Spleen ultrasound is a technique for noninvasive study of the morphofunctional state of the spleen using ultrasound waves. Echographic imaging of the spleen can be performed as part of a comprehensive ultrasound of the abdominal organs or as an independent diagnostic procedure. The purpose of the diagnosis is to determine the topographic and anatomical characteristics of the organ, to identify local and diffuse changes, pathological hyper- or hypoechoic inclusions. The study can be informative for abdominal injuries, infectious diseases, diseases of the blood system, oncological processes.
The procedure can be prescribed for a number of pathological conditions. In most cases, the basis for spleen ultrasound is its enlargement, determined by palpation (the lower edge of the spleen protrudes from under the left costal arch). Splenomegaly, in turn, can be accompanied by infections (tuberculosis, viral hepatitis, infectious mononucleosis, malaria, sepsis), helminthiasis, malignant diseases of the hematopoietic system (leukemia, lymphomas, hemolytic anemia), amyloidosis, sarcoidosis, splenitis, etc.
Spleen ultrasound is necessary for patients with liver diseases (cirrhosis, hepatitis), gallbladder and pancreas, since these organs are closely connected by a common vascular system. In some cases, the long-term chronic course of these diseases can cause the development of portal hypertension and secondary changes in the spleen.
Spleen ultrasound may be required for complaints of pain in the left hypochondrium, palpable formations of this area, suspected subdiaphragmatic abscess (in the case of fever of unknown genesis). Quite rarely, congenital anomalies of the organ are diagnosed by ultrasound: aplasia, hypoplasia, dystopia of the spleen, polysplenia, spleen cysts, etc. In addition, ultrasound can detect focal changes of the spleen: infarction, hemangiomas, calcifications, abscesses, metastatic organ lesions.
Ultrasound is mandatory for a closed abdominal injury, which is often accompanied by a rupture of the organ and massive intra-abdominal bleeding. The danger lies in the fact that at first only the parenchyma of the spleen can be damaged while maintaining the integrity of its capsule. This masks the signs of internal bleeding. However, with a significant stretching of the capsule, its rupture occurs with a rapid simultaneous outpouring of blood into the abdominal cavity and the development of hemorrhagic shock. Spleen ultrasound in abdominal injuries helps to identify such hidden, but extremely dangerous injuries.
In the presence of emergency indications for the study (acute pain, suspicion of rupture of the spleen), preparatory measures are not required. A necessary condition is the absence of open wounds and damage to the skin at the scanning site.
Scheduled spleen ultrasound is performed on an empty stomach: this is due to the fact that an overfilled stomach and over-inflated intestinal loops can create difficulties for visualization of the spleen. For a more accurate diagnosis, eating 6-8 hours before the procedure is excluded. Only the use of water in small quantities is allowed. Patients with diabetes mellitus are allowed a light breakfast. With severe flatulence, a slagless diet and intake of enterosorbents are prescribed three days before the study. If you are prone to constipation, it is recommended that you set up a cleansing enema.
Methodology of conducting
The spleen is visualized from a supine position on the back and on the right side. A conductive gel is applied to the left half of the anterior abdominal wall. Scanning is performed from various positions: through the anterior abdominal wall, from under the left hypochondrium, through the intercostal space. In order to expand the acoustic window, you can lift the patient’s body with a special roller and ask him to put his left hand behind his head. Periodically, the specialist asks the patient to hold his breath on a deep breath – in this state, the spleen is better visualized. During the procedure, adjacent organs (the left dome of the diaphragm, pancreas, renosplenal relationship), the left edge of the liver, the spleen gate, portal and inferior vena cava, and nearby lymph nodes are also examined.
Spleen ultrasound takes 15-20 minutes; the examination protocol is issued a few minutes after the end of the procedure. The unchanged spleen during ultrasound scanning has a crescent shape, smooth clear contours, average echogenicity, homogeneous echostructure. The dimensions of the organ in length are up to 12 cm, in width – 6-8 cm, anterior-posterior size – 3-4 cm. The diameter of the splenic vein normally does not exceed 5-6 mm.