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Spontaneous rupture of the spleen: ultrasound patterns, diagnosis and follow-up

¹ Zentrum für Innere Medizin, Klinikum der Philipps-Universität, Baldingerstraße, 35043 Marburg and ² Koordinationszentrum für klinische Studien, Klinikum der Philipps-Universität, Bunsenstraße, Marburg, Germany

View larger version (36K): [in a new window]   Figure 1. Distribution of symptoms of pain at the time of diagnosed splenic rupture in 41 study patients.

View larger version (74K): [in a new window]   Figure 2. 59-year-old patient with chronic myeloid leukaemia in the chronic phase and pain in the left upper abdomen. (a) Ultrasound of the spleen showed irregular delineated wedge shaped intrasplenic lesion (arrowheads) suggesting splenic infarction (INF), with a small echofree area (arrow). (b) On colour Doppler ultrasound a swirl flow was seen in the liquid intraparenchymatous parts suggesting a intrasplenic pseudoaneurysm, classified for grade 3 splenic injury (from reference [5] with the permission of the publisher).

View larger version (106K): [in a new window]   Figure 3. 38-year-old patient with metastatic malignant melanoma and pain in the left upper abdomen. (a) Ultrasound of the spleen showed a focal hypoechoic splenic lesions suggesting splenic metastases (M) with hyperechoic subcapsular haematoma (H) classified for a grade 2 splenic injury. (b) On ultrasound follow-up 6 weeks later a hypoechoic transformation of the haematoma was seen.

View larger version (26K): [in a new window]   Figure 4. Distribution of initial ultrasound findings in relation to sonographic grades.

View larger version (23K): [in a new window]   Figure 5. Therapeutic procedures in relation to ultrasound grades in 41 patients with spontaneous splenic rupture.

View larger version (168K): [in a new window]   Figure 6. 58-year-old patient with lower limb vein thrombosis. Coumarin therapy and pain in the left upper abdomen (from reference [5] with the permission of the publisher). (a) Ultrasound of the spleen showed a irregular delineated subcapsular haematoma (H) classified for grade 2 splenic injury. (b) On ultrasound follow-up 2 weeks later a hypoechoic transformation of the haematoma was seen. (c) On ultrasound follow up 6 weeks later a nearly complete healing was seen with a inhomogeneity of splenic texture. (d) CT at the time of primary diagnosis of spontaneous splenic rupture confirmed subcapsular haematoma of the spleen.

View larger version (106K): [in a new window]   Figure 7. 29-year-old patient with varicella sepsis and pain in the left upper abdomen. (a) Ultrasound of the spleen showed diffuse inhomogeneity of the splenic parenchyma (s). The spleen is covered by a hypoechoic mass suggesting subcapsular haematoma (H), classified for grade 2 splenic injury, (from reference [5] with the permission of the publisher). (b) On ultrasound follow-up 1 year later a small spleen was seen without flow signals by colour Doppler ultrasound (from Görg C, Schwerk WB (2000: Milz. In: Braun B, Günther R, Schwerk WB (Hrsg.). Ultraschalldiagnostik, Ecomed Verlagsgesellschaft, with the permission of the publisher). (c) Splenic scintigraphy using 270mbq 99Tcm-MDP. Physiological concentrations in the liver and an absent nuclide concentration in the spleen 20 min after injection, indicating functional asplenia.