BABKINA E. P., DOLOTIN S.A.

SZ "Lugansk State Medical University"(Lugansk)

ABOUT CHANGE OF ULTRASOUND IN SPLEEN AS A RESULT OF INJURY DEPENDING ON THE LENGTH OF ITS CAUSING

Introduction. In medical practice spleen injuries are common among parenchymal lesions of the abdominal cavity and outside the abdominal area. Data in the literature regarding the number of injuries and spleen differ, on average, the authors note that damage to the spleen observed from 15% to 33% of cases.

The aim of this work was to study the dynamics of changes in the ultrasonic parameters spleen United trauma depending on the period of injury.
Material and methods. Ultrasound diagnosis to detect pathological changes in organs and tissues performed using ultrasound frequency from 0.5 to 1.5 million vehicles fluctuations on Sonoace 8000 (South Korea), Sonosite Titan (USA) using low-frequency sensors which allow to study large depth. Preferably used convex and microconvectional sensors. Ultrasound of the abdomen and retroperitoneum performed traditionally with the patient standing, lying on the right and left side on the back. The study routinely carried his empty stomach. Used have longitudinal transverse and oblique scanning of all possible accesses. according to the protocol ultrasound scan of the abdomen and retroperitoneum consistently in the B-mode condition investigated liver, pancreas, spleen, kidneys then. Assessment of free fluid in the abdominal cavity was performed in the projection of over-and subhepatic space, small omentum, spleen, left subdiaphragmatic space left and right side channels, spleen, and interintestinal loop clusters. Examination of the abdomen and retroperitoneum conducted for admission to medical schools in 52 injured, as well as the dynamics of 1, 2, 3 and 5 days after injury.

Results and discussion. Isolated spleen damage we observed in 18 patients (35%) of 33 cases (65%), spleen injury was cumulative with injuries of other abdominal organs. When ultrasound we thought the main signs of damage detection heterogeneity spleen parenchyma and presence anechogenic structure, and the presence of free fluid in the abdominal cavity. In 35 cases (69%) observed blurred contours spleen and inequality, as well as increasing its size. In patients with lesions of the spleen in the first 6 hours in the presence of hematoma, we observed no clear contours of the body, change the nature of its echogenicity due to the appearance of hyperechogenic areas of different sizes. Over the next 12-24 hours in patients we observed heterogeneous hypoechogenic internal structure hematoma, the presence of hypoechogenic inclusions in the parenchyma of the spleen. From 2 to 7 day ultrasound picture hematoma becomes stable, relatively clear paths bruising, hematoma increased at in size, their internal echogenic structure could be both homogeneous and heterogeneous. After 7 days from the date of injury hematoma in amounts not increased. They were seen as single or multiple anechogenic formed oval with clear smooth contours, homogeneous or heterogeneous structure, but with a stable internal structure. In 4% of cases with a total number of victims with injuries of the spleen we have identified gaps spleen. When crushed spleen (2%), we visualized the absence of the normal structure of the spleen, the deformation of contours and shapes the body.

Conclusions. Thus, as a result of research we discovered the logical dynamics of ultrasonic parameters in spleen injured and killed as a result of injuries inflicted, indicating the possibility of developing a set of criteria for the evaluation of damage limitation set of internal abdominal organs, including the spleen. Found that ultrasound spleen major signs of damage are heterogeneous parenchyma and the presence anechogenic structure and free fluid in the abdominal cavity. In 69% of cases showed blurred contours spleen and inequality, as well as increasing its size. Revealed the following dynamics: the first day is a heterogeneous hypoechogenic internal structure hematoma, the presence of hypoechogenic inclusions in the parenchyma of the spleen; further ultrasound picture hematomas became relatively stable, sharper contours bruising, hematoma increased at in size, their internal echogenic structure could be as homogeneous and heterogeneous, after 7 days from the date of injury, hematoma in amounts not increased.

References

1. Bennett M.K. Ultrasonography in blunt abdominal trauma / M.K. Bennett, D. Jehle // Emerg. Med. Clin. North Am. - 1997. - Vol. 15, № 4. - P. 763-787.

2. Alvarez S. Assessment of post splenectomy residual splenic functions splenic autotransplants / S. Alvarez, С Escalante, D. Rituerto // Int. Surg. - 1987. - Vol. 72, № 3. - P. 149-153.

3. Amoroso T.A. Evaluation of the patient with blunt abdominal trauma: an evidence based approach / T.A. Amoroso // Emerg. Med. Clin. North Am. - 1999. - № 1. - P. 63-75.

4. Baesi T. Surgical diseases of the spleen / T. Baesi, R. Filler // Surg. Clin. 173 North Am. - 1985. - Vol. 65, № 5. - P. 1269-1286.

5. Bell W. Splenectomy: indications and complications / W. Bell, S. Sufian, T. Matsumo // Int. Surg. - 1982. - Vol. 67, № 1. - P. 29-36.

6. Brown M.A. Blunt abdominal trauma: Screening US in 2,693 patients / M.A. Brown [et al.] // Radiology. - 2001. - Vol. 218, № 2. - P. 352-358.

7. Federie M. Computed tomography in blunt abdominal trauma / M. Federie, R. Crass, R. Jeffrey, D. Trunkey //Arch. Surg. - 1982. - Vol. 17, № 5. - P. 645-650.

8. McGahan J.P. Use of ultrasonography in the patient with acute abdominal trauma / J.P. McGahan [et al.] // J. Ultrasound. Med. - 1997. - Vol. 16, № 10. - P. 653-662.

9. McKenney K.L. Sonography as the primary screening technique for blunt abdominal trauma: experience with 899 patients / K.L. McKenney [et al] // Am. J. Roentgenol. - 1998. - Vol. 170, № 4. - P. 979-985.

10. McKenney K.L. Ultrasound of blunt abdominal trauma / K.L. McKermey // Radiol. Clin. North Am. - 1999. - Vol. 37, № 5. - P. 879-893.