Variable sonographic appearance of acute splenic infarction

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  Classic

  
  
  
  
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    Hypoechoic, peripheral, wedge-shaped, and avascular

  
  
  
  
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  Nonclassic

  
  
  
  
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    Rounded or peripheral band morphology

    
    
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    Global infarction

    
    
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    Isoechoic to hyperechoic

  
  
  
  
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  Bright band sign

  
  
  
  
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    Parallel, thin specular reflectors perpendicular to US beam within hypoechoic parenchymal lesions

    
    
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    Thought to represent preserved fibrous trabeculae within infarcted tissue

  
  

Chronic infarction

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  Atrophic, scarred spleen ± calcification

Associated findings

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  Splenomegaly, splenic vein occlusion (with large perisplenic varices), splenic artery thrombosis

Splenic laceration

Splenic hematoma

Splenic cyst

Splenic mass

Splenic metastases

Splenic lymphoma

Color and power Doppler are critical components of US evaluation of splenic infarct

Grayscale appearance can be variable depending on morphology, evolution of infarct

Clinical history is very helpful

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  Multitude of underlying disorders can predispose to splenic infarction

Use of slow-flow settings in color or power Doppler helpful to confirm avascular or hypovascular nature of infarct

Visualization of blood flow in splenic hilar branches does not exclude splenic vein thrombosis