Spleen Dimensions Research Articles

Non-invasive predictors of esophageous varices in children and adolescents with chronic liver disease or extrahepatic portal venous obstruction

To identify non-invasive predictors of esophageal varices in children and adolescents with chronic liver disease or extrahepatic portal venous obstruction (EHPVO). 53 patients younger than 20 years with chronic liver disease or EHPVO and no history of bleeding or prophylactic treatment of esophageal varices (EV) were assessed. They were divided into 2 groups: group I (35 with chronic liver disease) and group II (18 with EHPVO). Their blood count, international normalized ratio (INR), albumin, bilirubin, abdominal ultrasonography and upper endoscopy results were taken. A splenic index was determined by dividing the patients' spleen dimension by its uppermost limit according to their age. The variables were compared to EV presence or not. Univariate (chi-square test, Fischer's exact test and Wilcoxon exact test) and multivariate (logistic regression) analyses were performed. A receiver operating characteristic (ROC) curve was constructed and the area under the ROC curve was calculated. EV were observed in 48.5% of group I patients and in 83.3% of group II patients. Low platelet count (p = 0.0015), splenomegaly (p=0.0003) and splenic index (p = 0.0007) were statistically significant predictors of EV among group I patients. The multivariate analysis showed low platelet count (odds = 21.7) as an independent predictor of EV in patients with chronic liver disease. Platelet count, splenic index and platelet-splenic index ratio were predictors of EV in children and adolescents with chronic liver disease. There were no EV predictors among group II patients.

Spleen Size in Idiopathic and Heritable Pulmonary Arterial Hypertension

Background: It is unknown whether the spleen size correlates with disease severity and outcome in patients with idiopathic and heritable pulmonary arterial hypertension (PAH). Objectives: To determine the prevalence of splenomegaly in PAH and assess whether it correlates with severity of disease and outcome. Methods: We identified subjects with either heritable or idiopathic PAH who had Doppler echocardiography, right-heart catheterization and computed tomography (CT) of the chest and/or abdomen that included the spleen. Results: We included 62 subjects with a mean age (±SD) of 49 (±15) years; 82% were women. Spleen dimensions were 10 (±3), 6 (±2) and 9 (±2) cm for the craniocaudal length, thickness and width measurements, respectively. The median [interquartile range (IQR)] spleen volume was 344 (225-533) cm³. Splenomegaly was observed in 52-63% of the patients, depending on the formula used. The spleen volume was not associated with clinical, echocardiographic or hemodynamic variables. Spleen volume was not associated with adjusted mortality. We studied the characteristics of the spleen during autopsy in 9 patients with idiopathic PAH who died of right-heart failure. The mean (IQR) spleen weight was 220 (151-325) g. We observed early congestion in all but 2 patients who had chronic congestion. Conclusions: Splenomegaly of predominantly mild degree is common in idiopathic and heritable PAH. However, spleen size was not associated with clinical, echocardiographic, hemodynamic and survival data in these patients.

Determination of normal dimension of the spleen by ultrasound in an endemic tropical environment

Background:To determine the normal dimensions of spleen by ultrasonography in our environment exposed to endemic tropical infection and infestation.Materials and Methods:A prospective study of normal spleen ultrasound-based measurements in 200 Nigerian adults at the University of Benin Teaching Hospital Benin, Nigeria.Results:There were 91 males and 109 females; their age ranged between 20 and 60 years. For the males the mean age was 32.4 years (± 9.2 SD), mean height was 175.0 cm (±7.3 SD), mean weight was 72.5 kg (±10.1 SD), and mean body mass index was 23.6 (±2.8 SD) and the females the mean age was 29.7 years (±9.0 SD) mean height was 164.6 cm (±5.8 SD), mean weight 64.1 kg (±12.9 SD), and mean BMI was 24.9 (±1.4 SD). For the males the mean splenic length, width, depth, and volume were 11.1 cm (±0.9 SD), 4.4 cm (±0.5 SD), 7.8 cm (±0.6 SD), and 202.7 cm3 (±49.4 SD), respectively. For the females the corresponding values of splenic length, width, depth, and volume were 10.1 cm (±0.7 SD), 4.0 cm (±0.4 SD), 7.1 cm (±0.5 SD), and 153.7 cm3 (±33.2 SD), respectively.Conclusion:Comparison between mean splenic dimension parameters for males and females (from unpaired t-test determination) showed a statistically significant difference (P<0.001 for splenic length, width, depth, and volume). There was also statistically significant increasing value correlation between subjects’ weight and height (in favor of height) when compared to spleen length, width, depth, and volume. The other parameters show no significant correlation in both female and male. In particular there was also no statistically significant correlation of splenic measurements with age in either sex. This is similar to what was noted in other centers.

Partial splenectomy for hereditary spherocytosis: a multi-institutional review

Background/Purpose Partial splenectomy has emerged as a surgical option for selected children with hereditary spherocytosis, with the goal of reducing anemia while preserving splenic function. This multi-institutional study is the largest series to date examining outcomes data for partial splenectomy in patients with hereditary spherocytosis. Methods Data were collected retrospectively from 5 North American pediatric hospitals. Sixty-two children underwent partial splenectomy for hereditary spherocytosis between 1990 and 2008. Results At 1 year following partial splenectomy, mean hemoglobin significantly increased by 3.0 ± 1.4 g/dL (n = 52), reticulocyte count decreased by 6.6% ± 6.6% (n = 41), and bilirubin level decreased by 1.3 ± 0.9 mg/dL (n = 25). Patients with poor or transient hematologic response were found to have significantly more splenic regeneration postoperatively compared with patients with a durable clinical response (maximal spleen dimension, 9.0 ± 3.4 vs 6.3 ± 2.2 cm). Clinically significant recurrence of anemia or abdominal pain led to completion splenectomy in 4.84% of patients. No patients developed postsplenectomy sepsis. Conclusions Our multi-institutional review indicates that partial splenectomy for hereditary spherocytosis leads to sustained and clinically significant improvement in hematologic profiles and clinical symptoms in most patients. Our data support partial splenectomy as an alternative for selected children with hereditary spherocytosis.

Splenectomy with chemotherapyvssurgery alone as initial treatment for splenic marginal zone lymphoma

To evaluate the clinical characteristics of splenic marginal-zone lymphoma (SMZL) following antigen expression and the influence of therapeutic approaches on clinical outcome and overall survival (OS). A total of 30 patients with typical histological and immunohistochemical SMZL patterns were examined. Splenectomy plus chemotherapy was applied in 20 patients, while splenectomy as a single treatment-option was performed in 10 patients. Prognostic factor and overall survival rate were analyzed. Complete remission (CR) was achieved in 20 (66.7%), partial remission (PR) in seven (23.3%), and lethal outcome due to disease progression occurred in three (10.0%) patients. Median survival of patients with a splenectomy was 93.0 mo and for patients with splenectomy plus chemotherapy it was 107.5 mo (Log rank = 0.056, P > 0.05). Time from onset of first symptoms to the beginning of the treatment (mean 9.4 mo) was influenced by spleen dimensions, as measured by computerized tomography and ultra-sound (t = 2.558, P = 0.018). Strong positivity (+++) of CD20 antigen expression in splenic tissue had a positive influence on OS (Log rank = 5.244, P < 0.05). The analysis of factors interfering with survival (by the Kaplan-Meier method) revealed that gender, general symptoms, clinical stage, and spleen infiltration type (nodular vs diffuse) had no significant (P > 0.05) effects on the OS. The expression of other antigens (immunohistochemistry) also had no effect on survival-rate, as measured by a c2 test (P > 0.05). Initial splenectomy combined with chemotherapy has been shown to be beneficial due to its advanced remission rate/duration; however, a larger controlled clinical study is required to confirm our findings.

Splenic constriction during isometric handgrip exercise in humans

During the first minute of a moderate-intensity isometric handgrip (HG) exercise, there is an increase in stroke volume and cardiac output that occurs without any change in systemic vascular conductance. Although the mechanism of increased venous return is not yet known, current focus has been placed on the constriction of visceral organs. The human spleen represents a compliant organ with high perfusion that constricts during the rather severe stresses of maximal exercise, a diving reflex, or prolonged apnea. This study tested the hypothesis that spleen constriction occurs during isometric HG exercise. Eight participants performed a 1 min isometric HG test at 40% maximum voluntary contraction. Splenic length and width were measured (with ultrasound imaging) after 1 min of exercise, and volume was calculated. To investigate the reflex specificity of this response, spleen dimensions were also measured during 4 min of lower-body negative pressure (LBNP; -20 mm Hg). To test the additional impact of altered breathing and intra-abdominal pressures during the HG, measures were also taken during Valsalva's manoeuvre (VM) at 30 mm Hg. Compared with baseline, both length and width of the spleen were reduced by 0.20 to 0.55 cm (or 4.44%-6.09%; p < 0.05) during each test. This resulted in relative reductions in splenic volume of 13 +/- 1% (HG), 9% +/- 7% (LBNP) and 18% +/- 7% (VM) (p < 0.05; all mean +/- SD). It was concluded that the spleen can constrict during the first minute of isometric HG exercise.

Sonographic determination of spleen size: normal dimensions in adults with a healthy spleen

Sonography can rapidly and reliably help to determine the size by the spleen. To standardise the sonographic dimensions of the healthy spleen, we effected sonographic examination of 793 female and male patients aged between 17 and 82 years with a healthy spleen. In 95% of the patients the length of the spleen was less than 11 cm, the breadth below 7 cm and the thickness less than 5 cm. The weight of the spleen as determined via the rotation ellipsoid formula was below 190 g in 95% of the patients. Whether or not a spleen larger than standard signals an acute disease can be clinically assessed only on the basis of a synopsis of all findings.

Magnetic Resonance Imaging Detected Renal Volume Reduction in Refluxing and Nonrefluxing Kidneys

Renal parenchymal damage is a well recognized sequela of urinary tract infection in the setting of vesicoureteral reflux. We investigated renal magnetic resonance imaging as a quantitative modality to detect renal parenchymal damage in children with primary vesicoureteral reflux and urinary tract infection. We retrospectively reviewed the medical records of children with primary vesicoureteral reflux and urinary tract infection who underwent renal magnetic resonance imaging evaluation. Those with other genitourinary pathology were excluded. Controls underwent magnetic resonance imaging for nongenitourinary pathologies. Kidneys were segregated among control, nonrefluxing, and low grade (I to III) and high grade (IV to V) reflux. Size plots (magnetic resonance imaging volume vs age) were drawn for comparison. Gross imaging abnormalities observed were renal scarring and small size. Magnetic resonance imaging was performed in 114 patients with vesicoureteral reflux (228 kidneys, patient age 0.5 to 17.8 years) and 21 controls (42, 0.5 to 12). Higher grades of reflux were associated with smaller volume, and smaller volume was noted in the refluxing and nonrefluxing kidneys of children with vesicoureteral reflux. Kidneys from patients with unilateral or bilateral reflux had significantly decreased renal volume compared to controls (p <0.0001). Kidneys in which vesicoureteral reflux spontaneously resolved had renal volumes similar to control kidneys (p = 0.23). Use of magnetic resonance imaging derived renal volume allows renal comparison and is helpful in evaluating patients with vesicoureteral reflux. In patients with a history of a febrile urinary tract infection and reflux the finding of measurably smaller kidneys appears to be more common than scarring. Whether these findings represent renal atrophy or hypoplasia needs further investigation.

Development of spleen during the fetal period

This study was aimed to determine the location and development of the spleen in the human fetuses. The study was carried on 141 dead human fetuses aged between 9 and 40 weeks with no marked pathology and anomaly in the years 2002-2003. The location of spleen with the neighboring structures, the existence of accessory spleens, notches on the borders, fissures on the surfaces, major ligaments and the shape of spleen and its hilum were established. The spleen was completely observed intraperitoneally (except at the hilum), in the left hypochondrium throughout the fetal period. The length, width, thickness, weight, volume, and the hilum dimensions of spleen were measured. The dimensions, weight, and volume of the spleen were increased with the gestational age, and positive significant correlations were determined (P < 0.001). There was no difference between sexes in all parameters (P > 0.05). The length of the spleen has ranged between 3.1 and 35.6 mm, between 9 weeks old and 40-week-old fetuses, respectively. One or more accessory spleens have been found in 14% of cases. The measurements and location of the spleen according to the gestational age were determined by the present study. The expression of morphometric parameters of the spleen at different gestational ages can be used in determination of pathologies of the spleen and may also contribute to future studies on this issue.

Ultrasonographic Spleen Dimensions in Preterm Infants During the First 3 Months of Life

The purpose of this study was to ultrasonographically evaluate spleen dimensions in healthy prematurely born neonates and infants during the first 3 months of life. Ninety-six neonates and infants aged from 2 to 90 days, with gestational ages from 25 to 35 weeks, were prospectively examined between 2001 and 2003. None had either infectious or other serious diseases or congenital disorders. The relationships between the ultrasonographically measured spleen size parameters and postmenstrual age, sex, gestational age, and somatometric parameters (height, weight, and body surface area) were studied with linear regression models with backward selection. Spleen dimension growth curves and upper/lower limits defined by the upper/lower 95% confidence interval were presented in graphs by height, weight, and body surface area. In addition, spleen length was compared with recently published data on term peers. All spleen dimensions were positively correlated with postmenstrual age and somatometric parameters. Sex did not influence the variability of spleen dimensions. Spleen length had lower values and a smaller rate of growth in preterm than term neonates and infants. We have provided ultrasonographic spleen volumetric values in preterm neonates and infants during the first 3 months of life, giving reference standards applicable for clinical practice or research purposes.

Normal sonographic values of maternal spleen size throughout pregnancy

This study aims to establish normal range of sonographically measured maternal spleen size throughout pregnancy. Currently, 288 healthy pregnant women between 6 and 42 weeks’ gestation underwent ultrasonographic measurements of spleen length and width. The relationships between ultrasound measurements with prepregnancy body mass index (BMI) and gestational age were assessed using the Pearson correlation coefficient. A linear regression model was applied to construct the appropriate equation for measuring the spleen area relative to BMI and gestational age. A significant correlation (R) was found between gestational age and spleen dimensions length (R = 0.486; p < 0.001), width (R = 0.455; p < 0.001) and area (R = 0.522; p < 0.001)) as well as between prepregnancy BMI and spleen length [(R = 0.314; p < 0.001), width (R = 0.380; p < 0.001) and area (R = 0.413; p < 0.001)]. We divided the spleen area by the BMI, thus enabling to perform a linear regression analysis with gestational age (weeks) as an independent continuous variable. A high multiple correlation (R) between spleen area and this variable was found (R 2 = 0.47; p < 0.001). The equation [spleen area/BMI = 1.598 + 0.032 × gestational age in weeks] was performed for calculating the spleen area throughout pregnancy. A significant overall growth pattern of spleen area in pregnancy with increasing gestational age was found. Normograms from these data can be used to evaluate splenomegaly throughout pregnancy. (E-mail: intposgr@post.tau.ac.il)

Ultrasound assessment of spleen size in collegiate athletes

Objectives: To determine normal spleen dimensions in a healthy collegiate athletic population. Methods: 631 Division I collegiate athletes from one university participated in the study. During pre-participation examinations, demographic data...

Sonographic Assessment of the Normal Limits and Percentile Curves of Liver, Spleen, and Kidney Dimensions in Healthy School-Aged Children

The purpose of this study was to determine the normal standards of liver, spleen, and kidney dimensions and the relationship of each with sex, age, body weight, height, body mass index, and body surface area in healthy school-aged children. Seven hundred twelve healthy school-aged children (7-15 years) in 2 neighboring cities, including rural areas and city centers, were evaluated prospectively. Sex, age, weight, height, body mass index, and body surface area were determined for each case. Organ dimensions were measured 3 times, and the mean values were recorded. All measured organs had a normal position, shape, and echo texture. The children were separated into 5 groups according to body weight. There were no significant differences in organ dimensions with respect to sex (P > .05). The mean right kidney length was shorter than the left kidney length, and the difference was significant (P = .009). Body weight showed the best correlation with liver, spleen, and kidney dimensions. The results were also supported by the variance and covariance of the correlation coefficients. The normal limits of the liver, spleen, and kidneys are important parameters during a sonographic examination. This study revealed that organ dimensions showed the best correlation with body weight. To our knowledge, in clinical practice there are no pediatric organ dimension percentile graphs for interpretation of sonographic examinations. We hope this study contributes to daily practice in radiology clinics.

Sonographic measurements of the liver, spleen and kidney dimensions in the healthy term and preterm newborns

This study was conducted in order to assess normal liver, spleen and kidney dimensions in premature and term newborns and determine the acceptable range. A total of 253 (99 preterm and 154 term) healthy newborns were evaluated within the first week of life by sonography. Gestational age ranged from 24 to 41 weeks, weight ranged from 638 to 4800 g. Measurements were compared with gestational age, weight and height of the infants. Normal ranges for kidney, liver and spleen measurements according to gestational age and weight were obtained. We found that weight showed the best correlation with any one of the mentioned organ dimensions.

Prognostic factors for survival in patients with compensated cirrhosis and small hepatocellular carcinoma after percutaneous ethanol injection therapy

The objective of this study was to identify clinical, biochemical, ultrasound, and/or pathologic parameters capable of predicting survival in a cohort of patients with well compensated cirrhosis and small hepatocellular carcinoma (HCC) who were treated with percutaneous ethanol injection (PEI). The study group included 111 patients with Child--Pugh Class A cirrhosis and with one (93 patients) or two (18 patients) HCC nodules measuring < 5 cm in greatest dimension. All patients underwent multisession PEI. The prognostic values of pretreatment and post-treatment variables were analyzed using the Kaplan-Meier method. The overall 3-year and 5-year survival rates of 62% and 41%, respectively, were not influenced by age, gender, duration of chronic hepatitis, serum albumin, prothrombin time ratio, total bilirubin, gamma-glutamyl transferase, hepatitis B surface antigen, antihepatitis C virus, HCC size, HCC ultrasound pattern, HCC histologic or cytologic grading, greatest spleen dimension, esophageal varices, or ascites. Levels of alpha-fetoprotein (AFP) > 14 ng/mL (P < 0.006), alanine aminotransferase > 75 IU/L (P < 0.04), and aspartate aminotransferase > 80 IU/L (P < 0.009) and platelet count < 92 x 10(9)/L (P < 0.02) before treatment were independent predictors of decreased survival. Among post-treatment parameters, AFP levels 6 months after PEI > 13.3 ng/mL (P < 0.003) and HCC recurrence in another segment of the liver (P < 0.04) were linked to decreased survival in univariate analysis. Among patients with Child--Pugh Class A cirrhosis with small uninodular or binodular HCC who are treated with multisession PEI, those with elevated serum AFP and transaminase levels and low platelet count before treatment are characterized by decreased survival. During follow-up, intrahepatic recurrence of the tumor is the main factor affecting survival.

Influence of different epinephrin applications on the dimensions of the spleen in the horse

Influence of different epinephrin applications on the dimensions of the spleen in the horse

Normal liver, spleen, and kidney dimensions in neonates, infants, and children: evaluation with sonography.

The objective of this study was to determine the normal range of dimensions for the liver, spleen, and kidney in healthy neonates, infants, and children. This prospective study involved 307 pediatric subjects (169 girls and 138 boys) with normal physical or sonographic findings who were examined because of problems unrelated to the measured organs. The subjects were 5 days to 16 years old. All measured organs were sonographically normal. At least two dimensions were obtained for each liver, spleen, and kidney. Relationships of the dimensions of these organs with sex, age, body weight, height, and body surface area were investigated. Suggested limits of normal dimensions were defined. Dimensions of the measured organs were not statistically different in boys and girls. Longitudinal dimensions of all three organs showed the best correlation with age, body weight, height, and body surface area. Height showed the strongest correlation of all. This correlation was a polynomial correlation. Determination of pathologic changes in size of the liver, spleen, and kidney necessitates knowing the normal range of dimensions for these organs in healthy neonates, infants, and children. Presented data are applicable in daily routine sonography. Body height should be considered the best criteria to correlate with longitudinal dimensions of these organs.

Portal vein pulsatility ratio and heart failure.

Heart diseases can alter liver volume, morphology, and circulation. The Doppler pulsatility of the portal vein and its pulsatility ratio (PR) have been reported as being closely associated with the right atrial pressure and with the New York Heart Association (NYHA) class. We examined the relationships between measurements of liver and spleen dimensions and blood flow in portal and hepatic veins, assessed noninvasively by Doppler sonography, and compared them with echocardiographic data. The study group comprised 87 inpatients with heart failure. The mean age was 64+/-12 years. Patients underwent duplex Doppler sonography of the heart and portal and hepatic veins. Patients with more severe left ventricular failure (NYHA class III-IV) showed more dilatation of the left ventricle and atrium, reduced systolic function, and reduced portal vein mean velocity compared with patients with milder heart failure (NYHA class I-II); in addition, the hepatic vein diameter was increased and portal vein PR was reduced. Considering all patients, significant positive correlations were found between portal vein PR and left ventricular shortening fraction (r= 0.34, p < 0.01) and ejection fraction (r= 0.38, p < 0.001). Significant negative correlations were found between PR and hepatic vein diameter (r= -0.44, p < 0.001), right ventricle diameter (r = -0.38, p < 0.001), left ventricular end-diastolic volume (r = -0.31, p < 0.01), and left atrium diameter (r = -0.33, p < 0.01). Patients with hepatic vein dilatation had increased left ventricular volumes, reduced systolic function indices, and portal vein alterations (increased diameter, reduced mean velocity, and reduced PR). In patients with an ejection fraction of no more than 50%, only PR was significantly reduced, while other sonographic liver measurements were not significantly different. The effects of cardiac failure on portal blood flow, which declines progressively with worsening cardiac function, is shown better by the pulsatility pattern of the portal vein than by morphologic caval and hepatic vein measurements. PR can be used as a reliable adjunctive sign of heart failure.

Ultrasonographic organometry: liver and spleen dimensions among children in Zimbabwe

Attempts have been made to develop a staging system of sonographic Schistosoma mansoni morbidity for use in epidemiological studies and for evaluation of control programmes. Therefore, normal dimensions of livers and spleens in children in countries with endemic S. mansoni infections need to be established. Normal dimensions of livers and spleens are presented, based on examination of 144 Zimbabwean children between 8 and 16 years of age found to be S. mansoni egg negative 12 months after treatment with praziquantel. Based on the liver and spleen measurements, an index of liver size and the spleen volume were calculated. Height was employed as the independent variable in all multiple regression models. The organometric data are presented as prediction plots, with observed values and fitted regression line with 95% confidence and prediction intervals. The mean spleen volume was 30% larger for boys than for girls, whereas there was no consistent difference in liver size. No effect of growth Z-scores was seen. The measurements were compared with normal dimensions of livers of German children. For a given height, the mean index of liver size was lower in Zimbabwean than in German children, but inter-observer variation could be a possible explanation for this difference.

Percussion and physical diagnosis: Separating myth from science

There are three percussion sounds, which are easily distinguishable by objective measures: tympany (heard with percussion over the intestines), resonance (heard over the normal lung), and dullness (heard over the liver or thigh). The percussion sound that is produced reflects the ease with which the body wall vibrates, which in turn is influenced by many variables, including the strength of the stroke, the condition and state of the body wall, and the underlying organs. Underlying organs or disease may cause dullness to occur at distant sites. There is good interobserver agreement among clinicians with regard to calling a particular percussion sound dull, resonant, or hyperresonant. In contrast, there is very poor interobserver agreement among clinicians using percussion to measure the span of a particular organ. The use of comparative percussion can detect most large pleural effusions, but this method is able to detect only a few pneumonias. Shifting dullness is a reliable and fairly accurate sign for the detection of ascites. Both of these techniques can still be recommended after a review of the literature. Topographic percussion (e.g., using percussion to locate the heart, liver, and spleen borders or dimensions) has poor reproducibility, is significantly inaccurate in many patients, and has little clinical utility; it should be abandoned. Its fundamental principle—that sound waves penetrate only several centimeters of tissue, resulting in a note reflecting abnormalities only in this layer of tissue—is incorrect. Auscultatory percussion offers no advantage over conventional percussion, with the possible exception of auscultatory percussion of the shoulder. Auscultatory percussion should be abandoned as a bedside diagnostic technique.