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
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 on a color map the presence and direction of vascular flow. Power Doppler(PW) allows to specifically characterize the blood flow, and this is of great importance to diagnose vascular abnormalities. The easiest approach for the visualization of splenic vessels is a transverse section through the upper abdomen. The artery runs at the superior border of the pancreas, usually localized more cranially than the vein.
KNOW THE CEUS: The injection of ultrasonographic contrast medium (2 mL of sulphur-hexafluoride microbubbles (Sonovue®, Bracco, Milan/Italy) (90 μg of sulphur-hexafluoride), followed by 10 ml of saline solution) allows to evaluate the early arterial phase and to continuously scan the region of interest during each contrast phase, increasing the diagnostic sensitivity and the specificity.