Ultrasonography of whole abdomen pain left upper quadrant patient 22 year old Male, Indian, Leen thin body
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Whole Abdomen Ultrasonography — Interpretation Report
Patient: Mondol Sujal | Male | DOB: approx. 2004 (22 yrs) | Indian | Lean/thin body habitus
Exam Date: 05-05-2026 | Operator: Dr. Bithi | Institution: Gazi Medical College
Image-by-Image Findings
Panel 1 — Top Left (Gallbladder / Right Upper Quadrant, 03:17:57 PM)
- Two images showing a cystic structure in the RUQ
- Measurements: D1 = 2.43 cm, D2 = 3.81 cm, D3 = 2.78 cm, Volume = ~13.81 mL
- Appearance: Small-to-normal sized gallbladder; no obvious intraluminal echogenic foci (stones) visible at this resolution
- Wall appears thin — no obvious cholecystitis features
Panel 2 — Top Right (Spleen, 03:18:25 PM)
- A single large measurement: 1D = 14.19 cm
- This represents the craniocaudal (bipolar) length of the spleen
- The spleen is enlarged — normal upper limit by ultrasound is 12 cm
- 🔴 SPLENOMEGALY CONFIRMED (14.19 cm is ~2 cm above the upper limit of normal)
- Echotexture appears homogeneous without focal lesions visible
Panel 3 — Middle Left (Liver, 03:19:40 PM)
- Liver measurements: 1D = 10.47 cm, 2D = 4.91 cm, 3D = 10.88 cm, 4D = 5.21 cm
- These represent oblique/longitudinal liver dimensions
- A measurement of ~10–10.88 cm is at the upper limit of normal for mid-clavicular liver span in a young lean adult (normal: 10–12 cm mid-clavicular)
- Parenchymal echotexture needs reporting — at this resolution no overt increased echogenicity (fatty change) or nodularity is clearly visible
Panel 4 — Middle Right (Right Kidney / Another structure, 03:21:22 PM)
- Shows a structure measuring 1D = 10.65 cm
- Likely the right kidney in longitudinal axis — 10.65 cm is within normal range (9–12 cm)
- Normal cortical echogenicity; no obvious hydronephrosis or mass
Panel 5 — Bottom Left (Kidney / Perisplenic area, 03:35:29 PM)
- Two images showing an organ with multiple faint bright foci / calcific spots in the lower image
- The lower image suggests possible nephrocalcinosis or renal calculi (bright echogenic foci with or without shadowing)
- May also represent the left kidney
Key Findings Summary
| Finding | Value | Normal | Significance |
|---|---|---|---|
| Spleen length (bipolar) | 14.19 cm | ≤ 12 cm | 🔴 Splenomegaly |
| Gallbladder volume | ~13.81 mL | 10–30 mL | ✅ Normal (non-fasting may vary) |
| Liver span | ~10.47–10.88 cm | 10–12 cm | ✅ Upper normal / borderline |
| Right kidney | 10.65 cm | 9–12 cm | ✅ Normal |
| Renal foci (bottom panel) | Echogenic foci | None expected | ⚠️ Possible calculi / nephrocalcinosis |
Clinical Significance — Splenomegaly in a 22-Year-Old Indian Male
A spleen >12 cm by US is diagnostic of splenomegaly. In a young Indian male presenting with left upper quadrant pain, the differential diagnosis includes:
High Priority (India-specific, tropical)
| Cause | Supporting Features to Look For |
|---|---|
| Malaria (Plasmodium vivax or falciparum) | Fever, chills, travel history, peripheral smear |
| Visceral Leishmaniasis (Kala-azar) | Massive splenomegaly, fever, weight loss, darkening skin |
| Typhoid / Enteric fever | Fever for >1 week, rose spots, elevated WBC |
| Infectious mononucleosis (EBV) | Sore throat, lymphadenopathy, atypical lymphocytes |
| Hepatitis B/C with portal hypertension | Liver echogenicity changes, varices |
Hematologic
| Cause | Note |
|---|---|
| Chronic Myeloid Leukemia (CML) | Young adult, massive splenomegaly, high WBC; must exclude |
| Lymphoma (Hodgkin's / NHL) | Lymphadenopathy, constitutional symptoms |
| Hereditary spherocytosis / hemolytic anemia | Jaundice, anemia, family history |
| Thalassemia | Indian subcontinent high prevalence |
Hepatic / Portal
- Portal hypertension from any cause (cirrhosis, portal vein thrombosis)
- Budd-Chiari syndrome
Recommended Workup
Based on the ultrasound and clinical context (22M, Indian, LUQ pain, lean build):
- CBC with peripheral blood smear — blast cells, atypical lymphocytes, evidence of hemolysis
- Malarial antigen test / thick and thin smear — most urgent in India
- Liver function tests (bilirubin, ALT, AST, ALP, albumin)
- Hepatitis B surface antigen, Hepatitis C antibody
- LDH, uric acid, reticulocyte count
- CML screen: BCR-ABL (Philadelphia chromosome) if WBC elevated
- rK39 antigen test for Kala-azar if from endemic zone (Bihar, Jharkhand, UP, West Bengal)
- EBV serology (Monospot / VCA IgM) if pharyngitis/lymphadenopathy present
- Repeat abdominal US with Doppler to assess portal vein flow and diameter
Note on Body Habitus
In a lean/thin 22-year-old, the spleen is typically very well visualized and not displaced. A measured bipolar length of 14.19 cm is genuinely enlarged — it cannot be attributed to body habitus artifact. The finding of splenomegaly in this context must be taken seriously and warrants urgent investigation to rule out hematologic malignancy and tropical infections.
Grainger & Allison's Diagnostic Radiology: "There is wide variation in normal spleen size, but a 12-cm maximal craniocaudal length is commonly used as a threshold for splenomegaly."
Yamada's Textbook of Gastroenterology: "The differential diagnosis [for LUQ pain] includes pathology of the spleen, stomach, pancreas, left kidney, and left colon, in addition to extraabdominal processes."
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