From the Guidelines
The initial diagnostic imaging for a 35-year-old male with splenomegaly found on routine examination should be an abdominal ultrasound. This non-invasive imaging modality provides excellent visualization of the spleen's size, contour, and parenchymal texture while avoiding radiation exposure. The ultrasound can confirm the presence and degree of splenomegaly, potentially identify underlying causes such as portal hypertension, and detect any focal lesions within the splenic tissue. According to the American Association for the Study of Liver Diseases, ultrasound provides safe and inexpensive imaging evidence of morphological abnormalities associated with cirrhosis and portal hypertension 1.
Key benefits of using ultrasound as the initial diagnostic imaging include:
- Excellent visualization of the spleen and surrounding structures
- Non-invasive and painless procedure
- No radiation exposure
- Cost-effective and widely available
- Can detect signs of portal hypertension, such as portocollateral circulation, and splenomegaly 1
Blood tests should accompany the imaging, including a complete blood count, liver function tests, and tests for infectious causes like mononucleosis. If the ultrasound findings are inconclusive or concerning, further imaging with a contrast-enhanced CT scan or MRI may be warranted to better characterize any abnormalities. The choice of ultrasound as first-line imaging is based on its accessibility, cost-effectiveness, and ability to provide sufficient initial information without exposing the patient to radiation, making it an ideal starting point in the diagnostic workup of splenomegaly. Additionally, the combination of ultrasound findings with laboratory data, such as platelet count, can improve the non-invasive diagnosis of clinically significant portal hypertension 1.
From the Research
Initial Diagnostic Imaging for Splenomegaly
The initial diagnostic imaging for a 35-year-old male with splenomegaly (enlarged spleen) found on routine examination includes:
- Ultrasound (US) of the spleen, which is a useful means of noninvasively examining the spleen 2
- Contrast-enhanced ultrasound (CEUS) of the spleen, which can provide valuable additional information about splenic abnormalities and is easy to perform, inexpensive, and safe 3, 4
Advantages of Ultrasound and CEUS
The advantages of using ultrasound and CEUS as initial diagnostic imaging modalities include:
- Ability to identify accessory spleens, a common congenital variation 2
- Ability to detect focal splenic masses and characterize them as cystic or solid 2
- Ability to demonstrate typical features of splenic infarction and detect splenic injury 2, 4
- High sensitivity and specificity in detecting parenchymal changes and lesion extent 4
Alternative Imaging Modalities
Alternative imaging modalities that may be used in the evaluation of splenomegaly include:
- Computed tomography (CT) of the spleen, which can provide detailed information about the spleen and surrounding structures 5, 6
- Magnetic resonance (MR) imaging of the spleen, which can provide additional information about the spleen and surrounding structures, particularly with the use of organ-specific contrast agents 6