Methodology of spleen ultrasound

The technique for performing an ultrasound of the spleen differs little from the techniques for echography of the liver, since scanning the condition of the spleen is a mandatory part of the general examination of the abdominal organs. The technique for performing an ultrasound of the spleen involves special preparation of the patient for the procedure. Preparation is standard for any type of examination of the abdominal organs using the ultrasound method and includes compliance with the following rules and recommendations:

• The procedure is performed in the morning on an empty stomach, the last meal before the ultrasound should be at least 8 hours before the procedure;
• For several days before the ultrasound (2-3), you should adhere to a gentle diet, excluding the consumption of all types of legumes, black bread, whole milk products and raw vegetables;
• It is recommended to take sorbent preparations (activated carbon) and enzymes for two days before the procedure;
• If the patient has chronic diseases that make it impossible to fast in the morning before an ultrasound, for example, diabetes, a light breakfast is allowed.

Spleen ultrasound, like almost all other ultrasound examinations of the lower body organs, is performed with the patient in a horizontal position. As for scanning the spleen, the visualization of which is difficult due to its anatomical features, the patient's position may vary depending on the number of ultrasound scans. It is also necessary to take into account that the spleen is usually examined during a fairly deep breath. If scanning does not provide clear visual results, examination through the intercostal space is possible. The patient turns to the right side (side) and throws his left hand behind his head. The examination is performed using a sensor inclined closer to the diaphragm, starting from under the costal arch area. Then the sensor is moved down the ninth intercostal space. Scanning continues with rhythmic repetitions, while it is recommended to change the patient's position - lying on the back, tilted position and lying on the right side. For better acoustic access and expansion of the intercostal spaces, it is recommended to raise the patient's body, lying on the right side, using a special cushion or a rolled-up towel.

The next stage is conducting longitudinal movements, sections along the entire axillary line (axillary) - both anterior and posterior. The upper abdominal area is also examined using longitudinal sections. Standardly, scanning of the spleen is carried out as part of the liver examination, this helps to comprehensively assess the presence of deviations in the functions of these interconnected organs. The specifics and options of the technique are directly related to the indications for examination, including the following:

• Hypersplenism and splenomegaly. The task is to assess the size, localization of the spleen and splenic vein, structure, an additional set of studies is mandatory (CT, laboratory analytical methods);
• Hematological diseases;
• Liver parenchyma pathology, cirrhosis. The task is to assess the degree of deviations from the norm (spleen size, splenic vein condition, presence of portal hypertension);
• Portal hypertension - extrahepatic form;
• Spleen lesions in situations of peritoneal trauma;
• Oncoprocess.

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

• Crescent-shaped curve;
• Location in the left quadrant of the abdominal cavity from above, localization is the left lower part of the diaphragm;
• The stomach is located closer to the middle of the spleen (more medially), the tail of the pancreas is located medially to the hilum splenicum – the splenic gate. The kidney on the left should be located slightly below the spleen and closer to the middle.

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

• How much does the right lobe protrude from under the costal space. The norm is no protrusion;
• The size from the lower edge to the thoraco-abdominal septum – the diaphragm, KVR (oblique vertical size) should not be more than 140 millimeters;
• How far does the left lobe protrude from under the processus xiphoideus - the xiphoid process;
• How much does the left lobe correspond to the norm? The norm is no more than 60 millimeters.

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

The following indicators and signs are considered normal:

• The linear signal is quite dense, comes from the capsule, denotes the organ as sickle-shaped, without pathological changes in size;
• Homogeneity of the parenchyma, which is visualized by signals as lobular. Echogenicity is average. A vascular network penetrating the parenchyma in the hilum area is possible;
• Visualization of additional small lobes in the organ gate area is possible;
• The splenic vein is indicated by an echo-negative straight cord. The diameter of the vein may vary, but not more than 5 millimeters;
• An oblique cut parallel to the left rib shows the organ size to be no more than 12 centimeters, a transverse cut gives no more than 8 centimeters, the thickness should not be higher than 4 centimeters.

When assessing the size of the spleen, the area of the oblique section is usually calculated. The calculation is made 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. The average value of 19.5 is considered normal, minimal deviations of no more than 5 millimeters are possible.

The technique of performing ultrasound examination of the spleen allows to determine acute and chronic pathologies:

• Leukemic or infectious organ infarction;
• Volvulus of the splenic pedicle requiring surgical intervention;
• Infarction abscesses, also abscesses caused by bacterial infections (endocarditis);
• Echinococcal cystic formations, most often serous cysts, traumatic ruptures;
• Amyloidosis of the spleen of tuberculous etiology or as a consequence of osteomyelitis, age-related atrophy of the organ, dystrophy of the spleen associated with anemia;
• Enlargement of an organ (hypersplenism, splenomegaly) of various etiologies.

The technique of conducting ultrasound examination of the spleen is constantly being improved and with each round of implementation of new methods and techniques it helps to obtain more specific, timely information about possible pathologies of the spleen. This information is of diagnostic value for gastroenterologists, hematologists, endocrinologists and is, in principle, important for studying the functioning of the spleen.

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