenia and pancytopenia, and can also be caused by typhus, tuberculosis, Beck's sarcoidosis, malaria, cirrhosis of the liver, thrombosis of the portal or splenic vein, reticulosis (Gaucher disease ), amyloidosis, lymphogranulomatosis and other diseases.

Splenomegaly

This is a fairly common condition of the spleen in various infectious diseases or septic conditions of the body, in which it can be diffusely or focally enlarged.

Splenite

Splenitis is an acute inflammation of the spleen. In this case, the spleen is diffusely enlarged, and its poles are rounded. The structure of the parenchyma remains homogeneous, fine-grained, and its echogenicity is slightly reduced. Sometimes, with septicopyemia, single or multiple, different sizes, weakly contoured an- or weakly echogenic foci can be found in the spleen parenchyma - acute necrosis, which in the process of evolution becomes echogenic or turns into calcifications.

Chronic splenitis

In chronic splenitis, the spleen continues to remain enlarged due to fibrous growths of tissue, echogenicity increases and takes on a motley picture - areas of increased and normal echogenicity alternate.

Subsequently, many calcifications can be located.

Splenomegaly is accompanied by a number of blood diseases, such as hemolytic anemia, chronic myeloid leukemia, polycythemia, Werlhof's disease, etc.

In this case, the spleen can be sharply enlarged, sometimes even extend beyond the left half of the abdominal cavity and, displacing the intestines and stomach, in contact with the left lobe of the liver, form a single whole, which is especially clearly visible in children and thin adults. The echogenicity of the spleen is slightly higher than usual and becomes similar to the picture of the second degree of liver steatosis.

Splenomegaly is also accompanied by portal cirrhosis of the liver due to circulatory failure in the systemic circulation.

In these cases, dilated portal and splenic veins are noted; in advanced cases, ascites is present. Splenomegaly in tumors has its own picture and depends on the location of the tumor. There may be a significant dilation of the common splenic trunk, and tortuous dilatations of the intrasplenic vessels are possible. In rare cases, significant local dilation of blood vessels in the form of lacunae (lakes) can be detected.

Focal changes

Splenic infarction

The most common causes leading to vascular thrombosis and embolism and the development of splenic infarction are diseases associated with portal hypertension, septic endocarditis, mitral stenosis, hemoblastosis, diffuse connective tissue diseases, atherosclerosis, rheumatism in children and some infectious diseases. Heart attacks can be single or multiple, their size depends on the caliber of the blocked vessel. Sometimes splenic infarctions can be very extensive and occupy a significant area.

In the acute stage, it is located as a formation with unclear contours and reduced echogenicity. When infarction areas become infected, tissue may melt and abscesses and false cysts of the spleen may form.

In the chronic stage, this is a round, irregularly shaped formation with defined edges; sometimes a thick echogenic capsule is visible. With positive involution, the formation decreases in size, the spleen becomes more echogenic, incrustation with calcium salts is visible, and is detected as a formation of mosaic acoustic density. Sometimes pseudocysts or pseudotumoral formations appear, which must be differentiated from solid structural formations.

Spleen abscesses

Frequent causes of the development of splenic abscesses are septicopyemia due to endocarditis, suppuration of splenic infarction, hematomas, transfer by contact from neighboring organs, etc. They can be single or multiple.

With single small abscesses, the size of the spleen does not change. With multiple abscesses, the spleen is enlarged in size, the contours may be uneven, oval-convex.

Acute abscesses on an echogram are identified as echo-negative formations with unclear intermittent contours and echo-positive inclusions (pus, decay particles). Subsequently, with the formation of a highly echogenic capsule, the abscess acquires more distinct contours. There can be two levels in the cavity at the same time - liquid and thick pus. The clinical course and manifestation of the abscess depend on the location. Sometimes, when localized in the upper pole of the spleen in the left pleural region, a reactive streak of fluid can be detected, which can subsequently give rise to empyema. Serious complications of a splenic abscess include the breakthrough of an abscess into the abdominal cavity with the development of diffuse peritonitis, into the left pelvis of the kidney and other organs. It can be very difficult to determine the location of the primary lesion, and it should be noted that the use of echography in these cases is a priority. Echography can provide accurate topographic data for therapeutic or diagnostic puncture and allows for dynamic monitoring of the effect of treatment.

In a chronic course, the splenic abscess has a round shape, a clear thick highly echogenic capsule, around which the echogenic zone of perifocal inflammation and the reflection effect from thick pus and a thickened posterior wall are preserved.

Amyloidosis of the spleen

It is very rare and is usually combined with generalized amyloidosis of other organs. On the echogram, the spleen looks blurred, the specificity of the structure of the parenchyma (granular structure) is lost, and shapeless echogenic (whitish) accumulations of amyloid are located in the parenchyma. With a large accumulation of amyloidosis, the spleen increases in size, the edges are rounded, and the parenchyma becomes high density (echogenicity).

Spleen tumors

Tumors of the spleen are rare, most often benign (lipoma, hemangioma, lymphangioma, fibroma and hemartroma). Their nosological echographic differentiation is very difficult or almost impossible, with the exception of some forms of hemangioma.

Lipoma

It is extremely rare on its own and is usually combined with the presence of lipomas in other areas of the body and organs. On the echogram it is a round, usually small and rarely growing, well-defined, fine-grained echogenic formation. With suppuration, the contents become less echogenic or heterogeneous.

Hemangiomas

They can be single, of different sizes, or multiple, small. The echographic picture of hemangioma mainly depends on the structure. In the classic echogenic type, the most common hemangiomas are round, weakly contoured echogenic formations of different sizes. With the capillary type, which is less common, it is a round, well-defined formation, separated by multiple thin echogenic septa, between which there is fluid - lacunae with blood. In the cavernous type, the internal contents are heterogeneous, have different echogenicity and are similar to the structure of brain tissue.

Lymphangiomas

More often they are located in the form of single nodes of slightly higher echogenicity than the splenic parenchyma, or heterogeneous accumulations of liquid formations, the echogenicity of which is slightly increased due to the turbid contents.

Fibromas and hemartromas

These are round or rounded-elongated, poorly defined formations of different acoustic densities. Their differentiation is possible only with the help of a puncture biopsy.

Lymphoma

It occurs as a round formation of slightly higher echogenicity than the splenic parenchyma, or in the form of small or large echogenic foci, poorly or almost undifferentiated from normal splenic parenchyma, located focally or diffusely throughout the spleen, and can infiltrate into nearby tissues.

Metastases

Metastases in the spleen are extremely rare. They can be single or multiple, of different sizes, with uneven, sometimes intermittent contours.

The echo picture is very different - weakly echogenic, increased echogenicity and even anechoic. In the process of increased metastasis or proliferation (enlargement), the fusion is difficult to differentiate from a chronic abscess or festering hematoma.

More often, metastases occur in intestinal melanomas and are located as round anechoic formations. In case of metastases from tumors of the ovaries and mammary glands, they have a hyperechoic structure and sometimes contain calcifications. Differential diagnosis of metastases with other pathological processes, such as chronic hematomas, hydative echinococcus with decay, infarction, abscess, etc., is difficult. A needle biopsy helps.

Thus, echography at the present stage of development of scientific and technological progress is the only fast, accessible method of real visualization of normal and pathologically altered spleen. The diagnostic value of echography increases significantly when it is combined with a puncture biopsy. In this regard, echography should be performed at the initial stage of examination of the spleen.

SPLEEN

The spleen is a lymphatic organ weighing about 150-200 g that produces and destroys blood cells. This oval organ made of soft tissue is located in the upper left part of the abdominal cavity. The inside of the spleen is porous and contains septa that divide it into lobes. The central part of the spleen includes the splenic artery, through which blood enters the spleen, distributed through numerous arteries until it reaches many lacunae, and then passes through numerous veins, which at the exit from the spleen form the splenic vein.

Around small arteries (arterioles) there are accumulations of lymphoid tissue, Malpighi bodies, which form the white pulp. Surrounding it is the red pulp of the spleen, which consists of a spongy base saturated with blood, called the venous cavity, and trabeculae of reticular tissue, called red pulp cords.

We will analyze the further structure of the spleen using the drawings to the right of the text. In Fig. Figure 1 shows the general structure of the organ. The splenic artery (A) and vein (Be), nerve fibers and lymphatic vessels enter and exit the hilum (B) of the organ.

In Fig. 2 in the left third of the figure is a small prismatic area that shows the histological structure of the spleen. In this section, the trabecula (T) in the form of a loop is a continuation of the trabecula shown on the right side of the figure.

Like most organs, the spleen consists of stroma (St) and parenchyma (P). On a histological section, the stroma and parenchyma closely interact with each other. The stroma of the spleen includes the capsule (Ka) and all the trabeculae (T) of varying thickness extending from the hilum region to the inner surface of the capsule. The parenchyma consists of white (BP) and red (RP) pulp.

The right two-thirds of the figure shows only the trabeculae after parenchyma has been removed by maceration. Separating from the splenic capsule and running perpendicular to it, the thin trabeculae then combine into a relatively regular network (C) parallel to the capsule. Thick trabeculae belonging to the internal trabecular network of the organ merge with this network. The trabecular arteries (TA) and veins (TV) that enter and exit these trabeculae are also visible.

Rice. 3. The capsule (Ca) of the spleen consists of dense connective tissue with rare smooth muscle cells. The outer side of the capsule is covered with peritoneum (Br). Trabeculae (T) with trabecular arteries (TA) and veins (TV) extend from the capsule. The structure of the trabecular artery is similar to the structure of the walls of other muscular arteries; The layers of the trabecular vein wall are reduced, with the exception of the endothelial layer.

The parenchyma consists of the aforementioned white (BP) and red (RP) pulps. The white pulp consists of periarterial lymphoid clutches (PALM) with splenic nodules (SU); The red pulp consists of splenic sinusoids (SS), cords (TS) of the spleen (Billroth's cords) and the blood contained in them.

In the picture in the middle part of the organ, the red pulp is partially or completely retracted. This allows us to consider the shape of the periarterial lymphoid coupling with splenic lymphoid nodules and the corresponding central artery (CA). The terminal branches of this artery open into the splenic cords and sinusoids.

If we depict the splenic cords without lymphoid tissue, then the sinusoids will appear as a widely anastomosing system of sinusoidal capillaries, which, uniting, form short pulpal veins (PV), through which blood then enters the trabecular veins (TV).

The nerve fibers are mainly sympathetic and innervate the smooth muscles of the middle layer of the trabecular arteries, without entering the white and red pulp.

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SPLEEN

Located along the blood vessels

Structure:

1. covered with a visceral layer of peritoneum

– serous membrane:

mesothelium - single-layer squamous epithelium -

source of development – mesoderm – visceral

splanchnotome leaf

2. connective tissue capsule

A. made of dense, unformed connective tissue

b. smooth muscle tissue (contraction - release of blood

from the sinuses - blood depot)

Mesenchyme derivatives

3 connective tissue layers - trabeculae - extend from the connective tissue capsule into the organ

Made from dense, unformed connective tissue

Individual smooth muscle cells

Mesenchyme derivative

4 from the connective tissue capsule - reticular tissue

Mesenchyme derivative

- cells:

Reticular

Free macrophages - actively motile

Macrophages fixed - non-motile

Dendritic (antigen-presenting cells)

highlight:

1. red pulp - outside

2. white pulp - inside - in the form of lymphoid nodules

Red pulp:

About 75% of organ volume

Includes:

1. venous sinuses

2 splenic cords

Venous sinuses:

Spaces lined with endothelium

Vessels with a diameter of up to 50 microns

Those. sinusoidal capillaries

Anastomose

Between endothelial cells there are gaps (1-3 microns), through which blood cells migrate

No basement membrane

Filled with formed elements of blood - depot of blood elements

Stroma - reticular tissue

Splenic cords:

Strands of blood cells, macrophages and plasma cells

Stroma - reticular tissue

White pulp:

It is represented by accumulations of lymphoid tissue located in the red pulp in the form lymphoid nodules of the spleen

About 20% pulp

Located in the form of couplings along the arteries

0.3-0.5 mm in diameter

The artery of the lymphoid nodule passes eccentrically through the nodules

Nodule structure:

Zones are distinguished:

1. germinal center - light center

2. mantle zone

3. periarterial zone

4. marginal (edge) zone

Germinal center:

Light center

Located in the center of the node

Medium and large lymphocytes

Under the influence of antigenic stimulation

Antigen-dependent proliferation of lymphocytes - the center of reproduction

Many mitoses

B lymphocytes (B-dependent zone)

Plasmocytes differentiate

Mantle zone:

Surrounds the germinal center

Densely packed small lymphocytes (T and B lymphocytes), plasma cells, macrophages

The area looks richly basophilic on preparations

Periarterial zone:

An accumulation of lymphoid tissue is located around the artery of the lymphoid nodule

Positioned eccentrically

T-lymphocytes (thymus-dependent zone)

In the stroma - “interdigitating cells” - a type of macrophages that synthesize substances that regulate the proliferation and differentiation of lymphocytes

Antigen-dependent differentiation occurs here

(maturation) and proliferation (division) of T-lymphocytes,

migrated from the thymus

Edge zone:

Transitional area between the nodule and the red pulp

Width about 100 microns

Representation of T- and B-lymphocytes

Small lymphocytes

More rarely located than in other areas

P.t. the zone is less intensely basophilic in color

Many macrophages and plasma cells

Immunohistochemistry (zones):

1. germinal center – B-cell zone (CD19+)

2. mantle zone – mixed – T- and B-cells

3. marginal – mixed – T- and B-cell

4. periarterial – T-cell (CD3+)

Features of the blood supply to the spleen:

The splenic artery enters the gate - muscular type

Branches penetrate trabeculae (trabecular arteries)

The artery wall is tightly fused with the trabecula - does not collapse when damaged

Artery of the lymphoid nodule

Muscular type

The adventitia is replaced by lymphoid tissue - lymphoid perarterial sheath - T-dependent zone

Exits into the red pulp and branches into 2-6 brush arterioles

A. closed circulation - blood flows into the veins

b. open circulation - blood flows out

directly into the red pulp strands, and only then

collects in venous sinuses

Pulp veins

Trabecular veins – fibrous type

Splenic veins - muscular type

Depending on the functional state, open or closed circulation may predominate.

Closed – associated with blood transport and oxygen saturation of tissue.

Open – blood deposition, sorting of formed elements, immunogenesis, immune reactions

Functions:

A. red pulp

1. deposition of mature blood cells - reserve pool of blood cells

2. destruction of old and damaged blood cells

Increased destruction of red blood cells - anemia

Increased destruction of platelets - thrombocytopenia -

bleeding

3. phagocytosis

4. antigen dependent differentiation and proliferation of lymphoid cells

b. white pulp:

5. phagocytosis of antigens from the blood

6. hematopoiesis - antigen - dependent differentiation and proliferation of lymphocytes

7. immune defense

A. differentiation of B lymphocytes into plasma cells

b. T lymphocytes transform into effector cells

Helpers

Suppressors

Killers

V. macrophages

Antigen presenting cells

Phagocytosis

those. just like in the lymph node, all three cells of the immune response are represented:

1. macrophage

2. T-lymphocyte

3. B lymphocyte

Histophysiology:

Blood enters through the splenic artery

When the blood circulation is open, it is filtered through reticular tissue and macrophages

Deposit

Phagocytosis of bacteria, viruses, foreign and modified cells - antigens

Release of antigenic determinant and triggering of immune response to antigen

The produced antibodies are released into the blood of the splenic cords and venous sinuses

Echolocation of the spleen is carried out from the back, through the left side, and with magnification it is clearly visible from the abdomen. Good echolocation is also possible with the patient in an upright position.

Pathology

Developmental defects

Aplasia

Absence of the spleen in an anatomical location or possible sites of dystopia.

Hypoplasia

Vestigial spleen

The spleen is significantly reduced in size (length 2-3 cm, width 1.5-2 cm), there is no specific structure, so it can easily be mistaken for a structural pathological process in this area.

Accessory spleen

Lobulated spleen

Multilobular spleen

It is extremely rare; on the echogram it is a normal spleen, consisting of several well-defined round formations or segments located in the same capsule and having a single gate.

Dystopia

Right-handed location

It occurs only with transposition of the abdominal organs; echographic differentiation from the liver does not present echographic difficulties.

Pathology of the splenic artery and veins

On the echogram, this is a narrow echo-negative strip of the artery, cut off by an echo-positive inclusion. There are single and multiple.

Spleen damage

Injuries to the spleen occupy one of the leading places in trauma to the abdominal cavity and retroperitoneal space; they can be open or closed.

For closed injuries, echography is a highly informative and indispensable technique for obtaining quick and fairly accurate information about the presence and extent of damage.

Closed injuries of the spleen are divided into supracapsular, subcapsular, and intraparenchymal.

Supracapsular

With this injury, a rounded-elongated, narrow or wide echo-negative formation in the form of an echo-negative strip is located along the outer capsule, while maintaining a somewhat thickened capsule.

Subcapsular

A hematoma in the form of an anechoic or low-echoic formation of various sizes and shapes is located between the capsule and the parenchyma. The detached solid capsule is clearly visible.

Intraparenchymal ruptures

Can be single or multiple. They are located as shapeless, sometimes round, poorly contoured, anechoic formations (hematomas).

After an hour, echo-positive inclusions (clots) may appear. With intraparenchymal tears, subcapsular tears are always present.

Involutive stages of traumatic hematomas of the spleen

Resorption stage

If the hematoma is not infected, then the resorption process can proceed quickly, after two weeks only faintly noticeable echo traces remain.

Stage of suppuration

Proliferation stage

Spleen cysts

True (innate)

Dermoid cysts

They are quite rare. Usually these are round, well-contoured, rather large formations with a thickened capsule, sometimes replacing the entire spleen.

Pseudocysts

The latter usually grow over time or the echogenicity of their contents changes. Immunological testing and puncture biopsy help.

Splenic calcifications

Hypersplenism

Splenomegaly

This is a fairly common condition of the spleen in various infectious diseases or septic conditions of the body, in which it can be diffusely or focally enlarged.

Splenite

Chronic splenitis

Subsequently, many calcifications can be located.

Splenomegaly is accompanied by a number of blood diseases, such as hemolytic anemia, chronic myeloid leukemia, polycythemia, Werlhof's disease, etc.

Splenomegaly is also accompanied by portal cirrhosis of the liver due to circulatory failure in the systemic circulation.

Focal changes

Splenic infarction

Spleen abscesses

With single small abscesses, the size of the spleen does not change. With multiple abscesses, the spleen is enlarged in size, the contours may be uneven, oval-convex.

Amyloidosis of the spleen

Spleen tumors

Lipoma

Hemangiomas

Lymphangiomas

Fibromas and hemartromas

These are round or rounded-elongated, poorly defined formations of different acoustic densities. Their differentiation is possible only with the help of a puncture biopsy.

Lymphoma

Metastases

Metastases in the spleen are extremely rare. They can be single or multiple, of different sizes, with uneven, sometimes intermittent contours.

Ultrasound of the spleen: indications, norm and pathology

Ultrasound of the spleen is a study of pathological changes in the organ using ultrasonic echolocation. The examination is carried out routinely during standard diagnostics of the abdominal cavity. After all, the circulatory system of the spleen is connected to the vessels of other organs, especially the liver, and its parenchyma reacts to any abdominal pathology. But sometimes the study is done for individual indications.

Indications: who is the test prescribed for?

The spleen is difficult to detect during physical examination. With illness, its size increases. This condition is called splenomegaly. One of the reasons is portal hypertension - a syndrome of increased pressure in the vessels of the abdominal cavity.

The increase can also be caused by voluminous diseases of the spleen. These include tumors and cysts of various etiologies. Thus, the indications for ultrasound of the spleen are:

all types of blood diseases
infectious diseases of the intestinal group
cancer tumors and metastases;
hepatitis and cirrhosis of the liver;
congenital anomalies;
splenomegaly of unknown origin.

Ultrasound is especially important for abdominal injuries, falls from a height and transport accidents. Good blood supply to the organ is due to the dense vascular network of the spleen. Therefore, blood loss during rupture can be fatal.

What does the spleen look like on an ultrasound?

The ultrasound machine monitor shows the crescent shape of the spleen. Its ventral surface is convex, and its diaphragmatic surface is concave. In the middle of the latter there is a vascular arteriovenous bundle and lymph nodes. They are easily accessible for ultrasound diagnostics. Their size and shape are determined.

Parenchyma echogenicity

This is a measure of the reflection of a sound wave. Low echogenicity indicates a violation of the maturation of leukocytes in the blood. Foci of high echogenicity (white spots) form with metastases and abscesses.

Pathological foci

The splenic parenchyma looks heterogeneous on ultrasound. Foci of different sizes, contours and density indicate a specific disease. A dark lesion with smooth contours and uniform echogenicity indicates a benign splenic cyst.

Heterogeneous lesions with unclear contours should alert the researcher. This could be a life-threatening tumor (lymphoma) or an acute purulent disease - an abscess. Light, blurry spots will suggest foci of metastasis.

Increased sizes of an organ with a uniform structure and rounded edges indicate an inflammatory process. If dark, small lesions appear against this background, then the disease has become chronic, and foci of dead cells (necrosis) have appeared in the parenchyma.

In the future, these “scars” in the tissues will become denser and remain light, uneven spots for life. Ultrasound gives a different picture of tissue necrosis due to vascular thrombosis. A wedge-shaped area of low echogenicity (dark spot) will appear on the screen. Its structure will be homogeneous, and its contours will be blurred.

With splenic abscesses, the echogenicity levels of the lesions will undergo changes depending on the stage of the process. Light spots gradually appear on the dark lesion, and then a light capsule with a dark spot in the middle is formed.

Ultrasound can detect parenchymal rupture. The following picture is determined:

contour discontinuity;
the presence of layers - internal and external;
dark blood stains between layers.

Hemorrhage is defined as dark areas. As they dissolve, the spots lighten and then disappear completely.

How to prepare?

Correct interpretation is possible with a high-quality ultrasound of the spleen. This requires proper preparation. Three days before the examination, you should not eat foods that contribute to gas formation: legumes, milk, rye bread, raw vegetables. It is also recommended to take sorbents and enzyme preparations that stimulate digestion (mezim, meteospasmil).

The procedure is performed in a certain body position. The patient takes a position on his side, the left cancer is raised behind the head. In a state of inspiration, a sensor through the intercostal space visualizes the state of the organ.

Preparing children for ultrasound diagnostics has its own particularities. Infants should not be fed before the procedure. Children from one to three years old should not eat for 4 hours before diagnosis, over three years old - 6 hours. You cannot drink for 1 hour.

How to decipher the conclusion?

Decoding the study data consists of assessing the parameters of the spleen. In the conclusion form, the doctor must indicate the size of the organ in three standard measurements, as well as the diameter of the vessels. If the dimensions are outside the norm, experts calculate an additional value - the area of the maximum oblique cut.

The size is determined by the ratio of the largest size/smallest. Normally The volume is calculated using the formula V = 7.5S -77.56. An increase in this indicator indicates splenomegaly.

Deciphering by a specialist identifies two main types of organ damage:

An experienced ultrasound specialist takes into account all the patient’s concomitant diseases when deciphering.

What indicators are considered normal?

Pathology of the spleen is a deviation of ultrasound readings from the norm. The permissible fluctuations in the characteristics of a healthy organ are as follows:

length dimensions are cm;
width can vary from 6 to 8 cm;
thickness is only 4-5 cm;
within normal sizes, the shape may be different;
the lumen of the splenic artery is 1-2 mm in diameter, and the vein is 5-9 mm;
the structure of the parenchyma is homogeneous, the contour is continuous.

In children, normal sizes change with age. The normal values for children, depending on age, are presented in the table.

It is customary to pay less attention to the spleen than to other organs. However, it is not only susceptible to pathology, but also sensitively reacts to many diseases of other organs. Considering the inaccessibility of the spleen for other examination methods, an ultrasound scan of the spleen is a must. To do this, you need to prepare properly, choose a qualified specialist and a clinic with decent equipment.

The spleen is not only susceptible to pathology, but also sensitively reacts to many diseases of other organs. Examination of pathological changes in the spleen is carried out using ultrasonic echolocation.

SPLEEN

The nerve fibers are mainly sympathetic and innervate the smooth muscles of the middle layer of the trabecular arteries, without entering the white and red pulp.

Psychology and psychotherapy

This section will include articles on research methods, medications and other components related to medical topics.

Spleen

The spleen is the only peripheral organ of the immune system that is located on the path of blood flow from the aorta to the portal vein system, which branches in the liver. This location of the spleen determines many of its functions. Like lymph nodes, the spleen functions as a kind of biological filter. However, unlike the lymph nodes, the spleen filters not lymph, but peripheral blood, as a result of which antigens, old and damaged cells are removed from the blood, and red blood cells and platelets are preserved. It is because of this that during intravenous immunization, the main role in the development of the immune response and antibody production belongs to the spleen. The spleen also functions as a blood depot. Erythropoietin is produced in the spleen, erythropoiesis develops, and hemolysis processes occur - the physiological breakdown of old red blood cells of post-day life.

Localization of cells of the immune system in the spleen and its features in different species of animals and birds

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- a cavity in the parenchyma of the spleen, filled with fluid and delimited by a capsule from the surrounding tissues. With small sizes there are no symptoms of the disease. The growth and increase in the number of cavities leads to nausea, belching, vomiting, and painful sensations in the left hypochondrium, radiating to the left arm and shoulder blade. The patient's general condition worsens: headache, weakness, dizziness occur. Diagnosis consists of surgical examination, ultrasound and MSCT of the spleen. Patients with small formations require dynamic ultrasound control. If there are indications, the cyst is removed with complete or partial resection of the organ, puncture of the cavity with the introduction of sclerosing substances.

General information

Causes of splenic cyst

The cause of the disease may be an intrauterine anomaly in the development of the spleen. At the stage of embryogenesis, under the influence of various factors (taking medications, alcohol, tobacco, unfavorable environmental conditions), a vascular malformation is formed, pathological cavities are formed, which can change after birth. Acquired cysts can occur as a result of:

Spleen cysts are divided into single and multiple, single-chamber and multi-chamber. The contents of the cystic cavity may be serous or hemorrhagic. Based on etiology, the following types of formations are distinguished:

The clinical picture depends on the location, size and type of formation. With a small (less than 2-3 cm) single cyst, there are no signs of the disease. The appearance of the first symptoms is associated with an increase in the size of the cavity formation or the formation of inflammatory processes in it. In this case, periodic aching pain appears in the left hypochondrium, weakness, and dizziness. As the cyst grows, intense pain radiates to the left shoulder blade and shoulder, nausea and vomiting. After eating, there is heaviness and discomfort in the left hypochondrium. Rarely, a disturbance in the functioning of the respiratory system occurs: shortness of breath, dry cough, and discomfort in the sternum when taking a deep breath.

With multiple and large (more than 7 cm) single cysts, a significant enlargement of the spleen (splenomegaly) occurs, frequent nausea, vomiting, belching occurs, and intestinal function is impaired (bloating, cramps, diarrhea or constipation). Severe pain and deterioration in the patient’s general condition are noted: apathy, dizziness, headache, severe weakness. When the inflammatory process occurs, chills and fever occur.

Complications

Exposure to environmental factors (bruise, blow) can lead to a rupture of the splenic cyst and spillage of the contents into the abdominal cavity. In the absence of emergency treatment measures, this condition causes peritonitis, and in severe cases, death. Suppuration of the cyst causes the formation of an abscess, intoxication of the body up to the development of bacteremia. A long course of the disease can provoke spontaneous bleeding into the cavity of the formation, and if it ruptures, bleeding into the abdominal cavity.

Diagnostics

Due to the absence of symptoms with small cyst volumes, the disease can be detected in later stages or during routine diagnostic and surgical procedures. To confirm the diagnosis, the following procedures must be performed:

Treatment of splenic cyst

rupture of the cyst into the abdominal cavity
abscess formation
development of bleeding
the presence of one large (more than 10 cm) or several (more than 5) small pathological cavities.
constantly relapsing course of the disease (more than 4 episodes per year).

In case of multiple calcified cysts affecting more than 50% of the spleen area, complete removal of the organ is performed - splenectomy. Treatment of a small formation is performed by puncture of the cyst, aspiration of its contents and subsequent injection of sclerosing drugs into the collapsed cavity. In case of a single formation, the cyst with capsule is excised and argon plasma coagulation of the affected areas of the spleen is performed. The middle and several small cavities located nearby are resected along with the organ section.

In modern surgery, laparoscopy is recognized as the most effective and least traumatic method of cyst removal. Laparoscopic surgery can significantly shorten the rehabilitation period and reduce postoperative pain. For a true cyst, combined treatment is indicated, which consists of percutaneous de-epithelialization under ultrasound control with further embolization of the artery supplying the wall of the formation.

Prognosis and prevention

The prognosis of the disease depends on the location, size of the cyst, the number of formations and the presence of complications. With a small single cyst of the spleen, which does not increase in size and does not suppurate, the prognosis is favorable. The development of inflammatory changes, an increase in the number of multiple formations, an increase in a single cavity, or a cyst breakthrough can lead to serious life-threatening complications. Prevention of cysts involves timely visits to medical examinations and adherence to personal hygiene rules. Patients with a history of surgery on the spleen must undergo ultrasound control once a year. Patients are advised to avoid risky sports.

The examination of the spleen is carried out using linear, convex and sector probes, the latter is used when the diaphragm is high and in those who have undergone pneumonectomy on the left, with strong filling of the stomach and transverse colon. Echolocation of the spleen is carried out from the back, through the left side, and with magnification it is clearly visible from the abdomen. Good echolocation is also possible with the patient in an upright position.

Normally, on an echogram, the spleen is a highly homogeneous parenchymal organ with a granular structure and slightly higher echogenicity than normal echogenicity. It should be noted that there is no strict version of the normal echogenicity of the spleen structure; in addition, much depends on its reaction to various pathological conditions of the body. Apparently, echogenicity also depends on the individual characteristics of the development of reticular parenchyma tissue. More often, the spleen normally has a crescent shape. Its size and shape vary significantly, so there are no uniform anatomical sizes and shapes. In practice, average sizes are used: length 11-12 cm, width 3-5 cm.

The spleen can be located horizontally, obliquely and vertically. The outer convex side is adjacent to the costal part of the diaphragm, and the inner, concave side is facing the abdominal organs. The anterior end is pointed and adjacent to, the posterior, more rounded, adjacent to the upper pole of the kidney and adrenal gland. On the inner surface, approximately in the middle, there are its gates, which consist of vessels: the splenic vein and artery, nerves. Almost always, regardless of its caliber, the splenic vein is detected under the body and tail; the artery is rarely detected.

Developmental defects

Aplasia

Absence of the spleen in an anatomical location or possible sites of dystopia.

Hypoplasia

Vestigial spleen

The spleen is significantly reduced in size (length 2-3 cm, width 1.5-2 cm), there is no specific structure, so it can easily be mistaken for a structural pathological process in this area.

Accessory spleen

Lobulated spleen

Multilobular spleen

It is extremely rare; on the echogram it is a normal spleen, consisting of several well-defined round formations or segments located in the same capsule and having a single gate.

Dystopia

Right-handed location

It occurs only with transposition of the abdominal organs; echographic differentiation from the liver does not present echographic difficulties.

Pathology of the splenic artery and veins

On the echogram, this is a narrow echo-negative strip of the artery, cut off by an echo-positive inclusion. There are single and multiple.

Spleen damage

Injuries to the spleen occupy one of the leading places in trauma to the abdominal cavity and retroperitoneal space; they can be open or closed.

For closed injuries, echography is a highly informative and indispensable technique for obtaining quick and fairly accurate information about the presence and extent of damage.

Closed injuries of the spleen are divided into supracapsular, subcapsular, and intraparenchymal.

Supracapsular

With this injury, a rounded-elongated, narrow or wide echo-negative formation in the form of an echo-negative strip is located along the outer capsule, while maintaining a somewhat thickened capsule.

Subcapsular

A hematoma in the form of an anechoic or low-echoic formation of various sizes and shapes is located between the capsule and the parenchyma. The detached solid capsule is clearly visible.

Intraparenchymal ruptures

Can be single or multiple. They are located as shapeless, sometimes round, poorly contoured, anechoic formations (hematomas).

After 10-12 hours, echo-positive inclusions (clots) may appear. With intraparenchymal tears, subcapsular tears are always present.

After 48-72 hours, when small hematomas are being organized, the echo picture resembles a heart attack, abscess or other structural tumors. A history of trauma helps in differentiation. When the capsule ruptures, a dip in the contour of the spleen is visible, the latter seems to be divided into two parts of different acoustic densities, depending on the amount of water with which the spleen is impregnated.

With large ruptures, free fluid is located in the left lateral canal of the abdominal cavity - blood, which can flow into the pouch of Douglas or retrovesically in men. Small collections of blood can be found anywhere in the retroperitoneal area, their location depending on the position at the time of examination. Echography allows for effective dynamic monitoring of the rupture site and makes recommendations on the method of treatment. Of the 273 cases of splenic injuries with multiple ruptures that we identified, only 53% of patients underwent splenectomy; in the remaining cases, treatment was carried out conservatively.

Involutive stages of traumatic hematomas of the spleen

Resorption stage

If the hematoma is not infected, then the resorption process can proceed quickly, after two weeks only faintly noticeable echo traces remain.

Stage of suppuration

Proliferation stage

Spleen cysts

True (innate)

Dermoid cysts

They are quite rare. Usually these are round, well-contoured, rather large formations with a thickened capsule, sometimes replacing the entire spleen.

Pseudocysts

The latter usually grow over time or the echogenicity of their contents changes. Immunological testing and puncture biopsy help.

Splenic calcifications

Hypersplenism

Splenomegaly

This is a fairly common condition of the spleen in various infectious diseases or septic conditions of the body, in which it can be diffusely or focally enlarged.

Splenite

Chronic splenitis

Subsequently, many calcifications can be located.

Splenomegaly is accompanied by a number of blood diseases, such as hemolytic anemia, chronic myeloid leukemia, polycythemia, Werlhof's disease, etc.

Splenomegaly is also accompanied by portal cirrhosis of the liver due to circulatory failure in the systemic circulation.

Focal changes

Splenic infarction

The most common causes leading to thrombosis and embolism, to the development of splenic infarction, are diseases associated with portal hypertension, septic endocarditis, mitral stenosis, hemoblastosis, diffuse connective tissue diseases, atherosclerosis, rheumatism in children and some infectious diseases. Heart attacks can be single or multiple, their size depends on the caliber of the blocked vessel. Sometimes splenic infarctions can be very extensive and occupy a significant area.

Spleen abscesses

With single small abscesses, the size of the spleen does not change. With multiple abscesses, the spleen is enlarged in size, the contours may be uneven, oval-convex.

Amyloidosis of the spleen

Spleen tumors

Lipoma

Hemangiomas

Lymphangiomas

Fibromas and hemartromas

These are round or rounded-elongated, poorly defined formations of different acoustic densities. Their differentiation is possible only with the help of a puncture biopsy.

Lymphoma

Metastases

Metastases in the spleen are extremely rare. They can be single or multiple, of different sizes, with uneven, sometimes intermittent contours.