Diagnostic Ultrasound - Abdomen and Pelvis

Approach to Splenic Sonography
Diagnoses: Spleen
(Left) Midline color Doppler US
shows a normal splenic vein
, deep to the pancreas ſt,
with flow directed toward the
liver. Note the left renal vein
st, draining into the IVC.
(Right) Color Doppler US in a
52-year-old man shows
reversal of flow in the splenic
vein (SV) st. Flow is directed
toward the spleen rather than
the liver.
(Left) US evaluation of the SV
at the hilum in the same
patient also shows reversal of
flow (directed toward the
spleen). In addition, the spleen
is enlarged. (Right) It is
important to assess for
potential causes of
splenomegaly and SV flow
reversal. Evaluation of the
liver shows nodular contour
and heterogeneous
parenchymal echogenicity.
Ascites is also present ſt. The
overall picture is that of
cirrhosis with portal
hypertension.
(Left) Portal hypertension may
also manifest by the presence
of varices in and around
the splenic hilum, as seen in
this patient with cirrhosis.
Note the flow reversal,
predominantly directed away
from the spleen. (Right)
Corresponding axial CT
through the left upper
quadrant shows the abundant
dilated varices along the
splenic hilum . In addition,
there are scattered calcified
granulomas in the spleen.
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