Scan plane for ultrasound of the spleen  Ultrasound of the normal spleen.
Intercostal scan plane Normal Spleen



  • Small spleen
  • Asplenia
  • Polysplenia
  • Splenunculus
  • Splenic artery calcification
 Normal transverse spleen  Ultrasound of a splenunculus.
The size of the spleen can be extremely variable ranging from 7cm- 14cm.

Accesory spleens or splenunculi are common.

(singular = splenunculus)

Ultrasound of the Spleen - Protocol

Role of Ultrasound

To assess the size, shape, texture and vascularity of the spleen.

Indications include:

  • Trauma
  • Liver disease
  • Malignancy

Ultrasound Appearances

The spleen has a homogeneous, "inverted comma" appearance.
When it becomes enlarged it loses this shape and, as it expands, it becomes very rounded and sometimes appears as an egg shape extending beyond the Left kidney.


Normal Spleen Size

<13 cm superior to inferior axis 

6-7cm in the medial  to lateral axis

5 to 6cm in the anterior to posterior plane. Average volume is approximately 350mls

Ref : SONOGRAPHY Introduction to Normal Structure and Function Second Edition  Reva Arnez Curry and Betty Bates Tempkin   Saunders

Ref: Ultrasound: The Requisites, CHAPTER 8, 209-219

The spleen is considered enlarged if it covers the entire left kidney.


Scanning Technique

Patient position

Start with the pt supine.
Angle the probe between the ribs intercostally from a posterolateral approach.

Overlying bowel gas, overlying lung base or rib shadows can cause problems. Slowly roll the patient, to improve visualistaion.

Try inspiration,expiration,distended abdomen,erect
Rarely the left lobe of the liver (if enlarged) may be used as a window to assess to superoanterior portion of the spleen.


Common Pathology

  • Splenomegaly >12-14 cm (or Volume >500cc)and becomes rounded.
  • Infection- multiple echogenic foci (granulomata)
  • Haemangioma
  • Cysts
  • Metastases
  • Lymphoma
  • Varices - portal hypertension
  • Haematomas-intraparenchymal, subcapsular and pericapsular
  • Abscess
  • Splenic infarction

Basic Hard Copy Imaging

At least one image of the spleen with a measurement from tip to tail.



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