Spleen
a nodule of normal splenic tissue commonly located near the splenic hilum.
a decrease in hemoglobin levels in the blood.
absence of the spleen associated with two right lungs, a midline liver, and gastrointestinal and urinary anomalies.
a rare benign neoplasm composed of lymphoid tissue. Also known as splenoma.
the percentage of red blood cells in the blood.
carries oxygen from the lungs to the cells and returns carbon dioxide back to the lungs.
hematoma located within the splenic parenchyma.
proliferation of white blood cells.
white blood cell count above 20,000 mm3.
white blood cell count below 4000 mm3.
malignant disorder involving the lymphoreticular system.
multiple small spleens associated with two left lungs and gastrointestinal, cardiovascular, and biliary anomalies.
a localized dilatation of the splenic artery.
occlusion of the main splenic artery or one of its branches.
hematoma located between the splenic capsule and parenchyma.
Anatomy (fig. 11-1)
• Predominant organ in the left upper quadrant.
• Except at the hilum, the spleen is covered by the peritoneum.
• The spleen is divided into the:
Splenic vasculature
• The splenic artery arises from the celiac axis, courses along superior pancreatic borders, dividing into six branches after entering the splenic hilum.
• The splenic vein joins the superior mesenteric vein, forming the main portal vein.
• In cases of portal hypertension, the splenic vein may shunt blood directly into the left renal vein.
Location
• Predominantly located in the left hypochondriac region with the superior aspect extending into the epigastric region.
• Located inferior to the diaphragm and anterior to the left kidney.
• Lies posterior and lateral to the stomach.
| VARIANT | DESCRIPTION | CLINICAL FINDINGS | SONOGRAPHIC FINDINGS | DIFFERENTIAL CONSIDERATIONS |
| Accessory spleen | Improper splenic fusionCommon variant incidentally found in 30% of the population | Asymptomatic | Homogeneous mass typically located medial to the splenic hilumEchogenicity similar to spleenRound or oval in shapeVariable size | LymphadenopathyPancreatic massAdrenal mass |
| Aplasia | Failure of the spleen to develop | Asymptomatic | Absence of the spleen | SplenectomyWandering spleen |
| Polysplenia | Multiple small spleens | AsymptomaticVaries with associated congenital anomalies | Multiple small spleensLocated along the greater curvature of the stomachAssociated with gastrointestinal, cardiovascular, and biliary anomalies | LymphadenopathyRetroperitoneal masses |
| Wandering spleen | Improper fusion of the dorsal mesentery with the posterior peritoneum | Asymptomatic | Abnormal location of the spleen | AspleniaSplenic rupture |
| SIZE | ETIOLOGY | CLINICAL FINDINGS | SONOGRAPHIC FINDINGS | DIFFERENTIAL CONSIDERATIONS |
| Normal adult spleen | Length: 10-12 cmWidth: 7 cmThickness: 3-4 cm | |||
| Splenomegaly | Congestive heart failureCirrhosisPortal hypertensionPortal vein thrombosisInfectionDiabetes mellitusHypertensionHepatitisTraumaHemolytic anemia | AsymptomaticDyspepsiaFatigueAbdominal painPalpable left upper quadrant mass | Enlargement of the spleenAdultsLength exceeding 13 cmHypoechoic parenchymaEvaluate liver for pathologyEvaluate abdominal cavity for ascites | Technical errorSplenic rupture |
Technique
Preparation
• No preparation is necessary for a sonogram of the spleen.
• Nothing by mouth 6 to 8 hours before examination is the typical preparation, because imaging the spleen is rarely requested alone.
Examination technique and image optimization
• Use the highest-frequency abdominal transducer possible to obtain optimal resolution for penetration depth.
• Place gain settings to display the normal splenic parenchyma as a medium shade of gray (similar to the liver) with adjustments to reduce echoes within the vessels.
• Focal zone(s) at or below the place of interest.
• Sufficient imaging depth to visualize structures immediately posterior to the region of interest.
• Harmonic imaging or decreasing system compression (dynamic range) can be used to reduce artifactual echoes within anechoic structures.
• Spatial compounding can be used to improve visualization of structures posterior to a highly attenuating structure.
• Patients may lie in the supine, right posterior oblique, or right lateral decubitus position.
• Coronal and transverse scanning planes are used to evaluate the spleen from the left hemidiaphragm to the left kidney.
• Evaluation and documentation of the length, width, and thickness of the spleen.
• Documentation and measurement of any abnormality in two scanning planes with and without color Doppler should be included.
Laboratory values
Erythrocyte
• Carries oxygen from the lungs to the tissues in the body.
• Carries carbon dioxide back to the lungs.
• Develops in the bone marrow and has a life span of 120 days.
• Spleen stores red blood cells and destroys old red blood cells.
• Elevation associated with polycythemia vera and severe diarrhea.
• Decreases associated with internal bleeding, hemolytic anemia, Hodgkin’s disease, and hemangiosarcomas.
Hemoglobin
• Oxygen-carrying pigment of the red blood cell.
• Carries oxygen from the lungs to the cells and carbon dioxide from the cells back to the lungs.
• Developed in the bone marrow inside the red blood cell.
• Recycled by the spleen into iron.
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| PATHOLOGY | ETIOLOGY | CLINICAL FINDINGS | SONOGRAPHIC FINDINGS | DIFFERENTIAL CONSIDERATIONS |
| Abscess | Infective endocarditis—most commonInfectionTrauma | FeverLeft upper quadrant (LUQ) painLeukocytosis |