Splenic morphometric characteristics in infectious mononucleosis (ultrasonic study)

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Abstract

The spleen is a secondary immune and the largest organ of the reticuloendothelial system, actively involved during infectious mononucleosis. Clinically, assessing a degree of organ involvement in the pathological process seems unlikely. As a rule, only palpation and percussion are used to determine the size of the spleen, which represents a late and subjective sign of potential splenomegaly. Ultrasound examination provides ample opportunities to estimate the spleen size during infectious mononucleosis. Our study was aimed at identifying morphometric and Doppler ultrasound changes in the spleen in patients with infectious mononucleosis. Materials and methods. There were enrolled 24 patients with infectious mononucleosis to be compared with 30 healthy medical institute students in control group. All participants underwent splenic ultrasound examination. Spleen echotexture and contour clarity together with measuring linear dimensions: length, width, and thickness were analyzed. Splenic artery and vein velocity parameters were measured at the gates of the spleen. Elastographic window for fibroelastometry was positioned within the window for standard grayscale examination. Measurements were performed at 5 or more points of the spleen parenchyma at least 4—5 mm away from the capsular zone and the zone of large vessels. Based on the morphometric measurements obtained, the mass, spleen mass coefficient (SMC), as well as the spleen mass/body height ratio and spleen mass/body surface area ratio were calculated. Results. We found that patients with infectious mononucleosis had the length, thickness and weight of the spleen significantly greater than those observed in control group. However, the mass of the spleen varies widely and justified to calculate the CMS as an objective criterion to assess the size of the spleen. It was revealed that infectious mononucleosis may proceed in one of the three variants of the splenic response: decreased size, CMR < 1.5; normal size, CMR ranged from 1.5 to 4; splenomegaly, CMR > 4. Splenomegaly is associated with increased organ stiffness, peak blood flow velocity and pressure in v. lienalis, as well as periportal lymphadenopathy. Identified changes are characteristics of young patients. Conclusion. Ultrasound examination of the spleen is of high diagnostic value for patients with infectious mononucleosis allowing highly accurate assessment state of the immune organs in the acute disease period. At the preclinical stage, gradation of splenomegaly is possible depending on its intensity, assessed hemodynamics and organ stiffness.

About the authors

S. A. Perepelitsa

Imannuel Kant Baltic Federal University; V.A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology

Author for correspondence.
Email: sveta_perepeliza@mail.ru
ORCID iD: 0000-0002-4535-9805

Svetlana A. Perepelitsa - PhD, MD (Medicine), Professor of the Department of Surgery, Imannuel Kant Baltic Federal University; Leading Researcher, Laboratory of Cell Pathology in Critical Conditions, V.A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology.

236041, Kaliningrad, A. Nevskiy str., 14.

Phone: +7 (401) 246-15-30

Russian Federation

L. A. Perminova

Imannuel Kant Baltic Federal University

Email: perminova72@mail.ru

PhD (Medicine), Associate Professor, Department of Therapy, Imannuel Kant Baltic Federal University.

Kaliningrad.

Russian Federation

I. A. Stepanyan

Imannuel Kant Baltic Federal University; Infectional Hospital of the Kaliningrad Region

Email: lublumedicinu@mail.ru

PhD Student, Assistant, Department of Fundamental Medicine, Imannuel Kant Baltic Federal University; Doctor of Ultrasound Diagnostics, Infectional Hospital of the Kaliningrad Region.

Kaliningrad.

Russian Federation

E. V. Zakhar

Infectional Hospital of the Kaliningrad Region

Email: nf-bol@infomed39.ru

Infectious Disease Doctor, 1st Infectious Department, Infectional Hospital of the Kaliningrad Region.

Kaliningrad.

Russian Federation

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Copyright (c) 2020 Perepelitsa S.A., Perminova L.A., Stepanyan I.A., Zakhar E.V.

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