spleen scan

Liver and Spleen Scan

Synonym/acronym: Liver and spleen scintigraphy, radionuclide liver scan, spleen scan.

Common use

To visualize and assess the liver and spleen related to tumors, inflammation, cysts, abscess, trauma, and portal hypertension.

Area of application

Abdomen.

Contrast

IV radioactive technetium-99m sulfur colloid.

Description

The liver and spleen scan is performed to help diagnose abnormalities in the function and structure of the liver and spleen. It is often performed in combination with lung scanning to help diagnose masses or inflammation in the diaphragmatic area. This procedure is useful for evaluating right-upper-quadrant pain, metastatic disease, jaundice, cirrhosis, ascites, traumatic infarction, and radiation-induced organ cellular necrosis. Technetium-99m (Tc-99m) sulfur colloid is injected IV and rapidly taken up through phagocytosis by the reticuloendothelial cells, which normally function to remove particulate matter, including radioactive colloids in the liver and spleen. False-negative results may occur in patients with space-occupying lesions (e.g., tumors, cysts, abscesses) smaller than 2 cm. This scan can detect portal hypertension, demonstrated by a greater uptake of the radionuclide in the spleen than in the liver. Single-photon emission computed tomography (SPECT) has significantly improved the resolution and accuracy of liver scanning. SPECT enables images to be recorded from multiple angles around the body and reconstructed by a computer to produce images or “slices” representing the organ at different levels. For evaluation of a suspected hemangioma, the patient’s red blood cells are combined with Tc-99m and images are recorded over the liver. To confirm the diagnosis, liver and spleen scans are done in conjunction with computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), and SPECT scans and interpreted in light of the results of liver function tests.

This procedure is contraindicated for

  • high alert Patients who are pregnant or suspected of being pregnant, unless the potential benefits of a procedure using radiation far outweigh the risk of radiation exposure to the fetus and mother.

Indications

  • Assess the condition of the liver and spleen after abdominal trauma
  • Detect a bacterial or amebic abscess
  • Detect and differentiate between primary and metastatic tumor focal disease
  • Detect benign tumors, such as adenoma and cavernous hemangioma
  • Detect cystic focal disease
  • Detect diffuse hepatocellular disease, such as hepatitis and cirrhosis
  • Detect infiltrative processes that affect the liver, such as sarcoidosis and amyloidosis
  • Determine superior vena cava obstruction or Budd-Chiari syndrome
  • Differentiate between splenomegaly and hepatomegaly
  • Evaluate the effects of lower abdominal trauma, such as internal hemorrhage
  • Evaluate jaundice
  • Evaluate liver and spleen damage caused by radiation therapy or toxic drug therapy
  • Evaluate palpable abdominal masses

Potential diagnosis

Normal findings

  • Normal size, contour, position, and function of the liver and spleen

Abnormal findings related to

  • Abscesses
  • Cirrhosis
  • Cysts
  • Hemangiomas
  • Hematomas
  • Hepatitis
  • Hodgkin’s disease
  • Infarction
  • Infection
  • Infiltrative process (amyloidosis and sarcoidosis)
  • Inflammation of the diaphragmatic area
  • Metastatic tumors
  • Nodular hyperplasia
  • Portal hypertension
  • Primary benign or malignant tumors
  • Traumatic lesions

Critical findings

  • Visceral injury

  • It is essential that a critical finding be communicated immediately to the requesting health-care provider (HCP). A listing of these findings varies among facilities.

  • Timely notification of a critical finding for lab or diagnostic studies is a role expectation of the professional nurse. Notification processes will vary among facilities. Upon receipt of the critical value the information should be read back to the caller to verify accuracy. Most policies require immediate notification of the primary HCP, Hospitalist, or on-call HCP. Reported information includes the patient’s name, unique identifiers, critical value, name of the person giving the report, and name of the person receiving the report. Documentation of notification should be made in the medical record with the name of the HCP notified, time and date of notification, and any orders received. Any delay in a timely report of a critical finding may require completion of a notification form with review by Risk Management.

Interfering factors

  • Factors that may impair clear imaging

    • Inability of the patient to cooperate or remain still during the procedure because of age, significant pain, or mental status.
    • Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images.
    • Other nuclear scans done within the preceding 24 to 48 hr.

  • Other considerations

    • The scan may fail to detect focal lesions smaller than 2 cm in diameter.
    • Improper injection of the radionuclide may allow the tracer to seep deep into the muscle tissue, producing erroneous hot spots.
    • Consultation with a health-care provider (HCP) should occur before the procedure for radiation safety concerns regarding younger patients or patients who are lactating. Pediatric & Geriatric Imaging Children and geriatric patients are at risk for receiving a higher radiation dose than necessary if settings are not adjusted for their small size. Pediatric Imaging Information on the Image Gently Campaign can be found at the Alliance for Radiation Safety in Pediatric Imaging (www.pedrad.org/associations/5364/ig/).
    • Risks associated with radiation overexposure can result from frequent x-ray or radionuclide procedures. Personnel working in the examination area should wear badges to record their level of radiation exposure.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this procedure can assist in evaluating liver and spleen function.
  • Obtain a history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or sensitivities to latex, anesthetics, sedatives, or radionuclides.
  • Obtain a history of the patient’s hematopoietic, hepatobiliary, and immune systems; symptoms; and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Note any recent procedures that can interfere with test results, including examinations using iodine-based contrast medium.
  • Record the date of the last menstrual period and determine the possibility of pregnancy in perimenopausal women.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Address concerns about pain related to the procedure and explain that some pain may be experienced during the test, or there may be moments of discomfort. Reassure the patient that the radionuclide poses no radioactive hazard and rarely produces side effects. Inform the patient the procedure is performed in a nuclear medicine department by an HCP specializing in this procedure, with support staff, and takes approximately 30 to 60 min.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Explain that an IV line may be inserted to allow infusion of IV fluids such as normal saline, anesthetics, sedatives, radionuclides, medications used in the procedure, or emergency medications.
  • Instruct the patient to remove jewelry and other metallic objects from the area to be examined.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.
  • Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.

Intratest

  • Potential complications:

  • Although it is rare, there is the possibility of allergic reaction to the radionuclide. Have emergency equipment and medications readily available. If the patient has a history of allergic reactions to any substance or drug, administer ordered prophylactic steroids or antihistamines before the procedure.

  • Establishing an IV site and injection of radionuclides is an invasive procedure. Complications are rare but do include bleeding from the puncture site related to a bleeding disorder, or the effects of natural products and medications known to act as blood thinners, hematoma related to blood leakage into the tissue following needle insertion, infection that might occur if bacteria from the skin surface is introduced at the puncture site, or nerve injury that might occur if the needle strikes a nerve.

  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
  • Ensure that the patient has removed all external metallic objects from the area to be examined prior to the procedure.
  • Administer ordered prophylactic steroids or antihistamines before the procedure if the patient has a history of allergic reactions to any substance or drug.
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Have emergency equipment readily available.
  • Instruct the patient to void prior to the procedure and to change into the gown, robe, and foot coverings provided.
  • Record baseline vital signs and assess neurological status. Protocols may vary among facilities.
  • Establish an IV fluid line for the injection of saline, anesthetics, sedatives, radionuclides, or emergency medications.
  • Instruct the patient to cooperate fully and to follow directions. Instruct the patient to remain still throughout the procedure because movement produces unreliable results.
  • Administer sedative to a child or to an uncooperative adult, as ordered.
  • Place the patient in a supine position on a flat table with foam wedges, which help maintain position and immobilization.
  • IV radionuclide is administered, and the abdomen is scanned immediately to screen for vascular lesions with images taken in various positions.
  • Monitor the patient for complications related to the procedure (e.g., allergic reaction, anaphylaxis, bronchospasm).
  • Remove the needle or catheter and apply a pressure dressing over the puncture site.
  • Observe/assess the needle/catheter insertion site for bleeding, inflammation, or hematoma formation.
  • The patient may be imaged by SPECT techniques to further clarify areas of suspicious radionuclide localization.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Instruct the patient to resume usual medication and activity, as directed by the HCP.
  • Unless contraindicated, advise patient to drink increased amounts of fluids for 24 to 48 hr to eliminate the radionuclide from the body. Inform the patient that radionuclide is eliminated from the body within 6 to 24 hr.
  • No other radionuclide tests should be scheduled for 24 to 48 hr after this procedure.
  • Instruct the patient in the care and assessment of the injection site.
  • If a woman who is breastfeeding must have a nuclear scan, she should not breastfeed the infant until the radionuclide has been eliminated. This could take as long as 3 days. She should be instructed to express the milk and discard it during the 3-day period to prevent cessation of milk production.
  • Instruct the patient to immediately flush the toilet and to meticulously wash hands with soap and water after each voiding for 24 hr after the procedure.
  • Instruct all caregivers to wear gloves when discarding urine for 24 hr after the procedure. Wash gloved hands with soap and water before removing gloves. Then wash hands after the gloves are removed.
  • Nutritional Considerations: A low-fat, low-cholesterol, and low-sodium diet should be consumed to reduce current disease processes. High fat consumption increases the amount of bile acids in the colon and should be avoided.
  • Recognize anxiety related to test results, and be supportive of perceived loss of independent function. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be needed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include ALT, antibodies antimitochondrial, AST, bilirubin, biopsy liver, CT abdomen, CT biliary tract and liver, GGT, HAV, HBV, HCV, hepatobiliary scan, MRI abdomen, and US liver.
  • Refer to the Hematopoietic, Hepatobiliary, and Immune systems tables at the end of the book for related tests by body system.