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Computed Tomography of the Spleen
Last reviewed: 23.04.2024
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Parenchyma of the spleen on native images in computed tomography of the spleen normally has a density of about 45 HU. Its structure is uniform only in native images and in the late venous phase of contrast enhancement. In the early arterial phase, the enhancement is heterogeneous (patchy or mottled) due to the trabecular internal structure of the spleen. This picture should not be taken for pathology. Also pay attention to the uneven distribution of contrast medium in the lumen of the inferior vena cava and the two metastases in the liver.
Splenic artery usually elongated and tortuous, so it can be traced in several consecutive sections. At elderly patients on a vessel wall atherosclerotic plaques are defined. Sometimes in the gates or near the lower pole of the spleen there is an additional spleen. It is clearly delineated from the surrounding fiber. 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 accumulation diseases. The size of the spleen is difficult to assess due to the wide variety of its shape. Explicit 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.
With ultrasound, the transverse size of the spleen is not determined, but the measurement is made 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 cut thickness of 1 cm, it should be visualized no more than 15 slices. The diagnosis of splenomegaly is raised if at least two of these three parameters are increased.
With splenomegaly, the semilunar form, defined in norm, is violated. Giant spleen in patients with chronic lymphocytic leukemia, acting as a volumetric formation, displaces neighboring organs.
Focal lesions of the spleen
Cysts of the spleen are characterized by the same features as the liver cysts. Metastases in the spleen are rare, and they are difficult to distinguish from cysts. If the spleen is defined by multiple formations with non-homogeneous contrast enhancement, the first thing to think about is lymphoma or candidiasis. Candidiasis can 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 examination should be particularly careful. The rupture of the parenchyma of the organ leads to the formation of a subcapsular hematoma. If the capsule is damaged too, massive bleeding occurs in the abdominal cavity.
Residual effects of small hematomas are defined as subcapsular or parenchymal calcifications.
Cysts of the spleen with internal septa are a typical sign of echinococcosis. They resemble changes in the liver. Defeat of the spleen is often combined with liver damage.
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