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119
Normal Splenic Size in Infants and Children: Sonographic Measurements
Henrietta
Kotlus
Richard
The
Rosenberg1
I. Markowitz1
Heidi Kolberg1’2 Chanhi Anne Hubbard1 Richard 0. Bellah1
purpose of this study was to establish guidelines for normal splenic size at ages by using a simple and reproducible sonographic method. Two hundred thirty patients, from neonate to 20-year-old, had sonography because of abdominal and/ or pelvic problems unrelated to the spleen. Findings on sonograms of the liver and kidneys were normal in all cases. Splenic size was measured by obtaining a coronal view that included the hilum, while the patient was breathing quietly. The greatest longitudinal distance between the dome of the spleen and the tip (splenic length) was
different
measured proposed
and correlated with age, height, and weight. The following guidelines are for the upper limit of normal splenic length based on this simple, easy to use,
one-measurement technique: splenic length no greater than 6.0 cm at 3 months, 6.5 cm at 6 months, and 7.0 cm at 12 months, 8.0 cm at 2 years, 9.0 cm at 4 years, 9.5 cm at 6 years, 10.0 cm at 8 years, 11.0 cm at 10 years, 11.5 cm at 12 years, 12.0 cm at 15 years or older for girls, and 13.0 cm at 15 years or older for boys. Twenty-two patients with known abnormalities of the spleen were randomly selected and their splenic lengths compared with the proposed guidelines; in each case, the length of the spleen exceeded the upper limit of normal for that age. Normal values of a single measurement of the greatest longitudinal diameter of the spleen, from the dome to the tip measured at the hilum in the coronal plane, were obtained in patients from newborn to 20 years old. AJR157:119-121,
July 1991
Evaluation of splenic size by percussion and palpation is notoriously inaccurate. Radiologic methods and scintigraphy, although dependable, require radiation exposure [1 2]. The calculation of splenic volume in children by using sonographic measurements can be cumbersome and time-consuming and therefore impractical for routine clinical use [3]. Our purpose was to establish the normal range of splenic size in a population of children, from full-term neonate to 20-year-old, to develop a practical, reliable sonographic approach for measurement, and to establish guidelines for normal splenic size in children. ,
Received sion January
August 23, 1990; accepted 28, 1991.
Presented for Pediatric
at the annual meeting of the Society Radiology, Cincinnati, OH, April 1990. of Radiology, Division of (Jtra-
I Department
after revi-
sound, The Children’s Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104. Address reprint requests to H. K. Rosenberg. 2
Present address: The Graduate
Graduate
Plaza,
Philadelphia,
Hospital, One
PA 19146.
Present address: Holy Cross Hospital, Fon’est Glen Rd., Silver Springs, MD 20910. 3
o361-803x/91/1571 0 American
Roentgen
-0119 Ray Society
1500
Materials
and Methods
We prospectively studied 230 nonconsecutive patients, including 89 boys and 141 girls. these, 58 were infants from full-term neonate to 12 months old. Among the 172 children between 1 and 20 years old, 58 were boys and 1 14 were girls. The patients selected for the study were being evaluated sonographically for abdominal and/or pelvic problems unrelated to the spleen, most often because of urinary tract infection or abdominal pain. They had no history of disease related to the liver or spleen and no gastrointestinal, hematologic, oncologic, or traumatic conditions. Their liver and both kidneys had to be normal in size, position, and Of
echotexture to qualify during quiet breathing
In the first 90 patients, image,
a measurement
measurement
for inclusion in the study. Splenic length was measured sonographically with the patient supine or in a slightly right lateral decubitus position.
we measured of the width
four different
of the spleen
taken at a point bisecting
parameters.
was made
the line indicating
On the transverse
at the hilum,
followed
coronal
by a depth
the width. The width of the spleen
120
ROSENBERG
AL.
AJR:157,July
1991
was also measured at the hilum on a longitudinal coronal image and the maximal splenic length, determined optically, was made in a plane
Discussion
where
Sonography provides a simple, practical, reliable means for obtaining splenic length measurements in infants and children. Our technique, however, does not allow volume measurements as other authors’ techniques have, but instead serves as a guide for selecting those patients who require more quantitative estimations of splenic size. Several groups have determined normal splenic volume and weight [4-6]. DeLand used data from 440 autopsy specimens in adults and found that splenic weight is related to the age and sex of the patient [7}. He noted that splenic weight decreases from 20 to 29 years of age and above 60 years, but is relatively constant from 30 to 59 years. He also observed that splenic weight is lower in women than in men for all ages.
the hilum
was
visualized
the only reliable, reproducible longitudinal
Downloaded from www.ajronline.org by Gazi Universitesi on 02/02/15 from IP address 194.27.18.18. Copyright ARRS. For personal use only; all rights reserved
ET
coronal
plane,
(Fig.
1). As it became
measurement
we
obtained
obvious
that
was the one made in the
only
this
measurement
in the
last 140 patients. The data were plotted as a function of age in months, sex, height, and weight. We ascertained that the height and weight of our patients followed normal growth curves. In addition, we obtained coronal measurements of the spleen in 22 randomly ent
and
selected explainable
patients
(1 4 boys,
splenomegaly.
eight girls) with clinically
Eleven
children
were
less
apparthan
10
years old and 1 1 were more than 10 years old. Seven patients had chronic hemolytic anemia, five had portal hypertension, four had a viral infection,
three
had leukemia/Iymphoma,
and three
had miscel-
laneous reasons for splenomegaly.
We compared the maximal coronal measurement of each enlarged spleen with the upper limit of normal seen in the same age group in our normal population.
Results A roughly logarithmic correlation between splenic length and age (r = .7) was found for the total group of 230 infants and children (Fig. 2). Likewise, good correlation was found between splenic length and patient’s height (r = .73) and weight (r = .78). No statistically significant difference was seen between boys and girls except in teenagers more than 1 5 years old, where males had slightly longer spleens than females, generally correlating with their larger size overall (Table 1). The data were grouped by age, and calculations of the median splenic length and the 1 0th and 90th percentile were made for each group (Table 2). These results are shown graphically in Figure 3. A suggested upper limit of normal was derived by using the next highest whole integer above the 90th percentile figure. Note that exceptions were made for three groups in which a half integer higher was thought to be more appropriate. Different guidelines for boys and girls were suggested for the 1 5- to 20-year-old group. In all the children with clinically obvious splenomegaly, the splenic length exceeded the suggested upper limit of normal (Fig. 4). In each patient more than 1 year old, the splenic length exceeded the suggested guideline by at least 2 cm.
.“
‘
“
.
..
-
--,
‘j;:t
.
#{163}::
0
. 0
S
sonogram is measured
5
0
0
0 0
0
0c.0
C 0 0
0 0
0
C
0. Cl)
0
0 Female C
Fig. 2.-Length roughly logarithmic and children.
-
#{149}:-“‘ “-
.h’
.
of spleen correlation
Male
(cm) plotted against age (years) shows a (r = .7) for total group of 230 normal infants
1: Median Splenic and Children
P
Length
..,
-
of spleen. Maximal splenic length, deterin longitudinal coronal plane, with splenic
a b
(n
in 230 Male and Female
Male = 89)
6-8 years 8-l0years 10-12 years 12-15 years
4.6 (n = 7) 5.6(n=11) 6.2 (n = 13) 7.4 (n = 5) 7.3 (n = 6) 7.8 (n = 10) 8.7 (n = 7) 9.5(n=7) 9.7 (n = 7) 10.1 (n = 11)
1 5-20
1 1 .2 (n
0-3 months 3-6months 6-12 months 1-2 years 2-4 years
-
.;
Fig. 1.-Coronal mined optically, hilum visualized.
S
o
s:
‘
#{149}0
%#{149} 0
E C,
4-6 .“
0 000 0S
0
..I
S.,’.
S
‘:
-
-
S
0
A ge .-.
S.
00 S
S
TABLE Infants
--C.
h-..
0
years
years
values calculated NS
=
No statistically
=
5)
with the Mann-Whitney significant
difference
Female = 141)
(n 4.4
(n
=
21)
p NSb
5.0(n=2) 5.9 (n = 4)
NS NS
6.8 7.5 7.8 8.2
7) 1 8)
NS NS
29) 14)
NS NS NS
10) 15) 1 2)
NS
(n (n (n (n
= = = =
9.2(n=9) 10.0(n
=
10.0(n
=
1 0.0
=
(n
U-test. between
NS
119
Normal Splenic Size in Infants and Children: Sonographic Measurements
Henrietta
Kotlus
Richard
The
Rosenberg1
I. Markowitz1
Heidi Kolberg1’2 Chanhi Anne Hubbard1 Richard 0. Bellah1
purpose of this study was to establish guidelines for normal splenic size at ages by using a simple and reproducible sonographic method. Two hundred thirty patients, from neonate to 20-year-old, had sonography because of abdominal and/ or pelvic problems unrelated to the spleen. Findings on sonograms of the liver and kidneys were normal in all cases. Splenic size was measured by obtaining a coronal view that included the hilum, while the patient was breathing quietly. The greatest longitudinal distance between the dome of the spleen and the tip (splenic length) was
different
measured proposed
and correlated with age, height, and weight. The following guidelines are for the upper limit of normal splenic length based on this simple, easy to use,
one-measurement technique: splenic length no greater than 6.0 cm at 3 months, 6.5 cm at 6 months, and 7.0 cm at 12 months, 8.0 cm at 2 years, 9.0 cm at 4 years, 9.5 cm at 6 years, 10.0 cm at 8 years, 11.0 cm at 10 years, 11.5 cm at 12 years, 12.0 cm at 15 years or older for girls, and 13.0 cm at 15 years or older for boys. Twenty-two patients with known abnormalities of the spleen were randomly selected and their splenic lengths compared with the proposed guidelines; in each case, the length of the spleen exceeded the upper limit of normal for that age. Normal values of a single measurement of the greatest longitudinal diameter of the spleen, from the dome to the tip measured at the hilum in the coronal plane, were obtained in patients from newborn to 20 years old. AJR157:119-121,
July 1991
Evaluation of splenic size by percussion and palpation is notoriously inaccurate. Radiologic methods and scintigraphy, although dependable, require radiation exposure [1 2]. The calculation of splenic volume in children by using sonographic measurements can be cumbersome and time-consuming and therefore impractical for routine clinical use [3]. Our purpose was to establish the normal range of splenic size in a population of children, from full-term neonate to 20-year-old, to develop a practical, reliable sonographic approach for measurement, and to establish guidelines for normal splenic size in children. ,
Received sion January
August 23, 1990; accepted 28, 1991.
Presented for Pediatric
at the annual meeting of the Society Radiology, Cincinnati, OH, April 1990. of Radiology, Division of (Jtra-
I Department
after revi-
sound, The Children’s Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104. Address reprint requests to H. K. Rosenberg. 2
Present address: The Graduate
Graduate
Plaza,
Philadelphia,
Hospital, One
PA 19146.
Present address: Holy Cross Hospital, Fon’est Glen Rd., Silver Springs, MD 20910. 3
o361-803x/91/1571 0 American
Roentgen
-0119 Ray Society
1500
Materials
and Methods
We prospectively studied 230 nonconsecutive patients, including 89 boys and 141 girls. these, 58 were infants from full-term neonate to 12 months old. Among the 172 children between 1 and 20 years old, 58 were boys and 1 14 were girls. The patients selected for the study were being evaluated sonographically for abdominal and/or pelvic problems unrelated to the spleen, most often because of urinary tract infection or abdominal pain. They had no history of disease related to the liver or spleen and no gastrointestinal, hematologic, oncologic, or traumatic conditions. Their liver and both kidneys had to be normal in size, position, and Of
echotexture to qualify during quiet breathing
In the first 90 patients, image,
a measurement
measurement
for inclusion in the study. Splenic length was measured sonographically with the patient supine or in a slightly right lateral decubitus position.
we measured of the width
four different
of the spleen
taken at a point bisecting
parameters.
was made
the line indicating
On the transverse
at the hilum,
followed
coronal
by a depth
the width. The width of the spleen
120
ROSENBERG
AL.
AJR:157,July
1991
was also measured at the hilum on a longitudinal coronal image and the maximal splenic length, determined optically, was made in a plane
Discussion
where
Sonography provides a simple, practical, reliable means for obtaining splenic length measurements in infants and children. Our technique, however, does not allow volume measurements as other authors’ techniques have, but instead serves as a guide for selecting those patients who require more quantitative estimations of splenic size. Several groups have determined normal splenic volume and weight [4-6]. DeLand used data from 440 autopsy specimens in adults and found that splenic weight is related to the age and sex of the patient [7}. He noted that splenic weight decreases from 20 to 29 years of age and above 60 years, but is relatively constant from 30 to 59 years. He also observed that splenic weight is lower in women than in men for all ages.
the hilum
was
visualized
the only reliable, reproducible longitudinal
Downloaded from www.ajronline.org by Gazi Universitesi on 02/02/15 from IP address 194.27.18.18. Copyright ARRS. For personal use only; all rights reserved
ET
coronal
plane,
(Fig.
1). As it became
measurement
we
obtained
obvious
that
was the one made in the
only
this
measurement
in the
last 140 patients. The data were plotted as a function of age in months, sex, height, and weight. We ascertained that the height and weight of our patients followed normal growth curves. In addition, we obtained coronal measurements of the spleen in 22 randomly ent
and
selected explainable
patients
(1 4 boys,
splenomegaly.
eight girls) with clinically
Eleven
children
were
less
apparthan
10
years old and 1 1 were more than 10 years old. Seven patients had chronic hemolytic anemia, five had portal hypertension, four had a viral infection,
three
had leukemia/Iymphoma,
and three
had miscel-
laneous reasons for splenomegaly.
We compared the maximal coronal measurement of each enlarged spleen with the upper limit of normal seen in the same age group in our normal population.
Results A roughly logarithmic correlation between splenic length and age (r = .7) was found for the total group of 230 infants and children (Fig. 2). Likewise, good correlation was found between splenic length and patient’s height (r = .73) and weight (r = .78). No statistically significant difference was seen between boys and girls except in teenagers more than 1 5 years old, where males had slightly longer spleens than females, generally correlating with their larger size overall (Table 1). The data were grouped by age, and calculations of the median splenic length and the 1 0th and 90th percentile were made for each group (Table 2). These results are shown graphically in Figure 3. A suggested upper limit of normal was derived by using the next highest whole integer above the 90th percentile figure. Note that exceptions were made for three groups in which a half integer higher was thought to be more appropriate. Different guidelines for boys and girls were suggested for the 1 5- to 20-year-old group. In all the children with clinically obvious splenomegaly, the splenic length exceeded the suggested upper limit of normal (Fig. 4). In each patient more than 1 year old, the splenic length exceeded the suggested guideline by at least 2 cm.
.“
‘
“
.
..
-
--,
‘j;:t
.
#{163}::
0
. 0
S
sonogram is measured
5
0
0
0 0
0
0c.0
C 0 0
0 0
0
C
0. Cl)
0
0 Female C
Fig. 2.-Length roughly logarithmic and children.
-
#{149}:-“‘ “-
.h’
.
of spleen correlation
Male
(cm) plotted against age (years) shows a (r = .7) for total group of 230 normal infants
1: Median Splenic and Children
P
Length
..,
-
of spleen. Maximal splenic length, deterin longitudinal coronal plane, with splenic
a b
(n
in 230 Male and Female
Male = 89)
6-8 years 8-l0years 10-12 years 12-15 years
4.6 (n = 7) 5.6(n=11) 6.2 (n = 13) 7.4 (n = 5) 7.3 (n = 6) 7.8 (n = 10) 8.7 (n = 7) 9.5(n=7) 9.7 (n = 7) 10.1 (n = 11)
1 5-20
1 1 .2 (n
0-3 months 3-6months 6-12 months 1-2 years 2-4 years
-
.;
Fig. 1.-Coronal mined optically, hilum visualized.
S
o
s:
‘
#{149}0
%#{149} 0
E C,
4-6 .“
0 000 0S
0
..I
S.,’.
S
‘:
-
-
S
0
A ge .-.
S.
00 S
S
TABLE Infants
--C.
h-..
0
years
years
values calculated NS
=
No statistically
=
5)
with the Mann-Whitney significant
difference
Female = 141)
(n 4.4
(n
=
21)
p NSb
5.0(n=2) 5.9 (n = 4)
NS NS
6.8 7.5 7.8 8.2
7) 1 8)
NS NS
29) 14)
NS NS NS
10) 15) 1 2)
NS
(n (n (n (n
= = = =
9.2(n=9) 10.0(n
=
10.0(n
=
1 0.0
=
(n
U-test. between
NS
