Spleen: an organ of multiple shapes
Bazo: un órgano de múltiples formas
Serghei Covantev, Rasul Uzdenov, Daria Turovets, Olga Belic
Abstract
Introduction: The spleen is located in the upper part of the abdominal cavity. As an organ, the spleen can have various shapes and size.
Material and methods: The human spleen was studied in 273 cadavers (154 men and 119 women) who did not have diseases of the spleen. The shape of the spleen was analyzed based on splenic index, Michels classification.
Results: The most common shape of the spleen in men is the elongated one. It was encountered in 79 (51.3%) cases out of 154. In women, the most common shape was the intermediate. It was encountered in 51 (42.9%) of the 119 cases. Based on Michels classification the clinoid (wedge) shape was encountered in 102 (37.74%) cases, triangular in 59 (21.83%) and tetrahedral in 30 (11.1%). In 30.26% the shape of the spleen couldn’t be classified according to Michels classification. In 21 cases (7.77%) the spleen had a flat shape; in 27 (9.99%) – dome-shaped; in 1 case (0,37%) – Z-shape; in 18 (6.66%) – round shape; in 6 (2.22%) – irregular shape; in 2 (0.66%) - shape with a node in the hilum; in 1 (0,37%) – rhomboid shape, in 2 (0,74%) – bilobed shape and in 4 cases (1,48%) – lobular shape. The splenic fissures located on the upper edge of the organ were found in 81 (29.91%) cases, and also on the lower edge - in 41 (14.02%) cases. In 13 (4.67%) cases fissures were encountered on both sides. In 148 (51.4%) cases the spleen had no fissures on its surface.
Conclusions: The spleen has various shapes beyond the classical wedge, triangular and tetrahedral. All of these shapes do not represent a pathological finding but in certain situation may require further analysis and interpretation depending on the imaging technique and experience of the physician.
Keywords
Resumen
Introducción: el bazo se localiza en la parte superior de la cavidad abdominal. Como órgano, el bazo puede tener varias formas y tamaños.
Material y métodos: Se estudió el bazo humano en 273 cadáveres (154 hombres y 119 mujeres) que no tenían enfermedades del bazo. La forma del bazo se analizó con base en el índice esplénico, clasificación de Michels.
Resultados: La forma más común del bazo en los hombres es la alargada. Se encontró en 79 (51,3%) casos de 154. En las mujeres, la forma más común fue la intermedia. Se encontró en 51 (42,9%) de los 119 casos. Según la clasificación de Michels, la forma clinoide (cuña) se encontró en 102 (37,74%) casos, triangular en 59 (21,83%) y tetraédrica en 30 (11,1%). En un 30,26%, la forma del bazo no se pudo clasificar según la clasificación de Michels. En 21 casos (7,77%) el bazo tenía forma plana; en 27 (9,99%) - en forma de cúpula; en 1 caso (0,37%) - forma de Z; en 18 (6,66%) - forma redonda; en 6 (2,22%) - forma irregular; en 2 (0,66%) - forma con un nodo en el hilio; en 1 (0,37%) - forma romboide, en 2 (0,74%) - forma bilobulada y en 4 casos (1,48%) - forma lobular. Las fisuras esplénicas ubicadas en el borde superior del órgano se encontraron en 81 (29,91%) casos, y también en el borde inferior, en 41 (14,02%) casos. En 13 (4,67%) casos se encontraron fisuras en ambos lados. En 148 (51,4%) casos el bazo no presentaba fisuras en su superficie.
Conclusiones: El bazo tiene varias formas más allá de la clásica cuña, triangular y tetraédrica. Todas estas formas no representan un hallazgo patológico, pero en determinadas situaciones pueden requerir un mayor análisis e interpretación según la técnica de imagen y la experiencia del médico.
Palabras clave
References
1. Micheli F. Unmittelbare Effekte der Splenektomie bei einem Fall von erworbenem hämolytischen splenomegalischen Ikterus Typus Hayem-Widal (spleno-hämolytischer Ikterus). Wien Klin Wochenschr. 1911;1(24):1269-74.
2. Kaznelson P. Zur Entstehnung der Blutplättchen. Verhandlungen der Deutsche(n). Ges Innere Med. 1922;34:557-8.
3. Morgenstern L. A History of Splenectomy. In: Hiatt JR, Phillips EH, Morgenstern L, editors. Surgical Diseases of the Spleen. Berlin, Heidelberg: Springer Berlin Heidelberg; 1997:3-14.
4. Covanțev S, Mazuruc N, Belic O. An unusual case of colon vascularization by the inferior mesenteric artery. J Vasc Bras. 2017;16(1):52-55. doi: 10.1590/1677-5449.009315.
5. Skandalakis PN, Colborn GL, Skandalakis LJ, Richardson DD, Mitchell WE Jr, Skandalakis JE. The surgical anatomy of the spleen. Surg Clin North Am. 1993;73(4):747-68. doi: 10.1016/s0039-6109(16)46083-4.
6. Mazuruc N, Covantev S, Belic O. A Case of Unusual Vascularization of Upper Abdominal Cavity' Organs. Case Rep Vasc Med. 2018;2018:5738037. doi: 10.1155/2018/5738037.
7. Yildiz AE, Ariyurek MO, Karcaaltincaba M. Splenic anomalies of shape, size, and location: pictorial essay. ScientificWorldJournal. 2013;2013:321810. doi: 10.1155/2013/321810.
8. Chen MJ, Huang MJ, Chang WH, Wang TE, Wang HY, Chu CH, et al. Ultrasonography of splenic abnormalities. World J Gastroenterol. 2005;11(26):4061-6. doi: 10.3748/wjg.v11.i26.4061.
9. De Rosa F, Lapiccirella G. [Splenic lobulation simulating a gastric neoformation. The diagnostic value of echography]. Radiol Med. 1994;87(4):521-2.
10. Varga I, Babala J, Kachlik D. Anatomic variations of the spleen: current state of terminology, classification, and embryological background. Surg Radiol Anat. 2018;40(1):21-9. doi: 10.1007/s00276-017-1893-0.
11. Inakov AK. [Anatomy and topography of the human spleen in postnatal ontogenesis. Ontogenesis and age-related anatomy of the human circulatory and lymphatic systems]. M. 1983: 32-6.
12. Umarani S, Sivaraj R, Ananthi V, Muniappan V. Morphological variations of spleen: a cadaveric study in south indian population. Int J Anat Res. 2018;6 (1.2):4914-19. doi: 10.16965/ijar.2017.506.
13. Das S, Abd Latiff A, Suhaimi FH, Ghazalli H, Othman F. Anomalous splenic notches: a cadaveric study with clinical importance. Bratisl Lek Listy. 2008;109(11):513-6.
14. Benelli G, Bonardi R, Parziale M, Campari PF. [Role of echography in the differential diagnosis of accessory lobulations and small capsular traumatic fissures of the spleen]. Radiol Med. 1992;84(6):770-3.
15. Drut RM, Drut R, Gilbert-Barness E, Reynolds JF Jr. Abnormal spleen lobulation and short pancreas. Birth Defects Orig Artic Ser. 1993;29(1):345-52.
16. Covantev S, Uzdenov R, Zabudskaya K, Belic O. Splenic abscess and accessory liver fissure: When anatomy meets surgery. Int Med. 2021;3(2):69-70. doi: 10.5455/im.38116.
17. Hegazy A. Clinical embryology for medical students and postgraduate doctors. Lap Lambert Academic Publishing; 2014.
18. Coffey W, Balasubramanya R. Spleen Imaging. Treasure Island (FL): StatPearls Publishing; 2021.
Submitted date:
08/07/2021
Reviewed date:
09/23/2021
Accepted date:
10/04/2021
Publication date:
10/05/2021