SAINT LOUIS UNIVERSITY

School of Nursing, Allied Health, and Biological Sciences

Department of Radiologic Technology

ULTRASOUND OF THE
SPLEEN
GROUP 2
Birung, Harold
Botis, Rochelle
Canlas, Kristina
Hafalla, Kurt
Lugo, Paula Jessica R.
Sagsago, Natasha Dorothy Jace D.
Tudias, Jelicah B.

7:30-8:30 MTW 0970

BLOCK D

Submitted to:

Ms. Aira Jane P. Obice, RRT, SO II

Date Submitted: October 19, 2022

LOCATION
The spleen is found in the left hypochondriac region of the abdomen (left upper
quadrant). More precisely, the spleen is located posterior to the stomach and anterior to
the left hemidiaphragm at the level of ribs 9-10. Medial to the spleen is the pancreatic tail;
posteromedial is the left kidney and adrenal gland while anteromedial is the stomach;
superior is the diaphragm, while inferiorly it rests directly on the left colic flexure (splenic
flexure).

ANATOMY
The spleen is a purple, fist-sized organ. It is wrapped by a fibroelastic capsule which
allows the spleen to significantly increase its size when necessary. It is an intraperitoneal
organ covered with peritoneum over its entire extent, except the hilum of the spleen,
where the vascular structures and lymph nodes are encased. The hilum transmits the
splenic vessels and nerves and provides attachment to the gastrosplenic and
splenorenal (lienorenal) ligaments. The hilum can be found on the inferomedial part of
the gastric impression. The gastrosplenic ligament attaches the spleen to the greater
curvature of the stomach and contains short gastric and left gastroepiploic arteries. The
Splenorenal ligament attaches the spleen to the left kidney and contains the splenic
artery and vein and pancreatic tail.
The arterial supply of the spleen comes from the splenic branch (splenic artery) of
the celiac trunk which supplies the spleen and part of the stomach. The venous drainage
of the spleen is from the splenic vein which also drains part of the pancreas and joins into
the inferior mesenteric artery before joining with the superior mesenteric artery which
then forms the portal vein. The lymphatic drainage is from the splenic hilar lymph nodes
to retropancreatic lymph nodes, then draining to celiac lymph nodes.
The spleen's 2 ends are the anterior and posterior end. The anterior end of the
spleen is expanded and is more like a border; it is directed forward and downward to
reach the midaxillary line. The posterior end is rounded and is directed upward and
backward; it rests on the upper pole of the left kidney.
The spleen's 3 borders are the superior, inferior, and intermediate. The superior
border of the spleen is notched by the anterior end. The inferior border is rounded. The
intermediate border directs toward the right.
The 2 surfaces of the spleen are diaphragmatic and visceral. The diaphragmatic
surface is smooth and convex, and the visceral surface is irregular and concave and has
impressions. The gastric impression is for the fundus of the stomach, which is the largest
and most concave impression on the spleen. The renal impression is for the left kidney
and lies between the inferior and intermediate borders. The colic impression is for the
splenic flexure of the colon; its lower part is related to the phrenicocolic ligament. The
pancreatic impression for the tail of the pancreas lies between the hilum and colic
impression.

PHYSIOLOGY
The spleen’s main roles are:
• filtering old or unwanted cells from the blood
• storing red blood cells and platelets
• metabolizing and recycling iron
• preventing infection
 The spleen filters the blood, removing old or unwanted cells and platelets. As
blood flows into the spleen, it detects any red blood cells that are old or damaged. Blood
flows through a maze of passages in the spleen. Healthy cells flow straight through, but
those considered unhealthy are broken down by large white blood cells called
macrophages.
After breaking down the red blood cells, the spleen stores useful leftover products,
such as iron. Eventually, it returns them to the bone marrow to make hemoglobin, the
iron-containing part of blood. The spleen also stores blood cells that the body can use in
an emergency, such as severe blood loss. The spleen holds around 25–30% of the body’s
red blood cells and about 25% of its platelets.
The spleen’s immune function involves detecting pathogens, such as bacteria,
and producing white blood cells and antibodies in response to threats.
The spleen contains two functionally and morphologically distinct compartments:
the red pulp and the white pulp. The red pulp functions as a blood filter that removes
foreign material and damaged erythrocytes, and the white pulp initiates immune
responses to blood-borne antigens

NORMAL VARIANTS:
Size and weight vary from person to person but on average are around 2.5 cm
thick, 7.5 cm broad, 12.5 cm in length, and 150-200 g in weight. The size of the spleen in
children is dependent on actual age:
3 months < 6 cm 8 years 10 cm
6 months 6.5 cm 10 years 11 cm
12 months 7 cm 12 years 11.5 cm
2 years 8 cm 15 years & above 12 cm
(girls)
4 years 9 cm 15 years & above 13 cm
6 years 9.5 cm (boys)

SONOGRAPHIC APPEARANCES:
The normal adult spleen appears homogeneous, with medium level echoes and
even texture that is described as isosonic or slightly hypoechoic when compared to the
normal liver, and hyperechoic relative to kidney parenchyma. In some cases, small
vascular branches can be seen interspersed within the spleen. They appear as anechoic,
round or tubular structures. Arterial walls usually appear brighter than venous walls;
however, the larger venous structures can clearly be distinguished from the smaller
arterial branches at the level of the splenic hilum. Occasionally, small, bright reflections
may be visualized throughout the spleen that represent calcified granulomatous
inclusions or calcifications of small arterial walls.
 The orientation of the spleen is vertically obliqued in the body, therefore
longitudinal and long axis views are seen in oblique sagittal scanning planes and oblique
coronal scanning planes as demonstrated in the image. This normal spleen appears
crescent in shape and hyperechoic compared to the adjacent left kidney. Notice the
spleen’s smooth outer convexity and its relationship to the diaphragm and pleural space
superiorly.

Axial sections of the spleen are visualized in transverse scanning planes. The
following is a transverse scanning plane image from a left lateral approach. It
demonstrates an axial section of the spleen that includes the splenic hilum. Note the
normal homogeneous appearance and even texture of the spleen.

REFERENCES:
Tempkin, B. B. (2014). Sonography Scanning: Principles and Protocols (4th ed.)
Retrieved from https://evolve.elsevier.com/cs/

Bindal, D., & Hacking, C. (2010, May 18). Spleen. doi:https://doi.org/10.53347/rID-

9737

Pai, A. (2014, January 13). Spleen Anatomy. Retrieved from Medscape:

https://emedicine.medscape.com/article/1948863-overview?reg=1#a2

Kapila V, Wehrle CJ, Tuma F. Physiology, Spleen. [Updated 2022 May 8]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 January
https://www.ncbi.nlm.nih.gov/books/NBK537307/

Drake, R. L., Vogl, A. W., & Mitchell, A. W. M. (2015). Gray’s Anatomy for Students
(3rd ed.). Philadelphia, PA: Churchill Livingstone.

Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). Clinically Oriented Anatomy (7th
ed.). Philadelphia, PA: Lippincott Williams & Wilkins
https://www.kenhub.com/en/library/anatomy/the-spleen