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Finally, evaluation of the splenic vasculature may help identify splenic torsion (Figure 9.16) (see above), thrombus formation, and splenic infarction.

 Thrombi are visualized as echogenic structures within the splenic vein or parenchymal splenic vessels, and may or may not have clinical consequences depending on the degree of occlusion of the vessel (Figure 9.17; compare to Figure 9.1). Their presence, however, does raise clinical suspicion for lymphosarcoma (Laurenson et al. 2010). See also Chapter 25.

Pearl: Splenic thrombi are most commonly associated with lymphosarcoma (Laurenson et al. 2010). They can also be seen with splenic torsion.

 Splenic infarction is a possible sequela to splenic thrombi and occurs when blood flow is occluded to an area of splenic parenchyma due to torsion or trauma. Infarcted areas tend to be hypoechoic due to edema in the acute phase, while having borders that are variable in appearance ranging from poorly defined to sharply delineated margins. The lesions generally become smaller and hyperechoic with time (see Figures 9.11 and 16.10B).

Figure 9.17. Splenic thrombus. (A) The splenic vein near the hilus appearing distended by its relative size to the body of the spleen. Within the lumen there appear to be isoechoic material/intraluminal echoes. (B) Same image as (A) confirming the presence of the suspected splenic thrombus using color flow Doppler. Splenic thrombi are most commonly associated with lymphosarcoma but are also associated with other prothrombotic conditions.