Ultrasound guided fine needle aspiration biopsy of splenic lesions

Fine needle aspiration biopsy (FNAB) of focal splenic lesions has been infr equently utilized because of the risk of haemorrhage. This study was carrie d out to evaluate the safety and efficacy of ultrasound guided FNAB of sple nic lesions. 35 patients with focal splenic lesions underwent FNAB under re al-time ultrasound guidance using a free hand technique. Ultrasound finding s were single or multiple focal hypoechoic lesions (n=33), focal hyperechoi c lesion (n=1) and diffuse heterogeneous echotexture (n=1). Aspirations wer e performed with 22 G spinal needles using either the subcostal or the inte rcostal approach. Definite cytological diagnosis was made in 22 patients (6 2.8%), including tuberculosis in 10 patients, lymphoma in seven patients, e xtramedullary haematopoiesis in two patients and aspergillosis, histoplasmo sis and bacterial abscess in one patient each. FNAB was negative in 12 pati ents because the aspirates were either scanty or contained only blood. FNAB was falsely positive in one patient. Only one patient had significant intr aabdominal bleeding, which was managed conservatively. In conclusion, splen ic FNAB performed under ultrasound guidance is a safe and accurate method i n the diagnosis of focal splenic lesions.