From the Guidelines
The most effective balance sign for spleen evaluation is not a physical examination technique, but rather the use of imaging studies such as E-FAST, CT scan with intravenous contrast, and contrast-enhanced US, as they provide a more accurate diagnosis of splenic injuries and complications 1.
Diagnostic Approach
When evaluating the spleen, the choice of diagnostic technique should be based on the hemodynamic status of the patient, with E-FAST being effective and rapid to detect free fluid, and CT scan with intravenous contrast being the gold standard in hemodynamically stable or stabilized trauma patients 1.
Imaging Studies
- E-FAST has a sensitivity up to 91% and a specificity up to 96% for detecting free fluid, but may have false-negative results in cases with no significant extravasation of blood or injuries near the diaphragm 1.
- Contrast-enhanced US (CEUS) increases the visualization of splenic injuries and complications, while Doppler US (DUS) is safe and effective in evaluating PSA or blush previously found at CT scan 1.
- CT scan has a sensitivity and specificity for splenic injuries near to 96–100%, but may underestimate splenic injuries at ilum and should only be performed in hemodynamically stable patients or those responding to fluid resuscitation 1.
Clinical Considerations
In clinical practice, the use of these imaging studies should be guided by the patient's hemodynamic status and the availability of rapid CT scan, with the goal of providing an accurate diagnosis and guiding management decisions to reduce morbidity, mortality, and improve quality of life 1.
From the Research
Spleen Disorders and Diagnostic Approaches
- The spleen is a commonly involved organ in various pathologic disorders, including congenital anomalies, infectious and inflammatory diseases, vascular disorders, benign and malignant tumors, and systemic disorders 2.
- Splenomegaly, or enlargement of the spleen, is a common finding on clinical examination and frequently features in postgraduate assessments 3.
- The diagnostic approach to spleen disorders can be challenging, and distinguishing pathologic conditions primarily involving the spleen from those in which splenomegaly presents as an epiphenomenon of hepatic or systemic diseases can be difficult 4.
Imaging Techniques for Spleen Disorders
- Abdominal ultrasound (US) can be a useful technique in the non-invasive assessment of spleen disorders, particularly in detecting multiple hypoechogenic splenic lesions 5.
- Computed tomography (CT) scans can also be used to diagnose and subtype malignant lymphoma, with radiomics features of the spleen serving as surrogates for CT-based lymphoma diagnosis and subtype differentiation 6.
- Imaging findings of the normal spleen, its variants, and relevant congenital and acquired abnormalities are essential for recognizing and correctly interpreting the variable spectrum of abnormalities that may involve the spleen 2.
Diagnostic Value of Radiomics Features
- Radiomics features of the spleen can be used to classify malignant lymphoma against non-lymphoma, as well as determine malignant lymphoma subtypes, including Hodgkin lymphoma, diffuse large B-cell lymphoma, mantle-cell lymphoma, and follicular lymphoma 6.
- The diagnostic value of radiomics features of the spleen has been demonstrated, with significant area under the curve (AUC) values achieved for various classification tasks, including malignant lymphoma vs. non-lymphoma and subtype differentiation 6.