Case report: hepatic and splenic calcification due to amyloid

Pancreatic islet cell amyloidosis manifesting as a large pancreas

A 39-year-old female patient presented to our hospital with epigastric pain lasting for two months. Laboratory results showed impaired glucose tolerance. Ultrasonography of the patient showed a hypoechoic, diffusely enlarged pancreas. CT revealed a large pancreas, with multiple calcifications. On MRI, a diffusely enlarged pancreas was seen hypointense on both T1- and T2-weighted images with heterogeneous enhancement after gadolinium administration. A biopsy of the pancreas revealed primary amyloidosis of islet cells. Decreased signal on T1-weighted images without inflammation findings on CT and MRI were clues for the diagnosis.

Primary hepatic amyloidosis: report of an unusual case presenting as a mass

Hepatic involvement of amyloidosis is common. Diffuse infiltration with hepatomegaly is a usual radiologic finding of hepatic amyloidosis. To our knowledge, this is the first case of amyloidosis involving the liver that presented as a mass.

Splenic hypoperfusion as a sign of systemic amyloidosis

BACKGROUND

The spleen is frequently involved in systemic amyloidosis; however, the computed tomographic (CT) or magnetic resonance (MR) pattern of splenic amyloidosis is not sufficiently described in the literature. This study evaluated the contrast-enhanced CT and MR findings of the spleen in patients with systemic amyloidosis.

METHODS

Data were extracted by reviewing pathology and radiology department records of the teaching hospital of Naples over 10 years, from 1 January 1993 to 31 December 2002. Thirty-three patients with amyloidosis were identified, 10 of whom had a CT scan and two of whom had an MR study. The population-based study was composed of 12 patients with histologically proved amyloidosis who underwent contrast-enhanced CT or MR scan of the abdomen. The spleen and liver were evaluated for organ size and perfusion.

RESULTS

The spleen was hypoperfused in nine of 12 patients. Mild splenomegaly was present in only one case. Hepatomegaly was associated with markedly acute left lobe margin in nine patients and with rounded anterior profile of segments 3 and 4 in four patients. Moreover, a large area of low attenuation with indefinite geographic margins involving the right hepatic lobe was observed in three patients.

CONCLUSION

The finding of splenic hypoperfusion may be a marker of systemic amyloidosis, which represents a useful clue when clinical findings fail to suggest the proper diagnosis.

Abdominal amyloidosis: spectrum of radiological findings

Amyloidosis is a disease characterized by the deposition of fibrillar protein amyloid of beta-structure in organs or tissues. It is usually classified as either a primary disease or secondary to a co-existent condition, such as rheumatoid arthritis, tuberculosis, or neoplasm (particularly multiple myeloma or renal cell carcinoma). Amyloid protein deposition can be seen in a variety of organs though it occurs with higher frequency in the gastrointestinal tract, kidney, and heart. Amyloidosis can have a wide spectrum of manifestations in nearly every abdominal organ. Some of these, for example, multiple cystic submucosal masses of the stomach, amyloidosis of the gallbladder, and dirty soft tissue infiltration of the subcutaneous fat, have not yet been covered in the radiological literature. The combination of various imaging techniques and the identification of characteristic computed tomography (CT) hepatic features may help in the differentiation of amyloidosis from other infiltrative diseases; however, confirmative diagnosis can usually only be achieved by tissue biopsy.

Calcificações hepáticas: freqüência e significado

OBJETIVO: Avaliar a freqüência e a origem de calcificações hepáticas identificadas na tomografia computadorizada (TC). MATERIAIS E MÉTODOS: Estudo retrospectivo de 1.362 exames consecutivos de TC do abdome, para determinar a freqüência de calcificações hepáticas. Foram revistos os prontuários clínicos, no sentido de estabelecer a origem das calcificações. RESULTADOS: Observaram-se calcificações intra-hepáticas em 3,6% (49/1.362) dos exames. Houve predominância no sexo feminino (57,2%) sobre o masculino (42,8%), e a idade dos pacientes variou de 18 a 92 anos (média: 59,4; mediana: 63,5). A maioria das calcificações (39/49; 79,5%) foi de origem residual e sem repercussão clínica, 14,4% (7/49) estavam associadas a metástases hepáticas e 6,1% (3/49) estavam associadas a lesões císticas. Foram observadas sete lesões metastáticas calcificadas, sendo cinco por neoplasia de cólon, uma por sarcoma e uma por teratoma maligno de ovário. Dessas metástases, duas apresentaram calcificações após tratamento quimioterápico. CONCLUSÃO: As calcificações hepáticas são de baixa prevalência em exames tomográficos (< 5%) e são mais freqüentemente de origem residual por processos infecciosos e inflamatórios pregressos.

A case with primary amyloidosis of the liver and spleen: radiologic findings

A case with primary amyloidosis of the liver and spleen is presented. In the liver, ultrasonography showed heterogeneous echogenicity. Portal phase CT showed heterogeneous enhancement, and delayed phase CT showed delayed enhancement with focal hypoattenuating areas. Bone scintigraphy showed diffuse accumulation. In the spleen, arterial phase CT showed the lack of parenchymal enhancement, and T2-weighted MR imaging showed decreased signal intensity. The combination of imaging findings of the liver and spleen was suggestive of amyloidosis.

Abdominal CT findings in nephropathic amyloidosis of familial Mediterranean fever

To evaluate the abdominal CT features of reactive amyloidosis, abdominal CT scans of 20 patients with amyloidosis of familial Mediterranean fever (FMF) were reviewed and compared with abdominal CT scans of 2 control groups: 22 patients with chronic renal failure (CRF) due to non-amyloidotic kidney diseases and 40 patients with normal kidney function. The kidney size of patients with amyloidosis of FMF were found to vary during the course of the disease from normal or slightly larger than normal at the proteinuric phase, to smaller than normal and comparable to kidney size in CRF, at the uremic stage. Compared to kidney disease of other causes, more patients with FMF-amyloidosis had dense kidneys with coarse parenchymal calcification and calcification in other abdominal organs. Patients with FMF-amyloidosis had fewer aortic calcifications than patients with non-amyloidotic kidney disease. These findings suggest that kidney disease of reactive amyloidosis may have abdominal CT findings distinguishing it from other types of kidney diseases.

Abdominal visceral calcification in secondary amyloidosis: CT findings

Amyloid fibrils have an affinity for calcium, and radiographically detectable calcified amyloid deposits may occur in both primary and secondary amyloidosis. However, abdominal visceral calcification is rare. A patient with secondary amyloidosis due to juvenile rheumatoid arthritis is described who developed extensive liver, adrenal, and renal calcification shown by computed tomography. Adrenal calcification in amyloidosis has not been previously described.