The spleen Spleen The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes. Spleen: Anatomy is the largest ductless gland and largest single lymphatic organ in the human body. The main functions of the spleen Spleen The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes. Spleen: Anatomy are immunologic surveillance Immunologic surveillance The theory that T-cells monitor cell surfaces and detect structural changes in the plasma membrane and/or surface antigens of virally or neoplastically transformed cells. Cancer Immunotherapy and red blood cell breakdown. The spleen Spleen The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes. Spleen: Anatomy can be affected by diseases of different origins, such as inflammatory, congenital Congenital Chorioretinitis, infectious Infectious Febrile Infant, neoplastic, and vascular diseases. Ultrasonography (US) is usually used as the 1st-line imaging modality due to its easy accessibility and lack of ionizing radiation Radiation Emission or propagation of acoustic waves (sound), electromagnetic energy waves (such as light; radio waves; gamma rays; or x-rays), or a stream of subatomic particles (such as electrons; neutrons; protons; or alpha particles). Osteosarcoma, but CT and MRI with contrast can also be helpful. Contrasted imaging modalities can delineate lesions and help differentiate disorders.
Last updated: 10 May, 2022
The common radiologic modalities used to evaluate the spleen Spleen The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes. Spleen: Anatomy are the following:
Normal ultrasound appearance:
Normal ultrasonographic image of the spleen Spleen The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes. Spleen: Anatomy (A) with Doppler mode Doppler Mode Scrotal Imaging (B)
Image: “F3” by Jordan, A.J., Becker, K.P., et al AL Amyloidosis. License: CC BY 2.0The maximum length of the spleen Spleen The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes. Spleen: Anatomy as measured by ultrasonography (US)
Image: “Maximum length of spleen Spleen The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes. Spleen: Anatomy on ultrasonography” by Mikael Häggström. License: CC0 1.0Standard CT scanning Standard CT scanning Imaging of the Liver and Biliary Tract:
The patient is advanced into the CT machine and the scanner revolves around the patient.
Image by Lecturio.Interpretation should follow a systematic and reproducible pattern:
A CT scan uses multiple
X-rays
X-rays
X-rays are high-energy particles of electromagnetic radiation used in the medical field for the generation of anatomical images. X-rays are projected through the body of a patient and onto a film, and this technique is called conventional or projectional radiography.
X-rays to create a 2- or 3-dimensional image:
The
X-ray
X-ray
Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source.
Pulmonary Function Tests “slices” are taken in the
axial
Axial
Computed Tomography (CT) plane and reconstructed into the
sagittal
Sagittal
Computed Tomography (CT) and
coronal
Coronal
Computed Tomography (CT) planes by a computer to produce the final image.
Normal CT appearance:
Tissue | T1-weighted images T1-Weighted Images Imaging of the Head and Brain | T2-weighted images T2-Weighted Images Imaging of the Head and Brain |
---|---|---|
Fluid (e.g., CSF) | Dark | Bright |
Fat | Bright | Bright |
Inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation | Dark | Bright |
Interpretation should follow a systematic and reproducible pattern:
Normal MRI appearance:
Computed tomography scans showing massive
splenomegaly
Splenomegaly
Splenomegaly is pathologic enlargement of the spleen that is attributable to numerous causes, including infections, hemoglobinopathies, infiltrative processes, and outflow obstruction of the portal vein.
Splenomegaly:
(a)
Sagittal
Sagittal
Computed Tomography (CT) sonographic view of the
spleen
Spleen
The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes.
Spleen: Anatomy showing a markedly enlarged and diffuse heterogeneous
spleen
Spleen
The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes.
Spleen: Anatomy (blue arrow) measuring 30 cm in length
(b)
Coronal
Coronal
Computed Tomography (CT) non-contrast CT (
NCCT
NCCT
Imaging of the Head and Brain) of the abdomen and
pelvis
Pelvis
The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities.
Pelvis: Anatomy showing enlarged
spleen
Spleen
The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes.
Spleen: Anatomy reaching 33.6 cm in length
Magnetic resonance imaging showing splenomegaly Splenomegaly Splenomegaly is pathologic enlargement of the spleen that is attributable to numerous causes, including infections, hemoglobinopathies, infiltrative processes, and outflow obstruction of the portal vein. Splenomegaly and hemangiomas
Image: “F1” by Kosmidis, C., Efthimiadis, C., et al AL Amyloidosis. License: CC BY 2.0A 2D grayscale ultrasound image demonstrates a small subcapsular splenic hematoma Hematoma A collection of blood outside the blood vessels. Hematoma can be localized in an organ, space, or tissue. Intussusception.
Image: “F4” by Azar, F., Brownson, E., Dechert, T. License: CC BY 2.0A CT scan showing subcapsular
hematoma
Hematoma
A collection of blood outside the blood vessels. Hematoma can be localized in an organ, space, or tissue.
Intussusception and hemoperitoneum:
A: A CT,
axial
Axial
Computed Tomography (CT) slice, without contrast, demonstrating dense collections (arrow) adjacent to the
spleen
Spleen
The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes.
Spleen: Anatomy
B: Contrast-enhanced
axial
Axial
Computed Tomography (CT) CT showing the dense collections adjacent to the
spleen
Spleen
The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes.
Spleen: Anatomy (arrow), without contrast enhancement, indicative of subcapsular
hematoma
Hematoma
A collection of blood outside the blood vessels. Hematoma can be localized in an organ, space, or tissue.
Intussusception
C: A CT,
axial
Axial
Computed Tomography (CT) slice, without contrast, demonstrating dependently layering dense free fluid in the
pelvis
Pelvis
The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities.
Pelvis: Anatomy (arrow), indicative of hemoperitoneum
Rupture of spleen Spleen The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes. Spleen: Anatomy with hemoperitoneum in the perisplenic area
Image: “Chronic rupture of spleen Spleen The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes. Spleen: Anatomy with hemoperitonem in perisplenic area” by Sharma, D. License: CC BY 2.0, edited by Lecturio.
Splenic rupture
Splenic rupture
Splenic rupture is a medical emergency that carries a significant risk of hypovolemic shock and death. Injury to the spleen accounts for nearly half of all injuries to intra-abdominal organs. The most common reason for a rupture of the spleen is blunt abdominal trauma, specifically, motor vehicle accidents.
Rupture of the Spleen:
Left image, abdominal ultrasound,
left upper quadrant view
Left Upper Quadrant View
Focused Assessment with Sonography for Trauma (FAST)
Right image, computed tomography scan (CT) of the abdomen and
pelvis
Pelvis
The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities.
Pelvis: Anatomy,
coronal
Coronal
Computed Tomography (CT) view
Abdominal ultrasound showing a large splenic cyst containing homogeneous internal echoes/debris
Image: “Fig. 1” by Sleiman, Y.A., Bohlok, A., et al AL Amyloidosis. License: CC BY 4.0A CT scan of the splenic cyst (arrow)
Image: “fig-002” by Avgerinos, D.V., Kyriakopoulos, C.E., et al AL Amyloidosis. License: CC BY 3.0Preoperative abdominal CT, (a)
axial
Axial
Computed Tomography (CT) and (b)
coronal
Coronal
Computed Tomography (CT).
(c) A T2-weighted MRI shows a giant rounded
cystic
Cystic
Fibrocystic Change
mass
Mass
Three-dimensional lesion that occupies a space within the breast
Imaging of the Breast anterior to the
spleen
Spleen
The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes.
Spleen: Anatomy, which is significantly displaced posteriorly.
(d) An
axial
Axial
Computed Tomography (CT) T1-weighted fat-saturated MRI, post–
gadolinium
Gadolinium
An element of the rare earth family of metals. It has the atomic symbol gd, atomic number 64, and atomic weight 157. 25. Its oxide is used in the control rods of some nuclear reactors.
Magnetic Resonance Imaging (MRI) administration, shows a thin peripheral enhancement of the splenic
mass
Mass
Three-dimensional lesion that occupies a space within the breast
Imaging of the Breast—possibly representing a
capsule
Capsule
An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides.
Bacteroides—and no internal enhancement consistent with its
cystic
Cystic
Fibrocystic Change nature.
A: Contrast-enhanced CT scan in a pre-assessment for
liver transplantation
Liver transplantation
The transference of a part of or an entire liver from one human or animal to another.
Hepatocellular Carcinoma (HCC) and Liver Metastases, showing
splenomegaly
Splenomegaly
Splenomegaly is pathologic enlargement of the spleen that is attributable to numerous causes, including infections, hemoglobinopathies, infiltrative processes, and outflow obstruction of the portal vein.
Splenomegaly with a sharply demarcated low-density area in the posterior–inferior pole of the
spleen
Spleen
The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes.
Spleen: Anatomy (arrow).
B: A split-screen view. Conventional ultrasound (right side of the screen) shows a
hypoechoic
Hypoechoic
A structure that produces a low-amplitude echo (darker grays)
Ultrasound (Sonography), heterogeneous lower pole of the
spleen
Spleen
The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes.
Spleen: Anatomy, and contrast-enhanced ultrasound (CEUS) (left side of the screen) shows a total absence of enhancement of the lower pole of the
spleen
Spleen
The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes.
Spleen: Anatomy, confirming a large wedge-shaped infarction (arrow).
Computed tomography shows splenic infarction (A: white arrow) and abscess Abscess Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. Chronic Granulomatous Disease with percutaneous drainage Percutaneous Drainage Echinococcus/Echinococcosis (B: wedge-shaped, white arrow)
Image: “Fig5” by Kim, J.S., Kang, M.K., et al AL Amyloidosis. License: CC0 1.0Abdominal CT with enhancement shows a low-attenuated, wedge-shaped lesion consistent with splenic infarction as well as splenomegaly Splenomegaly Splenomegaly is pathologic enlargement of the spleen that is attributable to numerous causes, including infections, hemoglobinopathies, infiltrative processes, and outflow obstruction of the portal vein. Splenomegaly in the arterial phase (A) and portal phase (B).
Image: “F2” by Hwang, J.H., Lee, C.S. License: CC BY 4.0Axial Axial Computed Tomography (CT) T2-weighted fat-suppressed MRI shows a wedge-shaped hyperintense Hyperintense Magnetic Resonance Imaging (MRI) area of infarction in the spleen Spleen The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes. Spleen: Anatomy (arrow) as well as decreased signal intensity of the liver Liver The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood. Liver: Anatomy.
Image: “f1” by Usküdar Teke, H., Karahan, S., Gümüş, U. License: CC BY 2.5Ultrasound examination demonstrating solitary, small, well-defined splenic abscess Abscess Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. Chronic Granulomatous Disease
Image: “Figure 2” by Aslam, A., Ahmed Shatla E.S., et al AL Amyloidosis. License: CC BY 4.0Splenic
abscess
Abscess
Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection.
Chronic Granulomatous Disease:
Axial
Axial
Computed Tomography (CT) contrast-enhanced CT of a 40-year-old woman demonstrates air (arrow) within a low attenuation splenic
abscess
Abscess
Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection.
Chronic Granulomatous Disease. A culture test was positive for E. coli.
Abscess
Abscess
Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection.
Chronic Granulomatous Disease:
A: Contrast-enhanced CT scan showing a hypodense splenic lesion with a thick, irregular wall (arrows)
B: Contrast-enhanced ultrasound (CEUS) showing no internal enhancement and an irregular wall in the larger
abscess
Abscess
Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection.
Chronic Granulomatous Disease, with thickened, enhancing septations in the smaller
abscess
Abscess
Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection.
Chronic Granulomatous Disease (arrows)
Follow-up MRI of the abdomen (24 days after admission):
A: The
coronal
Coronal
Computed Tomography (CT) T2-weighted image shows
splenomegaly
Splenomegaly
Splenomegaly is pathologic enlargement of the spleen that is attributable to numerous causes, including infections, hemoglobinopathies, infiltrative processes, and outflow obstruction of the portal vein.
Splenomegaly with
hyperintense
Hyperintense
Magnetic Resonance Imaging (MRI) lesions with a
hypointense
Hypointense
Magnetic Resonance Imaging (MRI) rim in the
spleen
Spleen
The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes.
Spleen: Anatomy.
B and C: The
coronal
Coronal
Computed Tomography (CT) post-contrast T1-weighted image and transverse
diffusion
Diffusion
The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space. Diffusion, especially facilitated diffusion, is a major mechanism of biological transport.
Peritoneal Dialysis and Hemodialysis-weighted image (
DWI
DWI
Imaging of the Head and Brain) (b 800 sec/mm2) show multiple areas of intrasplenic
abscess
Abscess
Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection.
Chronic Granulomatous Disease formation.