Ultrasound measurement of splenic length is standard practice, but it is not known how well this represents the true size of the spleen. Previous studies, using a combination of measurements from in vivo and resected spleens, were subject to error because of changes in splenic size. The aim of this study was to correlate the dimensions of the spleen measured by ultrasound with the splenic volume measured by helical CT. Ultrasound examination was performed on 50 adult patients at the time of their attendance for abdominal CT. Linear dimensions of the spleen were measured with the patient first in the supine and then in the right lateral decubitus (RLD) position. The splenic volume was calculated from a three-dimensional reconstruction of the CT images. There was good correlation, using Spearman's rank correlation, between ultrasound measurements and CT volumes with correlation coefficients exceeding 0.7 for all parameters except one. The linear measurement that correlated most closely with CT volume was the spleen width measured on a longitudinal section with the patient in the RLD position (correlation coefficient (r)=0.89, p<0.001). There was also good correlation between splenic length measured in the RLD position and CT volume (r=0.86, p<0.001). We conclude that a good correlation exists between in vivo ultrasound assessment of splenic size and true splenic volume. The most accurate single measurement is spleen width measured on a longitudinal section with the patient in the RLD position. However, measurement of splenic length, which is the most commonly used in clinical practice, also correlates well with splenic volume, particularly when performed with the patient in the RLD position.
Shrinkage of a massive, highly invasive, longstanding (probably 40 years) prolactin-secreting pituitary tumour is described in which tumour volume was reduced by 40% 8 d after beginning bromocriptine treatment. After 4 months of treatment the tumour was only 11% of the pretreatment volume and by 8 months it was further reduced in size being confined to the pituitary fossa, which was partially empty. Reduction in tumour volume was accompanied by a gradual reduction in serum prolactin concentrations to normal values at 4 months. Between 4 and 18 months serum prolactin has remained normal on 5 mg of bromocriptine daily. Visual function improved within 48 h of starting bromocriptine and was almost normal by 6 d. CSF rhinorrhoea developed as the tumour shrank and was successfully managed with the relatively minor procedure of a diversionary lumbo-peritoneal shunt. Bromocriptine should be considered as the initial treatment of choice for massive invasive prolactinomas because of the significant risk of morbidity from neurosurgical treatment.
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