Splenic contraction: a new member of the hypovolemic shock complex.
Abdom Radiol (NY). 2018 Sep;43(9):2375-2383. doi: 10.1007/s00261-018-1478-3.
Enslow MS1, Preece SR2, Wildman-Tobriner B3, Enslow RA4, Mazurowski M3, Nelson RC3.
OBJECTIVE: The objective of the article is to assess changes in splenic volume in the setting of hypovolemic shock; splenic enhancement in hypovolemic shock is also assessed.
MATERIALS/METHODS: 71 consecutive adult patients with the hypovolemic shock complex on computed tomography (CT) were identified. Spleen volume and enhancement were compared to a baseline CT scan (without shock) or to height- and sex-corrected normal values and a control population when a comparison CT was unavailable.
RESULTS: Splenic volume was significantly lower in the setting of shock. Average splenic volume in adult patients with shock was 107 ± 63 cm3 compared to 220 ± 164 cm3 in the control population (P < 0.001). All shock patients with a comparison CT (n = 35) had decreased splenic volume in the setting of shock. The area under the receiver operating characteristic (ROC) curve for spleen volume predicting shock was 0.83. Splenic enhancement was also significantly lower in the setting of shock. Mean splenic attenuation value in our shock population was 105 ± 34 HU compared to 134 ± 25 HU in the control population (P < 0.001). Decreased splenic enhancement was present in 25 of 71 shock patients and in none of the control patients (P < 0.001).
CONCLUSION: Decreased splenic volume is a ubiquitous and reliable sign of hypovolemic shock and should be considered a member of the hypovolemic shock complex. It is of particular utility when a prior study is available. Splenic hypoenhancement has high specificity and a high positive predictive value for hypovolemic shock in the correct patient population.