Henrique Rodrigues; Pedro Belo Oliveira; Paulo Donato; Filipe Caseiro-Alves

Henrique Rodrigues; Pedro Belo Oliveira; Paulo Donato; Filipe Caseiro-Alves

Splenic sarcoidosis

Author(s)

Henrique Rodrigues; Pedro Belo Oliveira; Paulo Donato; Filipe Caseiro-Alves

Patient

female, 43 year(s)

Clinical Summary

We report a case of a 43 years old female with a diagnosis of chronic idiopathic hepatitis made by liver biopsy, without alterations on initial radiological examinations. Later ultrasound, showed multiple solid splenic nodules, with a echoic central spot, that were hypovascular in CT. New biopsy confirmed sarcoidosis.

Clinical History and Imaging Procedures

Our patient was a 43 years old female with complaints of malaise, back pain for six mouths, associated with persistent elevation of serum liver enzymes, with negative serology for infectious agents, auto-antibodies and without radiological manifestations. Liver biopsy stated the presence of a chronic idiopathic hepatitis. Due to the clinical deterioration, she performed a new ultrasound that depicted multiple solid hypoechoic splenic nodules, measuring 1cm, with a tiny echoic central spot. There were no changes in the liver or abdominal lymphadenopathy (Fig 1). Abdominal CT confirmed the presence of splenic solid hypovascular nodules (Fig 2). In a new biopsy, pathologist described the presence of noncaseating Langerhans cells, and suggested the presence of a Sarcoidosis. After corticosteroids prescription there was an excellent clinical and laboratorial improvement, and nowadays the patient is perfectly well.

Discussion

Sarcoidosis is a multisystem granulomatous disease of unknown cause, characterized by the presence of noncaseating epithelioid granulomas that can affect all organs [1]. Has a higher incidence in females, blacks, and between 20 to 40 years [1]. Thoracic involvement is the must prevalent form, and radiological manifestations include lymphadenopathy (usually garland triad- right paratracheal, right and left hilar groups) and/ or parenchymal disease, that can be expressed by irregular septal thickening, perilymphatic nodules, ground glass opacity, traction bronchiectasis and honeycombing [2]. Skin, eye, lymph nodes, spleen and liver and joints are also greatly affected. Liver and spleen can be diffusely enlarged and/or can have solid nodules corresponding to granulomas. These nodules are hypoechoic and have small punctate areas of increased echogenicity [3]. In CT they are hypovascular without any distinguishing feature [4]. Biopsy of the lesions can confirm the diagnosis and treatment is mainly with corticosteroids [5]. Activity can be accessed through ACE titer; bronchopulmonary lavage and Gallium scan [5].

Final Diagnosis

Sarcoidosis

MeSH

  1. Liver [A03.620]
  2. Spleen [A15.382.520.604.700]
  3. Splenic Diseases [C15.604.744]

References

  1. [1]

1.Crystal RG. Sarcoidosis. Chap 318, pp. 1969-1973. Braunwald, E; Harrison´s Principles of Internal Medicine, New York, 2001.

  1. [2]

2.C Shaefer-Prokop, Mathias Prokop. Lungs and Tracheobronchial System. Chap 9: 350. Spiral and Multislice Computed Tomography of the body. Mathias Prokop, Michael Galanski. Thieme. Stuttgart-New York 2003

  1. [3]

3.Middleton W, Kurtz A, Hertzberg. The Requisits: Ultrasound. Mosby, 2004; 209-220.

  1. [4]

4.C Shaefer-Prokop, Mathias Prokop. The Spleen. Chap 13: 508. Spiral and Multislice Computed Tomography of the body. Mathias Prokop, Michael Galanski. Thieme. Stuttgart-New York 2003

  1. [5]

5.Weissleder R, Wittenberg J, Harisinghani M. Primer of Diagnostic Imaging, third edition. Mosby, 2003; 35-36.

Citation

Henrique Rodrigues; Pedro Belo Oliveira; Paulo Donato; Filipe Caseiro-Alves (2005, Jun 19).

Splenic sarcoidosis, {Online}.

URL:

DOI: 10.1594/EURORAD/CASE.3820

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  • Published 19.06.2005
  • DOI 10.1594/EURORAD/CASE.3820
  • SectionLiver, Biliary System, Pancreas, Spleen
  • Case-TypeClinical Case
  • Views 76
  • Language(s)
  • Figure 1

Abdominal Ultrasound

Spleen of normal size, with multiple solid nodules measuring around 1 cm, with a central hyperechoic spot

  • Figure 2

Abdominal CT

Liver and spleen of normal size; absence of lymphadenopathy in the region of celiac trunk; multiple solid hypovascular nodules in spleen parenchyma

Figure 1

Abdominal Ultrasound

Spleen of normal size, with multiple solid nodules measuring around 1 cm, with a central hyperechoic spot

Figure 2

Abdominal CT

Liver and spleen of normal size; absence of lymphadenopathy in the region of celiac trunk; multiple solid hypovascular nodules in spleen parenchyma

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