Abdominal imaging slenic nod c ridereau zins

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Abdominal imaging slenic nod c ridereau zins

  1. 1. How to manage a splenic nodule? Catherine Ridereau-Zins Department of Radiology University Hospital of ANGERS - FRANCE
  2. 2. Not so easy… ? Spleen nodule is fortuitously discovered, on US or CT ? no specific features on imaging ? 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 …
  3. 3. How to manage? ? Take into account clinical and biological data associated lesions prior exams ? Try to characterise the nodule on different imaging : Ÿ US +/- contrast Ÿ CT Ÿ MRI Ÿ FDG TEP CT unique or multiple cystic or solid ?
  4. 4. How to manage? ? Be able to biopsy When ? In oncologic context: Ÿ suspicion of splenic metastasis: changing treatment ? Ÿ suspicion of benign lesion: avoiding a splenectomy US-guided splenic biopsy Out oncologic context: atypical lesion Ÿ if benign: stop follow-up Ÿ if malignant: diagnosis before splenectomy Ÿ suspicion of granulomatosis (TB, sarcoidosis)
  5. 5. How to manage? ? Be able to biopsy Contra-indications Hemostasis troubles Suspicion of hydatidosis How? US-guided splenic biopsy Fine needle aspiration (22 G) or biopsy with a 18 G needle - 2 samples at most Complications ? bleeding (2-8% of biopsy, ì number of samples) pneumothorax; pleural effusion Keogan, AJR 1999; Kang, M Eur J Radiol. 2007; Singh AK, Radiographics 2012
  6. 6. How far to go? 1st level: know the 2 or 3 most common pathologies è hemangioma, epidermoid cyst, endothelial cyst 2nd level: take into account clinical and biological data be able to perform a biopsy è metastasis, lymphoma, infection 3rd level: know very rare pathologies (-1% of cases !)
  7. 7. How far to go? 1st level: know the 2 or 3 most common pathologies è hemangioma, epidermoid cyst, endothelial cyst Gilles Genin 2nd level: take into account clinical and biological data be able to perform a biopsy è metastasis, lymphoma, infection 3rd level: know very rare pathologies (-1% of cases !)
  8. 8. Characterise on imaging ☛  On US: hypo or anechoic septa ? if doubt: contrast Cystic nodule endothelial cyst
  9. 9. Characterise on imaging ☛  On US: hypo or anechoic septa ? if doubt: contrast ☛  On CT: more difficult hypodense mass Cystic nodule
  10. 10. Characterise on imaging ☛  On US: hypo or anechoic septa ? if doudt: contrast ☛  On CT: more difficult hypodense mass ☛  On MRI: easy ! hyper T2, hypo T1 Cystic nodule
  11. 11. Characterise on imaging Cystic nodule ? BENIGN (more often): Ÿ epidermoid cyst, mesothelial cyst Ÿ cystic lymphangioma Ÿ hydatid cyst Ÿ false cyst ( history of trauma, pancreatitis or spleen infarction)
  12. 12. Characterise on imaging Cystic nodule Tunisian man: cyst with septa and calcifications èhydatid serology + Hydatic cyst
  13. 13. Characterise on imaging Cystic nodule BE CAREFUL: cystic metastasis!
  14. 14. Characterise on imaging Cystic nodule BE CAREFUL: cystic metastasis! 49 year old man, lung cancer screening è normal spleen examination 3 years ago Cystic metastasis
  15. 15. Characterise on imaging Hypervascular Solid nodule Hemangioma ? BENIGN: common • hemangioma, hemangiomatosis • hamartoma • pseudo aneurysm ? Malignant : rare • epithelioid hemangioendothelioma • angiosarcoma Pseudo aneurysm
  16. 16. Characterise on imaging Solid nodule NON Hypervascular Lymphoma ? MALIGNANT : common • lymphoma • metastasis • sarcoma clinical data associated lesions Mets stomach cancer
  17. 17. Characterise on imaging NON Hypervascular ? But also: • infectious • granulomatosis clinical data biological data Solid nodule Toxocarosis
  18. 18. Characterise on imaging NON Hypervascular Solid nodule Toxocarosis ? But also: • infectious • granulomatosis History of colon cancer è biopsy : tuberculosis clinical data biological data FDG TEP CT biopsy ?
  19. 19. Things are not so easy … 52 year old woman, lung cancer screening
  20. 20. Things are not so easy … 52 year old woman, lung cancer screening ènon contributory biopsy èsplenectomy HAMARTOMA
  21. 21. Take home messages ? Diagnosis is not easy without clinical data ? Some lesions can be identified easily: cysts, hemangioma ? US-guided splenic biopsy can be performed, if doubt ? All rare etiologies: think about them … rarely they can be seen in literature.
  22. 22. Thank you 谢谢

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