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Computed tomography of the spleen
Last reviewed: 06.07.2025
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The parenchyma of the spleen on native images during CT scanning of the spleen normally has a density of about 45 HU. Its structure is homogeneous only on native images and in the late venous phase of contrast enhancement. In the early arterial phase, enhancement is heterogeneous (spotted or speckled) due to the trabecular internal structure of the spleen. This picture should not be mistaken for pathology. Also note the uneven distribution of the contrast agent in the lumen of the inferior vena cava and two metastases in the liver.
The splenic artery is usually elongated and tortuous, so it can be traced on several successive sections. In elderly patients, atherosclerotic plaques are determined on the vessel walls. Sometimes an additional spleen is found in the hilum or near the lower pole of the spleen. It is clearly demarcated from the surrounding tissue. An additional spleen is difficult to distinguish from a pathologically enlarged lymph node.
Splenomegaly
Diffuse enlargement of the spleen occurs for a number of reasons: portal hypertension, leukemia/lymphoma, myelofibrosis, hemolytic anemia, and various storage diseases. The size of the spleen is difficult to assess due to the great variety of its shape. Obvious splenomegaly is easily determined, but in borderline cases and for comparison with subsequent studies, it is necessary to know the normal size of the spleen. The transverse size of the spleen should not exceed 10 cm, the width should not be more than 5 cm.
During ultrasound examination, the transverse size of the spleen is not determined, but measured along an oblique line parallel to the intercostal space. Then the upper limit of the norm for the long axis is 11 cm. The size of the spleen in the craniocaudal direction should not exceed 15 cm. Therefore, with a slice thickness of 1 cm, it should be visualized in no more than 15 slices. The diagnosis of splenomegaly is made if at least two of these three parameters are increased.
In splenomegaly, its normally defined crescent shape is disrupted. The giant spleen in patients with chronic lymphocytic leukemia, acting as a space-occupying formation, displaces adjacent organs.
Focal lesions of the spleen
Splenic cysts have the same features as liver cysts. Metastases to the spleen are rare and difficult to differentiate from cysts. If multiple formations with non-homogeneous contrast enhancement are detected in the spleen, lymphoma or candidiasis should be considered first. Candidiasis may also be accompanied by ascites. Lymphoma of the spleen is usually characterized by diffuse infiltration of the organ and preservation of normal size.
In patients with blunt chest or abdominal trauma, the spleen should be examined particularly carefully. Rupture of the organ parenchyma leads to the formation of a subcapsular hematoma. If the capsule is also damaged, massive bleeding into the abdominal cavity occurs.
Residual effects of small hematomas are determined in the form of subcapsular or parenchymatous calcifications.
Spleen cysts with internal partitions are a typical sign of echinococcosis. They resemble changes in the liver. Spleen damage is often combined with liver damage.
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