Imaging

A number of imaging modalities are available to evaluate and aid in the diagnosis of splenic disorders. Plain abdominal x-rays can be used in the diagnosis of splenomegaly, with depiction of a large splenic shadow, and/or displacement of the stomach, colon, or left hemidiaphragm. Plain radiographs demonstrating fractures involving the lower half of the left rib cage (ribs 6-12) may be the first indication of splenic trauma.

Ultrasound is a very useful rapid, portable, and noninvasive diagnostic modality to evaluate splenic size, traumatic injury, cysts, abscesses, infarcts, masses, and accessory splenules. The use of ultrasound in the emergency

Figure 13-3 Massive splenomegaly in a patient with hepatic cirrhosis.

room to evaluate trauma victims for hemoperitoneum has become standard of care. The efficacy of ultrasound may be limited by patient body habitus, overlying bowel gas, and operator proficiency.

Cross-sectional imaging via computed tomography (CT) or magnetic resonance imaging (MRI) scans provide the most detailed information of splenic anatomy and pathologic processes, as well as information about potential disease processes in surrounding organs. Serial cross-sectional imaging studies can be used to monitor therapeutic response and to guide percutaneous catheter-based treatment. The main limitations on the use of cross-sectional imaging are the lack of portability, cost, and exposure to ionizing radiation and intravenous contrast agents in the case of CT scans.

Angiography, another imaging modality using ionizing radiation and catheter-guided contrast injection, has become an important therapeutic modality in addition to its diagnostic utility in evaluating splenic artery aneurysms and splenic vein thrombosis. Splenic artery embolization can be used as an adjunctive or primary treatment modality for the management of splenic trauma and splenomegaly.

Lastly, nuclear medicine scans using colloidal technetium or radiolabeled white blood cells (WBCs) or RBCs have been used to elicit information on splenic function and the presence of accessory spleens.

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