Splenic Emergencies: value of US exploration for the diagnosis

Congress:

ECR 2020

Poster Number:

C-12530

Type:

Educational Exhibit

Keywords:

Emergency Imaging, Abdomen, Spleen, Ultrasound, Ultrasound-Colour Doppler, Ultrasound-Power Doppler, Diagnostic procedure, Embolism / Thrombosis, Ischaemia / Infarction, Trauma, Not applicable, Performed at one institution

Authors:

F. Iacobellis¹, M. Di Serafino², A. Borzelli¹, M. L. Schillirò ¹, F. Pezzullo², L. Barbuto², C. D'errico², C. Acampora², L. Romano²; ¹Napoli/IT, ²Naples/IT

DOI:

10.26044/ecr2020/C-12530

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-12530

Fig. 1: US B-mode examination of a 56-year-old man with history of liver transplant,...

Fig. 2: Transverse grayscale sonogram of a 45-year-old woman presenting with left upper...

Fig. 3: US evaluation in two different cases of splenic abscess: B-mode US examination...

Fig. 4: 65 years-old patient referring to the emergency department for oliguria. US...

Learning objectives

To learn the ultrasound technique to evaluate the spleen. To become familiar with the most common imaging findings of spleen abnormalities, encountered in emergency settings.

Background

KNOW THE ANATOMY: Spleen is normally located behind the splenic flexure and stomach, so an anterior approach is almost invariably unsuccessful due to overlying bowel gas. A slightly posterior approach may overcome this. KNOW THE B-MODE TECHNIQUE: There are two important scans of the spleen to obtain: longitudinal and transverse plane including the splenic hilum. The contour, the echostructure and the splenic vessels should be described and also the presence of free fluid. KNOW THE DOPPLER: Color Doppler(CD) evaluation completes the B-MODE US examination, representing...

Findings and procedure details

To make a definite diagnosis the radiologist must recognize the main findings related with the most common emergencies: Splenic infarction The US appearance depends on the time of the event (Fig.1). In the acute phase, the infarcted areabecomes oedematous due to associated inflammation and necrosis (Fig.1), so the classic appearance is a wedge-shaped hypoechoic lesion, solitary and extending to the periphery of the spleen, withabsent flow on Doppler interrogation (Fig.2). The lesion may decrease in time, becoming gradually fibrous and so hyperechoic (Fig.1), without Doppler...

Conclusion

Ultrasound constitute the first modality to assess splenic emergencies. Each of the described features needs to be determined during the examination and specifically mentioned in the final report, leading to a correct and definite diagnosis.

Personal information and conflict of interest

Francesa Iacobellis; Naples/IT - nothing to disclose Marco Di Serafino; Naples/IT - nothing to disclose Maria Laura Schillirò; Naples/IT - nothing to disclose Antonio Borzelli; Naples/IT - nothing to disclose Filena Pezzullo; Naples/IT - nothing to disclose Chiara D'Errico; Naples/IT - nothing to disclose Luigi Barbuto; Naples/IT - nothing to disclose Ciro Acampora; Naples/IT - nothing to disclose Luigia Romano; Naples/IT - nothing to disclose Department of General and Emergency Radiology "A. Cardarelli" Hospital Via A. Cardarelli 9, 80131 Napoli, IT

References

Alabousi A et al. Cross-Sectional Imaging of Nontraumatic Emergencies of the Spleen. Curr Probl Diagn Radiol. 2014 Chen MJ et al. Ultrasonography of splenic abnormalities. World J Gastroenterol. 2005 Vanhoenacker FM et al. Vascular Disease of the Spleen. Semin Ultrasound, CT MRI. 2007 Tana C et al. Contrast-enhanced ultrasound in portal venous system aneurysms: A multi-center study. World J Gastroenterol. 2014 Al-Habbal Y et al. Aneurysms of the splenic artery - A review. Surgeon. 2010 Unal E et al. Imaging findings of splenic emergencies: a...