Felis ISSN 2398-2950

Ultrasonography: spleen

Contributor(s): Paul Mahoney

Introduction

  • The procedure is best performed in a quiet room with reduced lighting.
  • The patient should be still for the examination, sedation is often required.
  • A nurse is required to assist in restraint of the patient.
  • Optimal probe to skin contact is required.
  • The patient identification, date and name of practice should be entered into the ultrasound machine before commencing the procedure.
  • Images of the examination should be kept for future reference, either as thermal prints, on video tape, on multiformat camera or saved on hard disc.

Uses

  • Assessment of:
    • Palpable or radiographic splenomegaly.
    • Palpable or radiographic splenic mass.
    • Palpable or radiographic mid-abdominal mass.
    • Metastatic disease.
    • Infiltrative or inflammatory disease.

Advantages

  • Non-invasive, in some cases sedation not required and rare to require anesthesia.
  • Straightforward.
  • Non-painful.
  • Available in many practices.
  • Allows guided biopsies.
  • Short time required for assessment: 10-25 minutes, dependent upon patient compliance, and skill of ultrasonographer.

Experience will significantly reduce time required.

Disadvantages

  • Requires clipping of patient's coat.
  • Normal ultrasonographic appearance does not exclude disease.
  • Abnormal ultrasonographic appearance does not always represent significant disease.
  • Similar ultrasonographic appearance with different diseases.
  • Chemical restraint often required.
  • If chemical restraint is necessary, several drugs cause splenomegaly, including barbiturates, phenothiazines, halothane.

Problems

  • Inadequate probe-skin contact:
    • Inadequate clipping of coat.
    • Inadequate use of ultrasound gel.
  • Inadequate restraint of an active cat.
  • Equipment failure.

Alternatives

  • Radiography  Radiography: abdomen  : provides information about size, shape, position and radiodensity of organ and not internal architecture.
  • Cytopathology: fine needle aspirates   Fine-needle aspirate  can be obtained from enlarged spleens or splenic mass lesions for cytological examination. The diagnostic value of this technique is improved by combining it with ultrasonography to guide the needle to the site of interest (particularly with focal lesions).
  • Histopathology: biopsy taken at laparotomy. Cutting needle biopsy is occasionally used with post-biopsy monitoring for hemorrhage.
  • MRI/CT: provide detailed information about architecture of organ but use limited by reduced availability of equipment except through referral centers.

Criteria

  • Is the ultrasound examination appropriate?
  • Can splenic disease be confirmed without it?
  • Can intra-abdominal metastatic disease be confirmed without it?
  • Will the examination tell you what you need to know?
  • Will the management of the patient be affected by the findings?
  • Do you possess appropriate skills required?
    • Knowledge of normal anatomy, including location, vascular supply and drainage, and lymphatic drainage.
    • Knowledge of the normal ultrasonographic appearance.
    • Knowledge of the parenchymal variations seen with non-neoplastic disease.

Equipment

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Procedure

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Normal anatomy

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Pathological changes

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Further Reading

Publications

Refereed papers
  • Hanson J A, Papageorges M, Olby N J & Spaulding K (2001)Ultrasonographic appearance of splenic disease in 101 catsVet Radiol Ultrasound.42(5), 441-445
  • Lamb C R, Hartzband L E, Tidwell A S & Pearson S H (1991)Ultrasonographic findings in hepatic and splenic lymphosarcoma in dogs and cats. Vet Radiol32, 117-120.

Other sources of information

  • Miles K G (1997)Sonography of the liver, pancreas and alimentary tract.In: Consultations in Feline Internal Medicine. Ed: August JR. WB Saunders Company, Philadelphia. pp 79-90.
  • Nyland T G, Mattoon J S & Wisner E R (1995)Ultrasonography of the spleen.In: Veterinary Diagnostic Ultrasound. Eds: Nyland TG & Mattoon JS. WB Saunders Company, Philadelphia. pp 74-84.


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