ROLE OF ULTRASOUND IN DIAGNOSIS OF SPLENIC EMERGENCIESD

Summary and conclusionThe spleen is an intra peritoneal organ in left upper abdomen representing the largest lymphoid structure in the body and is considered as an important part of both the immunological and reticulo-endothelial system because of its location in the left upper abdomen, even enlarged spleen may be difficult to be palpated in some cases (Reem et al., 2000).Of all medical and surgical emergencies in the abdomen those involving the spleen are relatively less common than other abdominal organ. Though equally important to recognize a healthy respect for the preservation of splenic tissue has emerged, altering traditional surgical management of splenic emergenciesA more sophisticated clinical understanding of the important role of the spleen in immuno-competence has developed in parallel with advancement in imaging techniques.US has come to play a vital role in depicting acute abnormalities and determining the need for conservative interventional or surgical management.In keeping with the theme of this issue, the role of US for depicting potential splenic emergencies is outlinedUS proved its efficacy and accuracy in the diagnosis of various cases of splenic emergencies. In view of the reliability- simplicity, low cost and beside availability of ultra sound, it should be used in the intial assessment and diagnosis of those splenic disorder that might be classified as potential emergencies.US is also considered as the most reliable method for the intial diagnosis of splenic emergencies in pediatric population as US not affected by the lack of body fat and doesn’t require the patient to be sedated, stable or ambulant it can also give additional information about intrabdominal organ injuries without special preparation.Our study include (40) patients, 25 male and 15 female their ages range from 5 years to 60 years. All cases were subjected to US.In this study splenic emergencies were divided into 3 groups according final diagnosis as follow1- Group A: Traumatic splenic lesions2- Group B: Focal splenic lesion including lymphoma - abscess . infarction and rupture cyst3- Group C: Splenic torsion ( torsion pelvic spleen – torsion accessory spleen).US is easily available , low cost and doesn’t interfere with resuscitation of traumatized patientBy US, a focal splenic lesion can be easily diagnosed, splenic cyst, splenic abscess, infarction and small lymphomatous deposits are all seen by accuracy, internal echoes and even the multilocularity with intervening septae could be easily detectedUS is used to diagnose splenic abscess as US is non invasive and well tolerated by the patientUS is sensitive in the diagnosis of splenic infarction as the wedge shaped morphology of the lesion will be easily appreciated with the multi planar imaging capability of US.In splenic cysts. US has a valuable role in detection of multiocularity, septations and rupture cyst.Concerning splenic torsion as (torsion pelvic spleen and torsion accessory spleen)US was valuable in demonstrating the presence of splenic tissue characterization (echogenicities) either in normal site or ectopic as in cases of (wandering pelvic spleen - accessory spleen).To conclude US is an accurate non invasive tool for examination of cases of splenic emergencies and even a substitute or equivalent to other complicated imaging procedures which may not be available in many centers.From this study US is rapid non invasive non ionizing and easily repeatable without any complication or contraindication and because of its portability it can be performed at the bedside. US reduce the need for the more expensive diagnostic modalities.