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The spleen is an organ of the hematological system and has a role in immune response, storage of red blood cells and hematopoiesis.
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The spleen is a wedge-shaped organ lying mainly in the left upper quadrant (left hypochondrium and partly in the epigastrium) and is protected by the left 9th to 11th ribs. It is soft, highly vascular and dark purple in color.
Size and weight vary from person-to-person but on average is around 2.5 cm thick, 7.5 cm broad and 12 cm in length. Its volume is on average between 100 to 300 cm3 12. For pediatric measurements, see the article spleen size (pediatric)
The spleen has two poles (superior and inferior), three borders (superior, inferior and intermediate) and two surfaces (diaphragmatic and visceral). It is enclosed by a thin capsule, which is easily ruptured.
The diaphragmatic surface contains impressions from the 9th to 11th ribs. The visceral surface has three impressions. The gastric area for the stomach, colic area for the splenic flexure of the colon and renal area for the left kidney.
The spleen is completely covered by peritoneum, except at the hilum, which forms a number of ligaments 6,7:
attaches the spleen to the greater curvature of the stomach
contains short gastric and left gastroepiploic arteries
attaches the spleen to the left kidney
contains splenic artery and vein and the pancreatic tail
diaphragmatic surface (superoposteriorly): dome of the left hemidiaphragm, left 9th to 11th ribs
pancreatic tail - medial
left kidney and adrenal gland - posteromedial
stomach - anteromedial
splenic flexure of the transverse colon - inferior
from splenic hilar lymph nodes to retropancreatic lymph nodes, then draining to celiac lymph nodes
sympathetic: via the celiac plexus (influence blood flow) 9
parasympathetic: possibly via the vagal trunks 9, however there is contention in the literature as to whether the spleen has vagal (or any parasympathetic) innervation 13,14
splenic cleft: may mimic traumatic laceration
best assessed in the supine, right lateral position with the left arm placed behind the head
visualized best obliquely in the 9th or 10th intercostal spaces
echogenicity usually higher when compared to the liver, but may be iso- or hypoechoic
The splenic parenchyma should be assessed in the portal venous phase as inhomogeneous splenic enhancement (zebra or psychedelic spleen) seen in the arterial phase can mimic a splenic laceration or contusion 5.
Embryologically, the spleen forms from several splenic buds that fuse together within the dorsal mesentery of the foregut (dorsal mesogastrium) 10.
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