脾腫の鑑別のアルゴリズム

出典
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脾腫のCT画像

出典
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1: Splenomegaly: investigation, diagnosis and management.
著者: Pozo AL, Godfrey EM, Bowles KM.
雑誌名: Blood Rev. 2009 May;23(3):105-11. doi: 10.1016/j.blre.2008.10.001. Epub 2008 Dec 4.
Abstract/Text: Splenomegaly is a feature of a broad range of diseases, and presents to clinicians in many fields. This review examines the aetiology of splenomegaly in the developed world, and describes a logical approach to the patient with splenomegaly. In some patients, extensive radiological and laboratory investigations will fail to yield a diagnosis: these cases of "isolated" splenomegaly are not uncommon and can be particularly challenging to manage. The risks of serious underlying disease must be balanced against the risks of invasive investigations such as splenic biopsy and diagnostic splenectomy. We discuss the options in isolated splenomegaly and their evidence base, and incorporate them into a management strategy to aid the clinician in cases of diagnostic difficulty.
Blood Rev. 2009 May;23(3):105-11. doi: 10.1016/j.blre.2008.10.001. Epu...

Splenic Index

古賀の原法では、a×b＞20を脾腫とするが、これはリニア式プローブを用いた数値である。最近のコンベックス式プローブでは描出範囲が広いためa×b＞40を脾腫と考える。

千葉大学第1内科の方法

a×b＞20を脾腫とみなす。
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Castell法

前腋窩線上の第9肋間で打診を行い、濁音であれば脾腫を疑う。
赤破線はCastell’s sign
出典
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1: The spleen percussion sign. A useful diagnostic technique.
Ann Intern Med. 1967 Dec;67(6):1265-7. doi: 10.7326/0003-4819-67-6-1265.

Nixon法

右側臥位で後腋窩線上から中腋窩線上肋骨下縁に向かって斜めに打診する。
濁音界が季肋部より8 cm以上なら脾腫を疑う。

Traube三角の打診

トラウベ腔の打診で濁音なら胸水や脾腫の存在を疑う。
出典
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1: The clinical diagnosis of splenomegaly.
著者: Yang JC, Rickman LS, Bosser SK.
雑誌名: West J Med. 1991 Jul;155(1):47-52.
Abstract/Text: Assessing for the presence of splenomegaly is an important component of the physical examination. Although several methods of palpation and percussion of the spleen have been described, until recently they have not been validated by noninvasive imaging techniques such as ultrasonography, radionuclide scanning, and computed tomography that offer objective means to assess splenomegaly. We review the literature comparing various physical examination techniques with noninvasive imaging modalities and conclude that palpation and percussion of the spleen are complementary but frequently insensitive and that further studies are needed to evaluate the efficacy of specific diagnostic methods.
West J Med. 1991 Jul;155(1):47-52.

出典
img
1: 著者提供

脾腫の鑑別のアルゴリズム

出典
img
1: 著者提供

脾腫のCT画像

出典
imgimg
1: Splenomegaly: investigation, diagnosis and management.
著者: Pozo AL, Godfrey EM, Bowles KM.
雑誌名: Blood Rev. 2009 May;23(3):105-11. doi: 10.1016/j.blre.2008.10.001. Epub 2008 Dec 4.
Abstract/Text: Splenomegaly is a feature of a broad range of diseases, and presents to clinicians in many fields. This review examines the aetiology of splenomegaly in the developed world, and describes a logical approach to the patient with splenomegaly. In some patients, extensive radiological and laboratory investigations will fail to yield a diagnosis: these cases of "isolated" splenomegaly are not uncommon and can be particularly challenging to manage. The risks of serious underlying disease must be balanced against the risks of invasive investigations such as splenic biopsy and diagnostic splenectomy. We discuss the options in isolated splenomegaly and their evidence base, and incorporate them into a management strategy to aid the clinician in cases of diagnostic difficulty.
Blood Rev. 2009 May;23(3):105-11. doi: 10.1016/j.blre.2008.10.001. Epu...