Methods of ultrasound of the spleen

The technique of performing a spleen ultrasound differs little from the techniques of liver echography, since scanning the state of the spleen is an obligatory part of the general study of the organs of the abdominal cavity. The technique of carrying out ultrasound of the spleen requires special preparation of the patient for the procedure. The preparation is standard for any type of abdominal examination by the ultrasound method and includes compliance with such rules and recommendations: 

• The procedure is carried out in the morning on an empty stomach, the last meal before ultrasound should be at least 8 hours before the procedure; 
• A few days before ultrasound (2-3) should adhere to a gentle diet, excluding the use of all kinds of legumes, black bread, whole-milk products and vegetables in raw form; 
• It is recommended to take sorbents (activated charcoal), enzymes, for two days before the procedure; 
• If the patient has chronic diseases, in which morning fasting before ultrasound is impossible, for example, diabetes, a light breakfast is allowed.

The echography of the spleen, like almost all other ultrasound examinations of the lower body organs, is performed under the condition of the patient's horizontal position. With regard to scans of the spleen, visualization of which due to anatomical features is difficult, the patient's posture can vary depending on the number of ultrasound sections. Also it is necessary to take into account that the spleen is examined, as a rule, on a deep enough inspiration. If the scan does not provide clear visual results, examination through the intercostal space is possible. The patient thus turns on the right side (to the side) and throws the left hand behind the head. The study is carried out using a sensor that is inclined closer to the diaphragm, starting from under the zone of the costal arch. Then the sensor is moved down the ninth intercostal space. Scanning continues with rhythmic repetition, while it is recommended to change the patient's position - lying on his back, position in the slope and lying on his right side. For better acoustic access and widening of the intercostal spaces, it is recommended to lift the body of the patient lying on the right side with a special roller or a folded towel.

The next stage is the conduct of longitudinal movements, sections along the entire axillary line (axillary) - both the anterior and posterior. The upper abdomen is also examined using longitudinal sections. As a standard, scans of the spleen are performed as part of a liver study, it helps to comprehensively assess the presence of abnormalities in the functions of these interrelated organs. The specifics and variants of the methodology are directly related to the indications for the survey, among which are: 

• Hyperplenism and splenomegaly. The task - to assess the size, location of the spleen and splenic vein, the structure, an additional set of studies (CT, laboratory analytical methods) is mandatory; 
• Hematological diseases; 
• Pathology of liver parenchyma, cirrhosis. The task is to assess the degree of abnormalities (spleen size, splenic vein state, portal hypertension); 
• Portal hypertension is an extrahepatic form; 
• Splenic lesions in situations of peritoneal injury; 
• Oncoprocess.

Spleen as a hematological filter is extremely important for the human body and any changes in its functioning require detailed study and detailed diagnostic activities. On the ultrasound examination, provided the healthy spleen is clearly visualized the following parameters of this organ: 

• Curved in the form of a crescent shape; 
• Arrangement in the left quadrant of the abdominal cavity from above, localization - the left lower part of the diaphragm; 
• The stomach is located closer to the middle of the spleen (medial), the tail of the pancreas (pancreas) is medial to the hilum splenicum - the gate of the spleen. The kidney on the left should be slightly below the spleen and closer to the middle.

The technique of performing the ultrasound of the spleen includes the study of such signs of pathological processes and deviations from normal parameters: 

• How much the right share stands out from under the edge space. Norm - no protrusion; 
• The size from the lower edge to the bluntly obstructed - diaphragm, CWR (co-vertex size) should not be more than 140 millimeters; 
• As far as the left part extends from under the processus xiphoideus - the xiphoid process; 
• How much the left share corresponds or meets to norm or rate. The norm is no more than 60 millimeters.

Research practice shows that additional shares of the spleen can be an individual anatomical version of the norm. Additional lobes are small in size and on ultrasound are visualized as small, round, homogeneous formations localized in the portal zone of the spleen.

Such indicators and signs are considered normal: 

• The linear signal is quite dense, comes from the capsule, designates the organ as sickle-shaped, with no pathological changes in size; 
• The uniformity of the parenchyma, which is visualized by signals as lobular. Echogenicity is average. Possible vascular mesh, penetrating the parenchyma in the gate area; 
• It is possible to visualize additional small lobes in the gate area of the organ; 
• Designation of the splenic vein as an echo-negative direct tract. The diameter of the vein may be different, but not more than 5 millimeters; 
• The oblique cut, parallel to the left rib, shows an organ size of not more than 12 centimeters, the cross-section does not exceed 8 centimeters, the thickness should not be more than 4 centimeters.

Estimating the size of the spleen, the area of the oblique cut is usually considered. Counting is done by multiplying the maximum number by the minimum. The norm of the result: the lower limit is not less than 23.5 square centimeters, the upper limit is more than 15.5 square centimeters. An average of 19.5 is considered normal, with a minimum deviation of no more than 5 millimeters.

The technique of carrying out of a US of a spleen allows to define acute and chronic pathologies: 

• Leukemia or infectious organ infarction; 
• Sprain of the spleen's tail, requiring surgical intervention; 
• Infarction abscesses, also abscesses caused by bacterial infections (endocarditis); 
• Echinococcal cystic formations, more often - serous cysts, traumatic ruptures; 
• Amyloidosis of the spleen of tuberculous etiology or as a consequence of osteomyelitis, age-related organ atrophy, spleen dystrophy associated with anemia; 
• Increased organ (hypersplenism, splenomegaly) of various etiologies.

The technique of carrying out ultrasound of the spleen is constantly being improved and with each turn of introduction of new methods and methods helps to obtain more specific, timely information about possible pathologies of the spleen. This information is of diagnostic value for specialists-gastroenterologists, hematologists, endocrinologists and in principle important for studying the functioning of the spleen.

[1], [2], [3], [4], [5], [6], [7], [8], [9],