abdominal imaging slenic nod c ridereau zins
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How to manage a splenic nodule?
Catherine Ridereau-Zins Department of Radiology University Hospital of ANGERS - FRANCE
Not so easy…
? many etiologies: congenital epidermoid or endothelial cysts
infectious bacterial abscess , hydatidis, candidosis, tuberculosis inflammatory sarcoidose, SANT, inflammatory pseudotumor hemopathies lymphoma vascular hemangioma, angiosaroma, infraction trauma hematoma, pseudocyst, pseudo aneurysm metastases breast, colon, lung, melanoma, ovary .. other Gandi-Gamna nodules, hamartoma, Gaucher’s disease,
Castelman, drepanocytosis, amylose, extra medullary hematopoiesis …
? Spleen nodule is fortuitously discovered, on US or CT ? no specific features on imaging
How to manage?
? Take into account clinical and biological data associated lesions prior exams ? Try to characterise the nodule on different imaging : � US +/- contrast � CT � MRI � FDG TEP CT
unique or multiple cystic or solid
?
? Be able to biopsy When ?
In oncologic context: � suspicion of splenic metastasis: changing treatment ? � suspicion of benign lesion: avoiding a splenectomy
Out oncologic context: atypical lesion � if benign: stop follow-up � if malignant: diagnosis before splenectomy � suspicion of granulomatosis (TB, sarcoidosis)
How to manage?
US-guided splenic biopsy
Contra-indications
Hemostasis troubles Suspicion of hydatidosis
Fine needle aspiration (22 G) or biopsy with a 18 G needle - 2 samples at most
How?
Complications ?
bleeding (2-8% of biopsy, ì number of samples) pneumothorax; pleural effusion
? Be able to biopsy
US-guided splenic biopsy
How to manage?
Keogan, AJR 1999; Kang, M Eur J Radiol. 2007; Singh AK, Radiographics 2012
How far to go?
1st level: know the 2 or 3 most common pathologies è hemangioma, epidermoid cyst, endothelial cyst
3rd level: know very rare pathologies (-1% of cases !)
2nd level: take into account clinical and biological data be able to perform a biopsy è metastasis, lymphoma, infection
How far to go?
1st level: know the 2 or 3 most common pathologies è hemangioma, epidermoid cyst, endothelial cyst
3rd level: know very rare pathologies (-1% of cases !)
2nd level: take into account clinical and biological data be able to perform a biopsy è metastasis, lymphoma, infection
Gilles Genin
Characterise on imaging
☛ On US: hypo or anechoic septa ? if doubt: contrast
Cystic nodule
endothelial cyst
☛ On US: hypo or anechoic septa ? if doubt: contrast
☛ On CT: more difficult hypodense mass
Characterise on imaging Cystic nodule
☛ On CT: more difficult hypodense mass
☛ On US: hypo or anechoic septa ? if doudt: contrast
☛ On MRI: easy ! hyper T2, hypo T1
Characterise on imaging Cystic nodule
? BENIGN (more often): � epidermoid cyst, mesothelial cyst � cystic lymphangioma � hydatid cyst � false cyst ( history of trauma, pancreatitis or spleen infarction)
Cystic nodule Characterise on imaging
Tunisian man: cyst with septa and calcifications èhydatid serology +
Hydatic cyst
Characterise on imaging Cystic nodule
BE CAREFUL: cystic metastasis!
Cystic nodule Characterise on imaging
49 year old man, lung cancer screening
Cystic metastasis
BE CAREFUL: cystic metastasis!
Characterise on imaging
è normal spleen examination 3 years ago
Cystic nodule
Hypervascular
? BENIGN: common • hemangioma, hemangiomatosis • hamartoma • pseudo aneurysm
? Malignant : rare • epithelioid hemangioendothelioma • angiosarcoma
Hemangioma
Pseudo aneurysm
Characterise on imaging Solid nodule
NON Hypervascular
? MALIGNANT : common • lymphoma • metastasis • sarcoma
Lymphoma
Mets stomach cancer
clinical data associated lesions
Characterise on imaging Solid nodule
NON Hypervascular
? But also: • infectious • granulomatosis
Toxocarosis
Characterise on imaging Solid nodule
clinical data biological data
NON Hypervascular
? But also: • infectious • granulomatosis
Toxocarosis
History of colon cancer è biopsy : tuberculosis
Characterise on imaging Solid nodule
clinical data biological data FDG TEP CT biopsy ?
Things are not so easy …
52 year old woman, lung cancer screening
ènon contributory biopsy èsplenectomy HAMARTOMA
52 year old woman, lung cancer screening
Things are not so easy …
Take home messages
? Diagnosis is not easy without clinical data
? Some lesions can be identified easily: cysts, hemangioma
? All rare etiologies: think about them … rarely they can be seen in literature.
? US-guided splenic biopsy can be performed, if doubt
Thank you 谢谢
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