Various aspects of Contrast-enhanced Ultrasonography in splenic lesions - a pictorial essay.

Spleen pathology is rare in comparison with other abdominal organs, but often its lesions occur in complex pathological contexts, with systemic involvement. Although the lesions could be discretely symptomatic, their evolutionary potential might be severe. Conventional B-mode and Doppler ultrasound are the first-line imaging methods in spleen assessment, but frequently they do not allow the characterization of focal splenic abnormalities. Contrast-enhanced ultrasound (CEUS) is fast, safe, easy to perform, non-irradiating and can be used in patients with renal failure. By highlighting splenic macro and micro-vascularization, CEUS significantly increases the detection rate and allows the characterization of vascular (infarction, ischemia, thrombosis) and traumatic lesions, with high diagnostic accuracy. Additionally, ectopic splenic tissue can be identified with high accuracy. The method improves both the detection and characterization of splenic nodules, but some limitations still remain, especially in the differential diagnosis between malignant and some benign lesions. This article aims to portray aspects of CEUS imaging in various splenic pathologies using clinical examples from our experience and to review the CEUS contribution in the diagnosis of splenic lesions.

Hepatitis C-Associated B-cell Non-Hodgkin Lymphoma: A Pictorial Review.

BACKGROUND AND PURPOSE: Hepatitis C virus (HCV) can induce both hepatic and extrahepatic malignancies. A strong association between HCV and non-Hodgkin lymphomas (NHLs) has been demonstrated. The purpose of this article is to give emphasis on the clinical and imagistic particularities of the hepatitis C-associated NHL, revealing the importance of ultrasonography in discovering and characterizing splenic masses. METHODS: We present the cases of 3 women (aged 72, 61, and 56 years, respectively), all of which had a history of chronic hepatitis C and were subsequently diagnosed with different forms of lymphoma. In all 3 cases, conventional ultrasound exploration showed inhomogeneous splenomegaly. Contrast-enhanced ultrasound and computerized tomography were performed soon after admission, both clinical and imaging findings leading to the suspicion of lymphoma. The bone marrow biopsy was relevant for the diagnosis lymphoma in 2 patients, whereas the third woman only presented age-related changes in cellularity. Splenectomy was later performed in this case, for both diagnostic and therapeutic purposes; histopathological examination and immunohistochemistry revealed malignant non-Hodgkin diffuse large B-cell lymphoma. CONCLUSIONS: The cooccurrence of HCV infection and splenic lymphoma is a frequently encountered scenery. Ultrasonography, both conventional and contrast-enhanced, plays an important role in the exploration of the spleen, representing a first-line imagistic method and a valuable means of characterizing different types of splenic lesions. IMPLICATIONS FOR PRACTICE: This article states the importance of ultrasonographic evaluation regarding the splenic pathology, by revealing clinical and imagistic findings in 3 cases of hepatitis C-associated lymphoma.