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Abnormal findings that may be appreciated during the POCUS spleen examination include the four features mentioned above: subjective evaluation of size (splenomegaly), changes in echogenicity (evaluation for diffuse parenchyma disorders), presence of mass lesions (solitary and multifocal mass lesions), and assessment of vasculature (thrombosis and torsion).

Figure 9.4. Normal appearance of spleen. Spleen by itself showing its homogeneous nature with normal echogenicity. The anechoic areas (circular) are normal vasculature and readily appreciated in real time evidenced by their branching. The splenic capsule is recognized as a hyperechoic (bright white) line.

Pearl: The four key features to evaluate with the focused spleen examination are size, echogenicity, presence of nodules or masses and assessment of the vasculature.