Area of applicationSpleen/left upper quadrant.
ContrastDone without contrast.
Spleen US is used to evaluate the structure, size, and position of the spleen. This test is valuable for determining the internal components of splenic masses (solid versus cystic) and evaluating other splenic pathology, splenic trauma, and left upper quadrant perisplenic tissues. It can be performed to supplement a radionuclide scan or computed tomography (CT). It is especially valuable in patients who are in renal failure, are hypersensitive to contrast medium, or are pregnant, because it does not rely on adequate renal function or the injection of contrast medium to obtain a diagnosis.
This procedure is contraindicated for
- Detect the presence of a subphrenic abscess after splenectomy
- Detect splenic masses; differentiate between cysts or solid tumors (in combination with CT), as evidenced by specific waveform patterns or absence of sound waves respectively; and determine whether they are intrasplenic or extrasplenic
- Determine late-stage sickle cell disease, as evidenced by decreased spleen size and presence of echoes
- Determine the presence of splenomegaly and assess the size and volume of the spleen in these cases, as evidenced by increased echoes and visibility of the spleen
- Differentiate spleen trauma from blood or fluid accumulation between the splenic capsule and parenchyma
- Evaluate the effect of medical or surgical therapy on the progression or resolution of splenic disease
- Evaluate the extent of abdominal trauma and spleen involvement, including enlargement or rupture, after a recent trauma
- Evaluate the spleen before splenectomy performed for thrombocytopenic purpura
- Normal size, position, and contour of the spleen and associated structures
Abnormal findings related to
- Accessory or ectopic spleen
- Lymphatic disease; lymph node enlargement
- Splenic calcifications
- Splenic masses, tumors, cysts, or infarction
- Splenic trauma
Factors that may impair clear imaging
- Attenuation of the sound waves by ribs and an aerated left lung, which can impair clear imaging of the spleen
- Incorrect placement of the transducer over the desired test site; quality of the US study is very dependent upon the skill of the ultrasonographer
- Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images
- Inability of the patient to cooperate or remain still during the procedure because of age, significant pain, or mental status
- Masses near the testing site, which can displace the spleen and cause inaccurate results if confused with splenomegaly
- Dehydration, which can cause failure to demonstrate the boundaries between organs and tissue structures
- Gas or feces in the gastrointestinal tract resulting from inadequate cleansing or failure to restrict food intake before the study
- Retained barium from a previous radiological procedure
- Failure to follow dietary restrictions and other pretesting preparations may cause the procedure to be canceled or repeated.
Nursing Implications and Procedure
- Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
- Patient Teaching: Inform the patient this procedure can assist in assessing the function of the spleen.
- Obtain a history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or sensitivities to latex.
- Obtain a history of the patient’s hematopoietic system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
- Note any recent procedures that can interfere with test results (i.e., barium procedures, surgery, or biopsy). There should be 24 hr between administration of barium and this test.
- Endoscopic retrograde cholangiopancreatography, colonoscopy, and CT of the abdomen, if ordered, should be scheduled after this procedure.
- Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
- Review the procedure with the patient. Address concerns about pain related to the procedure and explain that some pain may be experienced during the test, and there may be moments of discomfort. Inform the patient that the procedure is performed in a US department by a health-care provider (HCP) who specializes in this procedure, with support staff, and takes approximately 30 to 60 min.
- Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
- Instruct the patient to remove jewelry and other metallic objects in the area to be examined.
- Instruct the patient to fast and restrict fluids for 8 hr prior to the procedure. Protocols may vary among facilities.
- Potential complications: N/A
- Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
- Ensure that food and fluids have been restricted for at least 8 hr prior to the procedure.
- Ensure that the patient has removed all external metallic objects in the area prior to the procedure.
- Instruct the patient to void and change into the gown, robe, and foot coverings provided.
- Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
- Instruct the patient to cooperate fully and to follow directions. Ask the patient to remain still throughout the procedure because movement produces unreliable results.
- Place the patient in the supine position on an examination table. The right- or left-side-up position may be used to allow gravity to reposition the liver, gas, and fluid to facilitate better organ visualization.
- Expose the abdominal area and drape the patient.
- Conductive gel is applied to the skin, and a transducer is moved over the skin to obtain images of the area of interest.
- Ask the patient to breathe normally during the examination. If necessary for better organ visualization, ask the patient to inhale deeply and hold his or her breath.
- Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
- When the study is completed, remove the gel from the skin.
- Instruct the patient to resume usual diet and fluids, as directed by the HCP.
- Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate.
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
- Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
- Related tests include angiography abdomen, biopsy bone marrow, CBC platelet count, CBC WBC and differential, CT abdomen, KUB study, liver and spleen scan, MRI abdomen, sickle cell screen, US abdomen, and WBC scan.
- Refer to the Hematopoietic System table at the end of the book for related tests by body system.