Ultrasound signs of the pathology of the spleen

Increased spleen / splenomegaly

There are no absolute criteria for determining the size of the spleen for ultrasound examination, if it is normal, it is slightly larger or about the same size as the left kidney. The length should not exceed 15 cm along the long axis.

A chronically enlarged spleen can rotate and dislodge the left kidney, causing a decrease in the anteroposterior size and width of the kidney.

Splenomegaly with a homogeneous ehostruktura

Can take place when:

1. Tropical splenomegaly, which includes idiopathic splenomegaly, malaria, trypanosomiasis, leishmaniasis and schistosome.
2. Sickle-cell anemia (without infarction).
3. Portal hypertension.
4. Leukemia.
5. Metabolic diseases.
6. Lymphoma (may also contain hypoechoic structures).
7. Infectious diseases, such as rubella and infectious mononucleosis.

When detecting splenomegaly, determine the size of the liver and its echogenicity, also examine the splenic and portal veins, the lower vena cava, the hepatic veins, the mesenteric vein for dilatation. It is necessary to investigate the area of the spleen gates for revealing tubular structures in varicose veins.

Disturbance of spleen echostructure with or without splenomegaly

Well-delineated cystic formations

If there are clearly delimited anehogenic formations with distal acoustical amplification, it is necessary to differentiate:

1. Polycystic (cysts may be multiple). Examine the liver or pancreas for cysts.
2. Vrozkdennye cysts. They are usually single and may contain internal echostructures as a result of hemorrhage.
3. Echinococcal (parasitic) cysts. They are usually clearly delineated, have a double contour (periciitis wall and cysts) and often - septa. A clear reinforcement of the posterior wall is determined and often there is a different thickness of the cyst wall. However, parasitic cysts can be represented by rounded formations with an uneven contour, a heterogeneous echostructure that simulates an abscess. Cysts can be hypoechoic with a few different internal echostructures or hyperechoic and solid without any acoustic shade: there are different combinations of similar types of structures. The walls of the cyst may be asleep or prolapse, inside the cysts floating structures can be observed, even a cyst inside the cyst can be visualized (this sign is pathognomonic for the parasitic cyst). Calcification can occur in the wall of the cyst, in the cavity may be "sand", located in the lowest place. Carry out a study of the entire abdomen and do a chest x-ray. Parasitic cysts are often multiple, but their ehostruktura can be different, and cysts in the liver do not necessarily look the same as cysts in the spleen.
4. Hematoma.

If there is an increase in the spleen and a history of injury, it is necessary to conduct an ultrasound examination of the spleen to exclude its damage.

Education in the spleen with an even but fuzzy contour

Scan in different projections.

1. A hypoechoic cystic zone with an uneven contour, usually with a suspension, combined with splenomegaly and local soreness, is most likely to be an abscess of the spleen. Examine the liver for other abscesses.

With adequate treatment, the abscess can be resolved or increased and become almost anechogenous, but it will not be painful any more.

2. Similar cystic structures, large in size and containing a liquid, may be abscesses as a result of a heart attack for sickle cell anemia. Amoebic abscesses are rarely found in the spleen: more often abscesses are bacterial.

Splenic vein

The normal size of the splenic vein does not exclude the possibility of portal hypertension.

Splenic vein dilatation

If the splenic vein looks large and has a diameter of more than 10 mm in all phases of the respiratory cycle, portal hypertension may be suspected. If the portal vein has a diameter of more than 13 mm and does not change size during breathing, the likelihood of portal hypertension is very high.

Formation of the spleen with or without splenomegaly

Formations in the spleen can be single or multiple, with clear or fuzzy contours. Lymphoma is the most common cause of the appearance of lesions in the spleen, and these formations are usually hypoechoic. Malignant tumors, primary or metastatic, are rare in the spleen and can be hyper- and hypoechoic. In the presence of necrosis, a cystic-solid internal structure, similar to an abscess, may appear. Infectious diseases, such as tuberculosis or histoplasmosis, can produce diffuse granulomatosis, represented by hyperechogenous formations, in some cases resulting in calcification of the acoustic shadow. It is necessary to exclude hematoma.

If there is an abnormality of the contour of the spleen near the formation, it is likely that this formation is an old hematoma or a scar after trauma. On the other hand, this may be an old infarction (for example, sickle cell disease).

When detecting education in the spleen, it is necessary to exclude its fresh damage, especially if there is splenomegaly.

Splenic abscess: cystic structure with uneven contour, hypoechoic or mixed ehostruktury.

Fever (usually of unknown origin)

If possible, check the number of white blood cells and the white blood formula. Start with longitudinal sections.

Anechogenous or mixed echogenicity formation located near the spleen, sub-diaphragmatic, anterior to the spleen, but limited by the left dome of the diaphragm, may be a subdiaphragmatic abscess. The mobility of the diaphragm can be reduced. Do the research and the right sub-diaphragmatic area to exclude the presence of liquid on the right. Also scan the entire abdomen, including the pelvis, to eliminate fluid anywhere. Scan the lower and lateral sections of the left side of the thorax to exclude pleural fluid, which at times can be visualized through the spleen. It may be useful chest radiography.

Injury

The study implies an accurate examination of the contours of the spleen in order to see any area of its local enlargement, as well as a scan of the abdominal region to exclude the presence of free fluid in the abdominal cavity. If the patient's condition does not improve, then repeat the test in a few days.

1. If there is free fluid in the abdominal cavity or fluid in the sub-diaphragmatic space and uneven contour of the spleen, then there may be a rupture or injury to the spleen.
2. Visualization of anechoic or mixed zone echogenicity in combination with diffuse or local enlargement of the spleen suggests the presence of subcapsular hematoma. Thoroughly look for free fluid in the abdominal cavity.
3. An anechoic or mixed echogenic structure with an uneven contour inside the spleen suggests the presence of acute hematoma. An additional spleen can have the same echographic pattern.
4. Education in the spleen of high echogenicity can be an old calcified hematoma, giving bright hyperechoic structures with an acoustic shadow. Hemangioma can have a similar echographic pattern.
5. Anehogenous or mixed echogenicity formation with an uneven contour may be a traumatic cyst or a damaged parasitic cyst.

If splenomegaly, persistent anemia or loose fluid in the abdominal cavity are detected, if there is a history of abdominal trauma during the last 10 days, it is necessary to think about spleen damage.