86 Decreased-Attenuation Masses in the Spleen

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig GI 86-1 Congenital splenic cyst. Large, low-density mass with pencil-sharp margins filling almost all of the spleen.181

• Fig GI 86-2 Echinococcal cyst. Rounded, low-density intrasplenic mass with an area of intracyst calcification (solid arrow). The cyst has pencil-sharp margins and a rim (open arrows) that is enhanced after the injection of contrast material.181

Fig GI 86-3 Infarction. Wedged-shaped, low-attenuation lesion (arrow) in the periphery of the spleen. (S, stomach; L, liver.)95

• Fig GI 86-4 Autoinfarction of the spleen in a 56-year-old woman with sickle cell disease. Nonenhanced scan of the upper abdomen reveals a small, densely calcified spleen.182

• Fig GI 86-5 Traumatic subcapsular hematoma. Contrast-enhanced scan shows the hematoma as a large zone of decreased attenuation (arrowheads) that surrounds and flattens the lateral and anteromedial borders of the adjacent spleen (S).183

Fig GI 86-6 Traumatic subcapsular splenic abscess. The abscess (a) appears as an area of diminished attenuation in the center of spleen.184

• Fig GI 86-7 Fungal abscesses. Multiple low-attenuation lesions within the spleen in an immunocompromised patient

• Fig GI 86-8 Pyogenic abscess. Enlarged spleen containing a massive amount of air. The presence of perisplenic air and fluid indicates rupture of the spleen (straight solid arrow). The inflammation extends into the adjacent perisplenic fat (open arrow). Note the retroperitoneal air adjacent to the right adrenal gland (curved solid arrow).182

Fig GI 86-9 Lymphoma. Focal low-attenuation lesion (arrowheads) posteriorly in a markedly enlarged spleen.183

• Fig GI 86-10 Lymphoma. Multiple discrete low-attenuation lesions in an enlarged spleen.126

• Fig GI 86-11 Metastases from melanoma. Multiple confluent lesions, with necrotic central areas showing a cystic appearance. The liver is not involved.89

• Fig GI 86-12 Metastases. Three discrete low-attenuation lesions (arrowheads) in the spleen (S). (L, liver.)95

• Fig GI 86-13 Kaposi's sarcoma. (A) Contrast CT scan shows an ill-defined, wedge-shaped hypoattenuating lesion (arrow) in the spleen. Note also the enhancing enlarged nodes in the region of the lesser curvature of the stomach. (B) In another patient, there are multiple tiny nodules in the spleen. (Courtesy of Diego Aguirre, M.D., Department of Radiology, Fundacion Santa Fe de Bogota, Bogota, Columbia.)185

Fig GI 86-14 Angiosarcoma. Noncontrast scan shows multiple splenic masses that have increased attenuation reflecting previous hemorrhage.182

• Fig GI 86-15 Angiosarcoma with liver metastases. (A) Axial T1-weighted MR image shows a dominant splenic mass with a central area of high signal intensity, a finding consistent with hemorrhage. The liver metastases also demonstrate high-signal-intensity hemorrhage. (B) T2-weighted MR image shows mixed high signal intensity in the splenic mass and liver metastases.186

• Fig GI 86-16 Cavernous hemangioma. (A) Contrast scan shows a well-defined intrasplenic mass with peripheral enhancement surrounding areas of nonenhancement (*). (B) In another patient, an axial T1-weighted MR image shows a large hypointense mass completely replacing the spleen. Several foci of high signal intensity (arrow) within the mass probably represent hemorrhage.187

• Fig GI 86-17 Multiple hemangiomas. (A) Contrast scan shows multiple densely enhancing masses (arrows). (B) In a young boy with Klippel-Trebaunay syndrome and worsening left upper quadrant pain, an axial T2-weighted MR image shows several high-intensity masses (arrow).187

• Fig GI 86-18 Hamartoma. (A) Contrast CT scan shows heterogeneous enhancement of the mass (arrows), which was discovered incidentally. (B) In another patient, a T2-weighted MR image shows a mass that is slightly hyperintense relative to the normal splenic parenchyma. (C) A T1-weighted image after contrast administration shows homogeneous enhancement of the mass.187

• Fig GI 86-19 Lymphangiomatosis. Low-density, nonenhancing cystic areas within an enlarged spleen. Note the calcification in the posterior aspect of the spleen.188

• Fig GI 86-20 Littoral cell angioma. (A) Contrast CT scan shows an enlarged spleen containing innumerable hypoattenuating masses. (B) In a different patient, a T2-weighted MR image shows multiple hypointense masses (arrow) adjacent to the normally bright splenic parenchyma.

• Fig GI 86-21 Intrasplenic pseudocyst. Enhanced scan demonstrates extension of a pancreatic tail pseudocyst into the spleen. Note the mild peripancreatic inflammation and extensive pancreatic calcification.182

• Fig GI 86-22 (A) Sarcoidosis. Contrast-enhanced scan in an asymptomatic man obtained during the hepatic parenchymal phase shows multiple discrete nodules throughout the spleen. The liver nodules are faintly visualized.113 (B) In this patient, there are innumerable small hypoattenuating nodules.189

• Fig GI 86-23 Gaucher's disease. Multiple discrete nodules of decreased enhancement corresponding to local deposits of glucocerebroside in reticuloendothelial cells.190

• Fig GI 86-24 Peliosis. Multiple rounded, low-attenuation lesions of different sizes throughout the splenic parenchyma. Preoperatively, these lesions were thought to be intrasplenic hematomas. The hemoperitoneum (*) occurred secondary to trauma and was unrelated to the splenic peliosis.191