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Splenic contraction: a new member of the hypovolemic shock complex

Michael S Enslow1, Stephen R Preece2, Benjamin Wildman-Tobriner3

  • 1Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA. Mike.Enslow@gmail.com.

Abdominal Radiology (New York)
|February 21, 2018
PubMed

Insights

Decreased splenic volume and enhancement are reliable indicators of hypovolemic shock. These changes, particularly reduced spleen size, are consistently observed in patients experiencing shock, aiding in diagnosis.

Area of Science:

  • Radiology and Imaging
  • Emergency Medicine
  • Physiology

Background:

  • Hypovolemic shock significantly impacts organ perfusion.
  • The spleen's response to shock is a key indicator of circulatory status.
  • Assessing splenic changes can aid in diagnosing hypovolemic shock.

Purpose of the Study:

  • To evaluate changes in splenic volume during hypovolemic shock.
  • To assess splenic enhancement patterns in patients with hypovolemic shock.
  • To determine the diagnostic utility of splenic volume and enhancement in hypovolemic shock.

Main Methods:

  • Computed tomography (CT) scans of 71 adult patients with hypovolemic shock were analyzed.
  • Splenic volume and enhancement were compared to baseline scans or control populations.
  • Statistical analysis, including ROC curve analysis, was performed.

Main Results:

  • Splenic volume was significantly reduced in shock patients (107 cm³ vs. 220 cm³ in controls, P < 0.001).
  • Reduced splenic enhancement was observed in shock patients (105 HU vs. 134 HU in controls, P < 0.001).
  • Spleen volume decrease was a consistent finding in shock, with an ROC AUC of 0.83 for predicting shock.

Conclusions:

  • Decreased splenic volume is a ubiquitous and reliable sign of hypovolemic shock.
  • Reduced splenic volume is particularly useful when prior imaging is available.
  • Splenic hypoenhancement is specific and has a high positive predictive value for hypovolemic shock.
Abstract

Keywords:
Hypoperfusion complexHypovolemic shock complexShockSpleen

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