Skip to main content
SpringerLink
Log in

Doppler Sonography of the Spleen

  • Chapter
  • First Online:
Doppler Sonography in Infancy and Childhood

Abstract

Although the spleen is highly vascularised, the rate of focal lesions is far less frequent than in other abdominal organs, such as the liver or kidneys, possibly due to protective factors from the phagocytic and immunological competence of the spleen. Common pathological findings like splenic cysts, infarction or trauma can be diagnosed by ultrasonography with a high sensitivity and specificity. Other pathologies of the spleen such as focal splenic lesions are often unspecific and need further diagnostic evaluation.

In this chapter on Doppler sonography of the spleen in infants and children, the main indications, normal findings and the most common splenic pathologies in children are described. Special subsections deal with the ultrasound assessment of splenic involvement in infectious diseases, benign and malignant focal lesions, vascular pathologies (splenic aneurysms, infarction, peliosis), congenital alterations (wandering spleen, splenunculi, polysplenia) and trauma.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 279.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 379.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

CDS:

Colour-coded Doppler sonography

CEUS:

Contrast-enhanced US

DS:

Doppler sonography

IVC:

Inferior vena cava

PH:

Portal hypertension

PRF:

Pulse repetition frequency (synonym: pulse repetition rate, velocity range, scale)

PW-DS:

Pulsed-wave Doppler sonography

RI:

Resistive index (synonym: resistance index, Pourcelot index)

TAV:

Time average velocity (cm/s)

US:

Ultrasonography

Ved:

End-diastolic velocity

Vs:

Peak systolic velocity

References

  • Abbott RM, Levy AD, Aguilera NS, Gorospe L, Thompson WM (2004) Primary vascular neoplasms of the spleen: radiologic-pathologic correlation. Radiographics 24:1137–1163

    Article  PubMed  Google Scholar 

  • Abramowsky C, Alvarado C, Wyly JB, Ricketts R (2004) “Hamartoma” of the spleen (splenoma) in children. Pediatr Dev Pathol 7:231–236

    Article  PubMed  Google Scholar 

  • Ayaz UY, Dilli A, Ayaz S, Api A (2012) Wandering spleen in a child with symptoms of acute abdomen: ultrasonographic diagnosis. Case report. Med Ultrason 14:64–66

    PubMed  Google Scholar 

  • Bachmann C, Görg C (2004) The value of B-mode and colour Doppler sonography in the diagnosis of focal splenic lesions. Ultraschall Med 25:444–447

    Article  CAS  PubMed  Google Scholar 

  • Bachmann C, Görg C (2005) Color Doppler sonographic findings in focal spleen lesions. Eur J Radiol 56:386–390

    Article  PubMed  Google Scholar 

  • Barakat M, Hassan A et al (1998) Intrasplenic venous flow patterns demonstrated by Doppler ultrasound in patients with portal hypertension. Br J Radiol 71:384–387

    Article  CAS  PubMed  Google Scholar 

  • Benjamin DR, Shunk B (1978) A fatal case of peliosis of the liver and spleen. Am J Dis Child 132:207–208

    CAS  PubMed  Google Scholar 

  • Benter T, Klühs L, Teichgräber U (2011) Sonography off the spleen. J Ultrasound Med 30:1281–1293

    PubMed  Google Scholar 

  • Bolognesi M, Quaglio C, Bombonato G, Gaiani S, Pesce P, Bizotto P, Favaretto E, Gatta A, Sacerdoti D (2012) Splenic Doppler impedance indices estimate splenic congestion in patients with right-sided or congestive heart failure. Ultrasound Med Biol 38:21–27

    Article  PubMed  Google Scholar 

  • Brink JS, Brown AK et al (2003) Portal vein thrombosis after laparoscopy-assisted splenectomy and cholecystectomy. J Pediatr Surg 38:644–647

    Article  PubMed  Google Scholar 

  • Chen MJ, Huang MJ, Chang WH, Wang TE, Wang HY, Chu CH, Lin SC, Shih SC (2005) Ultrasonography of splenic abnormalities. World J Gastroenterol 11(26):4061–4066.

    Google Scholar 

  • Chen JW, Yeh DM, Peng SH, Chen GS, Tseng YH, Lin CW, Tyan YS, Tsao TF (2012) Sonographic diagnosis of a subclinical wandering spleen: role of the decubitus position. J Ultrasound Med 31(3):483–487

    PubMed  Google Scholar 

  • Chiavaroli R, Grima P, Tundo P (2011) Characterization of nontraumatic focal splenic lesions using contrast-enhanced sonography. J Clin Ultrasound 39:310–315

    Article  PubMed  Google Scholar 

  • Czauderna P, Vajda P, Schaarschmidt K, Kalman A, Jainsch M, Englis A, Lewicki K, Verebely T, Koltai J, Petersons A, Pinter AB (2006) Nonparasitic splenic cysts in children: a multicentric study. Eur J Pediatr Surg 16:415–419

    Article  CAS  PubMed  Google Scholar 

  • Danaci M, Belet U et al (2000) Power Doppler sonographic diagnosis of torsion in a wandering spleen. J Clin Ultrasound 28:246–248

    Article  CAS  PubMed  Google Scholar 

  • Di Crosta I, Inserra A, Gil CP, Pisani M, Ponticelli A (2009) Abdominal pain and wandering spleen in young children: the importance of an early diagnosis. J Surg 44:1446–1449

    Google Scholar 

  • Dilli A, Tatar IG, Ayaz UY, Hekimoglu B (2011) Isolated splenic hydatid disease. Case Rep Med. doi:10.1155/2011/763895

    Google Scholar 

  • Dormagen J, Meyerdierks O, Gaarder C, Naess P, Sandvik L, Klow NE (2011) Contrast-enhanced ultrasound of the injured spleen after embolization—comparison with computed tomography. Ultraschall Med 32:485–491

    Article  CAS  PubMed  Google Scholar 

  • Elsayes KM, Narra VR, Mukundan G, Lewis JS Jr, Menias CO, Heiken JP (2005) MR imaging of the spleen: spectrum of abnormalities. Radiographics 2:967–982

    Article  Google Scholar 

  • Fitoz S, Atasoy C et al (2001) Post-traumatic intrasplenic pseudoaneurysms with delayed rupture: color Doppler sonographic and CT findings. J Clin Ultrasound 29:102–104

    Article  CAS  PubMed  Google Scholar 

  • Fotiadis C, Lavranos G, Patapis P, Karatzas G (2008) Abscesses of the spleen: report of three cases. World J Gastroenterol 14:3088–3091

    Article  PubMed Central  PubMed  Google Scholar 

  • Goletti O, Ghiselli G et al (1996) Intrasplenic posttraumatic pseudoaneurysm: echo color Doppler diagnosis. J Trauma 41:542–554

    Article  CAS  PubMed  Google Scholar 

  • Görg C (2011) The spleen. In: Schmidt G, Greiner L, Nürnberg D (eds) Sonografische Differential diagnose,2nd Auflage. Thieme Verlag, Stuttgart

    Google Scholar 

  • Görg C, Schwerk WB (1994) Color Doppler imaging of focal splenic masses. Eur J Radiol 18:214–219

    Article  Google Scholar 

  • Görg C, Zugmaier G (2003) Chronic recurring infarction of the spleen: sonographic patterns and complications. Ultraschall Med 24:245–249

    Article  PubMed  Google Scholar 

  • Görg C, Eichkorn M, Zugmaier G (2003) The small spleen: sonographic patterns of the functional hyposplenia or asplenia. J Clin Ultrasound 31:152–155

    Article  PubMed  Google Scholar 

  • Görg C, Seifart U et al (2004) Acute, complete splenic infarction in cancer patient is associated with a fatal outcome. Abdom Imaging 29:224–227

    Article  PubMed  Google Scholar 

  • Görg C, Görg K, Bert T, Barth P (2006) Colour Doppler ultrasound patterns and clinical follow-up of incidentally found hypoechoic, vascular tumors of the spleen: evidence for a benign tumor. Br J Radiol 79:319–325

    Article  PubMed  Google Scholar 

  • Günter E (2005) Sonoquiz. Endo Heute 18:77–79

    Article  Google Scholar 

  • Hartmann M, Marx A, Geißinger E, Müller-Hermelink HK, Rüdiger T (2008) Vaskuläre Tumoren der Milz. Pathologe 29:129–135

    Article  CAS  PubMed  Google Scholar 

  • Hofmann V (2005) Chapter 9: Milz. In: Hofmann V, Deeg KH, Hoyer PF (eds) Ultraschalldiagnostik in Pädiatrie und Kinderchirurgie, 3rd edn. Thieme, Stuttgart/New York, p 323–336

    Google Scholar 

  • Ksiadzyna D (2011) A case report of abdominal splenosis – a practical mini-review for a gastroenterologist. J Gastrointestin Liver Dis 20:321–324

    PubMed  Google Scholar 

  • Lopez-Tomassetti Fernandez EM, Arteaga Gonzalez I et al (2006) An unusual case of hemoperitoneum owing to acute splenic torsion in a child with immunoglobulin deficiency. J Postgrad Med 52:41–42

    CAS  PubMed  Google Scholar 

  • Lynn KN, Werder GM, Callaghan RM, Sullivan AN, Jafri ZH, Bloom DA (2009) Pediatric blunt splenic trauma: a comprehensive review. Pediatr Radiol 39:904–916

    Article  PubMed  Google Scholar 

  • Manetta R, Pistoia ML, Bultrini C, Stavroulis E, Di Cesare E, Masciocchi C (2009) Ultrasound enhanced with sulphur-hexafluoride-filled microbubbles agent (SonoVue) in the follow-up of mild liver and spleen trauma. Radiol Med 114:771–779

    Article  CAS  PubMed  Google Scholar 

  • Neesse A, Huth J, Kunsch S, MIchl P, Bert T, Tebbe JJ, Gress TM, Görg C (2010) Contrast-enhanced ultrasound pattern of splenic metastases – a retrospective study in 32 patients. Ultraschall Med 31:264–269

    Article  CAS  PubMed  Google Scholar 

  • Nemcek AA Jr, Miller F (1991) Acute torsion of a wandering spleen: diagnosis by CT and duplex Doppler and colour Doppler sonography. AJR AM J Roentgenol 157:307–309

    Article  PubMed  Google Scholar 

  • Neuhauser TS, Derringer GA, Thompson LDR, Fanburg-Smith JC, Mittinen M, Saarist A, Abbondanzo SL (2000) Splenic angiosarcoma: a clinicopathological and immunophenotypic study of 28 cases. Mod Pathol 13:978–987

    Article  CAS  PubMed  Google Scholar 

  • Özcan H, Yagmurlu B et al (2006) Asymptomatic splenic artery occlusion in a child: incidental detection with Doppler ultrasonography. Diagn Interv Radiol 12:68–69

    PubMed  Google Scholar 

  • Paterson A, Frush DP, Donelly LF, Foss JN, O’Hara SM, Bisset GS (1999) A pattern-oriented approach to splenic imaging in infants and children. Radiographics 19:1465–1485

    Article  CAS  PubMed  Google Scholar 

  • Peddhu P, Shah M, Sidhu PS (2004) Splenic abnormalities: a comparative review of ultrasound, microbubble-enhanced ultrasound and computed tomography. Clin Radiol 59:777–792

    Article  Google Scholar 

  • Raghavan A, Wong CK et al (2004) Spontaneous occlusion of post-traumatic splenic pseudoaneurysm: report of two cases in children. Pediatr Radiol 34:355–357

    Article  PubMed  Google Scholar 

  • Richards JR, Knopf NA, Wang L et al (2002) Blunt abdominal trauma in children: evaluation with emergency US. Radiology 222:749–754

    Article  PubMed  Google Scholar 

  • Romano F, Caprotti R et al (2006) Elective laparoscopic splenectomy and thrombosis of the spleno-portal axis: a prospective study with ecocolordoppler ultrasound. Surg Laparosc Endosc Percutan Tech 16:4–7

    Article  PubMed  Google Scholar 

  • Romero JR, Barksdale EM Jr (2003) Wandering spleen: a rare cause of abdominal pain. Pediatr Emerg Care 19:412–414

    Article  PubMed  Google Scholar 

  • Safavi A, Beaudry P, Jamieson D, Murphy JJ (2011) Traumatic pseudoaneurysms of the liver and spleen in children: is routine screening warranted? J Pediatr Surg 46:938–941

    Article  PubMed  Google Scholar 

  • Saxena AK, Sodhi KS, Narayanan S, Singhi S, Khandelwal N (2011) Splenic lesions in visceral leishmaniasis. Indian J Pediatr 78:753–754

    Article  PubMed  Google Scholar 

  • Shimono T, Yamaoka T, Nishimura K, Naya M, Hojo M, Yamamoto E, Mukaihara S, Hayakawa K (1998) Peliosis of the spleen: splenic rupture with intraperitoneal hemorrhage. Abdom Imaging 23:201–202

    Article  CAS  PubMed  Google Scholar 

  • Sivit CS, Siegel MJ (2002) Spleen and peritoneal cavity. In: Siegel M (ed) Pediatric sonography, 3rd edn. Lippincott, Williams & Wilkins, Philadelphia, pp 305–336

    Google Scholar 

  • Stamou KM, Toutouzas KG et al (2006) Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric and splenic veins. Arch Surg 141:663–669

    Article  PubMed  Google Scholar 

  • Stang A, Keles H, Hentschke S, von Seydewitz CU, Dahlke J, Habermann C, Wessling J (2011) Incidentally detected splenic lesions in ultrasound: does contrast-enhanced ultrasonography improve the differentiation of benign hemangioma/hamartoma from malignant lesions? Ultraschall Med 32:582–592

    Article  CAS  PubMed  Google Scholar 

  • Sutherland T, Temple F, Hennessy O, Lee W-K (2010) Abdomen’s forgotten organ: sonography and CT of focal splenic lesions. J Med Imaging Radiat Oncol 54:120–128

    Article  CAS  PubMed  Google Scholar 

  • Sutherland T, Temple F, Galvin A, Hennessy O (2011) Contrast-enhanced ultrasound of the spleen: an introduction and pictorial essay. Insights Imaging 2:515–524

    Article  PubMed Central  PubMed  Google Scholar 

  • Taibbi A, Bartolotta TV, Matranga D, Midiri M, Lagalla R (2012) Splenic hemangiomas: contrast-enhanced sonographic findings. J Ultrasound Med 31:543–553

    PubMed  Google Scholar 

  • Tataria M, Nance ML, Holmes JH et al (2007) Pediatric blunt abdominal injury: age is irrelevant and delayed operation is not detrimental. J Trauma 63:608–614

    Article  PubMed  Google Scholar 

  • Teramoto R, Opas LM, Andrassy R (1981) Splenic torsion with prune belly syndrome. J Pediatr 98:91–92

    Article  CAS  PubMed  Google Scholar 

  • Tolgonay G, Ozbek SS et al (1998) Regression of splenic vein aneurysm following resolution of splenomegaly. J Clin Ultrasound 26:98–102

    Article  CAS  PubMed  Google Scholar 

  • von Herbay A, Barreiros AP, Ignee A et al (2009) Contrast-enhanced ultrasonography with SonoVue. Differentiation between benign and malignant lesions of the spleen. J Ultrasound Med 28:421

    Google Scholar 

  • Vural M, Kacar S et al (1999) Symptomatic wandering accessory spleen in the pelvis: sonographic findings. J Clin Ultrasound 27:534–536

    Article  CAS  PubMed  Google Scholar 

  • Weinspach S, Tenenbaum T, Schönberger S, Schaper J, Engers R, Rueggeberg J, MacKenzie CR, Wolf A, Mayatepek E, Schroten H (2010) Cat scratch disease – heterogeneous in clinical presentation: five unusual cases of an infection caused by Bartonella henselae. Klin Padiatr 222:73–78

    Article  CAS  PubMed  Google Scholar 

  • Weskott HP (2012) Ultrasound in the diagnostic management of malignant lymphomas. Radiologe 52(4):347–359.

    Google Scholar 

  • Weskott HP (ed) (2013) Contrast enhanced ultrasound. Uni-Med, Bremen

    Google Scholar 

  • Yardeni D, Polley TZ Jr et al (2004) Splenic artery embolization for post-traumatic splenic artery pseudoaneurysm in children. J Trauma 57:404–407

    Article  PubMed  Google Scholar 

  • Zhan F, Wang CJ, Lin JZ, Zhong PJ, Qiu WZ, Lin HH, Liu YH, Zhao ZJ (2010) Isolated splenic tuberculosis: a case report. World J Gastrointest Pathophysiol 1:109–111

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatric Kidney, Liver and Metabolic Diseases, Children’s Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Doris Franke

  2. Clinic for Children and Adolescents, Sozialstiftung Bamberg, Buger Straße 80, 96049, Bamberg, Germany

    Karl-Heinz Deeg

Authors
  1. Doris Franke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karl-Heinz Deeg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Doris Franke .

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Franke, D., Deeg, KH. (2015). Doppler Sonography of the Spleen. In: Doppler Sonography in Infancy and Childhood. Springer, Cham. https://doi.org/10.1007/978-3-319-03506-2_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-03506-2_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-03505-5

  • Online ISBN: 978-3-319-03506-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation