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Sambon P, Sellimi A, Kozyreff A, Gheysens O, Pothen L, Yildiz H, van Pesch V. Epidemiology, clinical presentation, treatment, and outcome of neurosarcoidosis: A mono-centric retrospective study and literature review. Front Neurol 2022; 13:970168. [PMID: 36388212 PMCID: PMC9641157 DOI: 10.3389/fneur.2022.970168] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/30/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Neurosarcoidosis is a rare granulomatous disorder, and treatment guidelines are mainly based on retrospective studies. Materials and methods This retrospective study was performed to provide a detailed description of the clinical characteristics and treatment outcomes of patients with neurosarcoidosis followed at Cliniques Universitaires Saint Luc in Belgium. The second objective of our study was to perform a comparative literature review of neurosarcoidosis, with a focus on treatment outcomes with the use of TNF-α antagonist. Results Among 180 patients with sarcoidosis followed in our hospital, 22 patients with neurosarcoidosis were included in the final analysis. Our literature research identified 776 articles of which 35 articles met our inclusion criteria, including 1,793 patients diagnosed with neurosarcoidosis. In our cohort, the majority of patients (86%) were diagnosed with systemic sarcoidosis which was similar to that reported in the literature (83%). Serum CRP and calcemia were elevated only in 33 and 18% of patients, respectively. Serum lysozyme and angiotensin-converting enzyme were elevated in 79 and 16% of patients, respectively. Lumbar puncture and CSF fluid analysis were performed in 15/22 patients and were abnormal in all patients. Brain MRI was performed in 21/22 patients and showed abnormalities in 16 patients consisting of parenchymal lesions in 63%, hypothalamic-pituitary axis lesions in 38%, and meningeal enhancement in 31%. In both cohort patients, methotrexate was the most frequently used treatment (>45% of cases) with a favorable outcome in an average of 50% of patients. A TNF-α antagonist was administered in 9% of patients in our cohort and in 27% of patients in the literature review. The proportion of favorable outcomes in literature research was significantly higher in patients treated with TNF-α antagonists compared to methotrexate (p < 0.0001), mycophenolate mofetil (p < 0.0001), or azathioprine (p < 0.0001). Conclusion The results of our cohort and literature review confirm that neurosarcoidosis occurred most frequently in the context of systemic sarcoidosis. Methotrexate is the most frequent second-line therapy. The effectiveness of therapy with TNF-α antagonists is well-demonstrated and associated with a better outcome. Their earlier use during the disease course among aggressive and/or refractory neurosarcoidosis should be considered.
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Affiliation(s)
- Pauline Sambon
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Amina Sellimi
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Alexandra Kozyreff
- Department of Ophthalmology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc and Institute of Clinical and Experimental Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Lucie Pothen
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Halil Yildiz
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Vincent van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- *Correspondence: Vincent van Pesch
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[Incidental and leave me alone findings of abdominal organs-part 2 : Spleen, kidneys and adrenal glands and efferent urinary tracts]. Radiologe 2022; 62:439-450. [PMID: 35441883 DOI: 10.1007/s00117-022-00998-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
Abstract
For masses of the spleen, which are mostly benign, accessory spleens, cysts and hemangiomas should be radiologically described; however, if confirmed further follow-up control is unnecessary. In the case of disseminated small masses, chronic inflammation and granulomatous diseases, such as tuberculosis and sarcoidosis should be considered in the differential diagnostics. Solid masses in the kidneys should always be further clarified, with the exception of a fat-rich angiomyolipoma. For cystic masses of the kidneys, the modified Bosniak classification for computed tomography or magnetic resonance imaging should be used. Masses of the adrenal glands greater than 10mm in size should be clarified further as well as those where fat is not detected, independent of the size and evidence of malignancy.
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Muhanna A, Al Momani L, Likhitsup A. Sarcoidosis Manifesting as Liver Granuloma With Asteroid Bodies. Cureus 2021; 13:e17915. [PMID: 34540506 PMCID: PMC8439400 DOI: 10.7759/cureus.17915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 11/05/2022] Open
Abstract
Sarcoidosis is an autoimmune disease, which most commonly affects the lungs and lymph nodes and is characterized with non-caseating granulomas. Hepatic involvement in sarcoidosis occurs in less than 1% of patients. Most patients with hepatic sarcoidosis remain asymptomatic with only laboratory abnormalities. We present the case of a 59-year-old man with sarcoidosis who was evaluated for an elevation of alkaline phosphatase. Laboratory test results revealed an alkaline phosphatase level of 230 U/L, with normal alanine aminotransferase, aspartate aminotransferase, bilirubin, and albumin. Computed tomography of the abdomen and pelvis with intravenous contrast of the liver showed a mildly enlarged liver. Liver biopsy sections showed steatosis, active steatohepatitis, and focal portal granuloma formation with asteroid body. The patient was scheduled regular liver function tests and clinical monitoring. Most patients with hepatic sarcoidosis remain asymptomatic with only laboratory abnormalities such as elevation of liver enzymes and alkaline phosphatase. Although liver involvement is common in gastrointestinal sarcoidosis, progression to liver cirrhosis is rare in such patients. While symptomatic patients may be managed with systematic prednisone, asymptomatic patients may require only laboratory and clinical monitoring.
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Affiliation(s)
- Adel Muhanna
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Laith Al Momani
- Gastroenterology, University of Missouri Kansas City, Kansas City, USA
| | - Alisa Likhitsup
- Gastroenterology and Hepatology, University of Missouri Kansas City, Kansas City, USA
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4
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Abstract
As sarcoidosis may involve any organ, sarcoidosis patients should be evaluated for occult disease. Screening for some organ involvement may not be warranted if it is unlikely to cause symptoms, organ dysfunction, or affect clinical outcome. Even organ involvement that affects clinical outcome does not necessarily require screening if early detection fails to change the patient's quality of life or prognosis. On the other hand, early detection of some forms of sarcoidosis may improve outcomes and survival. This manuscript describes the approach to screening sarcoidosis patients for previously undetected disease. Screening for sarcoidosis should commence with a meticulous medical history and physical examination. Many sarcoidosis patients present with physical signs or symptoms of sarcoidosis that have not been recognized as manifestations of the disease. Detection of sarcoidosis in these instances depends on the clinician's familiarity with the varied clinical presentations of sarcoidosis. In addition, sarcoidosis patients may present with symptoms or signs that are not related to specific organ involvement that have been described as parasarcoidosis syndromes. It is conjectured that parasarcoidosis syndromes result from systemic release of inflammatory mediators from the sarcoidosis granuloma. Certain forms of sarcoidosis may cause permanent and serious problems that can be prevented if they are detected early in the course of their disease. These include (1) ocular involvement that may lead to permanent vision impairment; (2) vitamin D dysregulation that may lead to hypercalcemia, nephrolithiasis, and permanent kidney injury; and (3) cardiac sarcoidosis that may lead to a cardiomyopathy, ventricular arrhythmias, heart block, and sudden death. Screening for these forms of organ involvement requires detailed screening approaches.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, New York
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5
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Shaikh F, Abtin FG, Lau R, Saggar R, Belperio JA, Lynch JP. Radiographic and Histopathologic Features in Sarcoidosis: A Pictorial Display. Semin Respir Crit Care Med 2020; 41:758-784. [PMID: 32777856 DOI: 10.1055/s-0040-1712534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Sarcoidosis is a multisystemic granulomatous disorder that can affect virtually any organ. However, pulmonary and thoracic lymph node involvement predominates; abnormalities on chest radiographs are present in 80 to 90% of patients with sarcoidosis. High-resolution computed tomographic (HRCT) scans are superior to chest X-rays in assessing extent of disease, and some CT features may discriminate an active inflammatory component (which may be amenable to therapy) from fibrosis (for which therapy is not indicated). Typical findings on HRCT include micronodules, perilymphatic and bronchocentric distribution, perihilar opacities, and varying degrees of fibrosis. Less common findings on CT include mass-like or alveolar opacities, miliary opacities, mosaic attenuation, honeycomb cysts, and cavitation. With progressive disease, fibrosis, architectural distortion, upper lobe volume loss with hilar retraction, coarse linear bands, cysts, and bullae may be observed. We discuss the salient CT findings in patients with sarcoidosis (with a major focus on pulmonary features) and present classical radiographic and histopathological images of a few extrapulmonary sites.
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Affiliation(s)
- Faisal Shaikh
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Fereidoun G Abtin
- Department of Radiology, Thoracic and Interventional Section, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ryan Lau
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Rajan Saggar
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - John A Belperio
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, David Geffen School of Medicine at UCLA, Los Angeles, California
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6
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Tana C, Ticinesi A, Ricci F, Tana M, di Carlo S, Meschi T. Extrapulmonary Sarcoidosis: A Chameleon Disease at Imaging. Curr Med Imaging 2019. [DOI: 10.2174/157340561505190619094634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Claudio Tana
- Medicine Geriatric-Rehabilitation Department, Internal Medicine and Critical Subacute Care Unit, University- Hospital of Parma, Parma, Italy
| | - Andrea Ticinesi
- Medicine Geriatric-Rehabilitation Department, Internal Medicine and Critical Subacute Care Unit, University- Hospital of Parma, Parma, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Institute of Cardiology, Imaging and Clinical Sciences, , Italy
| | - Marco Tana
- Internal Medicine Unit, Urbino Hospital, Urbino, Italy
| | - Silvio di Carlo
- Geriatrics Unit, Hospital of Pescara, AUSL Pescara, Pescara, Italy
| | - Tiziana Meschi
- Medicine Geriatric-Rehabilitation Department, Internal Medicine and Critical Subacute Care Unit, University- Hospital of Parma, Parma, Italy
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7
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Abstract
Despite advances in the understanding of the pathophysiology, granulomatous diseases remain a diagnostic challenge for the clinician as well as for the pathologist. However, establishing the correct diagnosis of these diseases is a crucial prerequisite of targeted therapy. It is particularly essential to distinguish between an infectious and a non-infectious cause, since anti-infectious and anti-inflammatory or immunosuppressive approaches are opposing. Failure to establish the correct diagnosis can lead to adverse consequences for the patient. An interdisciplinary approach and a critical assessment of clinical, laboratory-chemical, microbiological, imaging, and anatomical-pathological findings are crucial for the evaluation of granulomatous disorders. This overview summarizes important landmarks and their value in the interplay of arriving at the correct diagnosis.
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8
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Abstract
Chronic liver disease, irrespective of cause, can eventually lead to cirrhosis, which is the primary risk factor for developing hepatocellular carcinoma (HCC). In patients with cirrhosis or appropriate risk factors, HCC can be diagnosed by imaging with high specificity using liver imaging reporting and data system v2017, obviating the need for histologic confirmation. Confident recognition of cirrhosis by conventional imaging alone can be challenging, as radiologists are not always provided with the requisite information to determine if the patient has cirrhosis or other risk factors for HCC. Moreover, cirrhosis-associated abnormalities may impair the diagnostic accuracy of imaging for HCC. This article addresses the diagnosis of cirrhosis by non-invasive imaging and the implications of cirrhosis for imaging interpretation and accuracy.
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9
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Ricci ZJ, Mazzariol FS, Flusberg M, Chernyak V, Oh SK, Kaul B, Stein MW, Rozenblit AM. Improving diagnosis of atraumatic splenic lesions, part II: benign neoplasms/nonneoplastic mass-like lesions. Clin Imaging 2016; 40:691-704. [DOI: 10.1016/j.clinimag.2016.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/16/2016] [Accepted: 02/03/2016] [Indexed: 02/07/2023]
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10
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Judson MA. The three tiers of screening for sarcoidosis organ involvement. Respir Med 2016; 113:42-9. [DOI: 10.1016/j.rmed.2016.02.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/22/2016] [Accepted: 02/22/2016] [Indexed: 02/08/2023]
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Yonenaga Y, Kushihata F, Inoue H, Watanabe J, Tohyama T, Sugita A, Takada Y. Sarcoidosis manifesting as hepatic and splenic nodules mimicking ovarian cancer metastases: A case report. Oncol Lett 2015; 10:2166-2170. [PMID: 26622813 PMCID: PMC4579816 DOI: 10.3892/ol.2015.3566] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 06/05/2015] [Indexed: 12/15/2022] Open
Abstract
The current study presents a case of sarcoidosis manifesting as hepatic and splenic nodules, which was difficult to differentiate from ovarian cancer metastases. A 24-year-old female, who was previously diagnosed with right ovarian cancer and underwent surgery at the age of 21, was found to have two nodules in the spleen revealed by contrast-enhanced computed tomography (CT). 18F-fluorodeoxyglucose positron emission tomography/CT revealed two abnormal high uptake lesions in the spleen and one abnormal high uptake lesion in the liver. Under a diagnosis of hepatic and splenic metastases from right ovarian cancer, a laparoscopic splenectomy and partial hepatectomy were performed. Histopathological examination showed that a large number of non-caseating epithelioid cell granulomas formed these nodules, which was compatible with sarcoidosis. This case indicates that it is difficult to distinguish sarcoidosis from metastatic disease even using the latest modalities, and that laparoscopic surgery is a minimally invasive and useful tool for forming a differential diagnosis.
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Affiliation(s)
- Yoshikuni Yonenaga
- Department of Hepatobiliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan ; Department of Surgery, Nagahama City Hospital, Nagahama, Shiga 526-8580, Japan
| | - Fumiki Kushihata
- Department of Hepatobiliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Hitoshi Inoue
- Department of Hepatobiliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Jota Watanabe
- Department of Hepatobiliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Taiji Tohyama
- Department of Hepatobiliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Atsuro Sugita
- Pathology Division, Ehime University Hospital, Toon, Ehime 791-0295, Japan
| | - Yasutsugu Takada
- Department of Hepatobiliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
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13
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14
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Hepatosplenic sarcoidosis: contrast-enhanced ultrasound findings and implications for clinical practice. BIOMED RESEARCH INTERNATIONAL 2014; 2014:926203. [PMID: 25215299 PMCID: PMC4151864 DOI: 10.1155/2014/926203] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 07/17/2014] [Indexed: 12/14/2022]
Abstract
Sarcoidosis is a complex granulomatous disease that affects virtually every organ and tissue, with a prevalence that varies significantly among the sites involved. The role of conventional imaging, such as computed tomography and magnetic resonance imaging, in the assessment of hepatosplenic sarcoidosis is well established by revealing organ enlargement, multiple discrete nodules, and lymphadenopathy. In this review, we aim to describe contrast-enhanced ultrasound (CEUS) findings in liver and spleen involvement by sarcoidosis, reporting evidence from the literature and cases from our experience, after a brief update on safety profile, cost-effectiveness, and clinical indications of this novel technique. Furthermore, we highlight potential advantages of CEUS in assessing hepatosplenic sarcoidosis that may be useful in the clinical practice.
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15
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Jeong WK, Choi SY, Kim J. Pseudocirrhosis as a complication after chemotherapy for hepatic metastasis from breast cancer. Clin Mol Hepatol 2014; 19:190-4. [PMID: 23837145 PMCID: PMC3701853 DOI: 10.3350/cmh.2013.19.2.190] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University Schoold of Medicine, Seoul, Korea.
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16
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Sekine T, Amano Y, Hidaka F, Takagi R, Machida T, Naito Z, Kumita S. Hepatosplenic and muscular sarcoidosis: characterization with MR imaging. Magn Reson Med Sci 2012; 11:83-9. [PMID: 22790294 DOI: 10.2463/mrms.11.83] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Sarcoidosis is a multisystem disorder of unknown etiology that involves multiple organs. Computed tomography is the first-line imaging modality for diagnosing sarcoidosis because of its capacity to detect hilar lymphadenopathy and pulmonary lesions. Magnetic resonance (MR) imaging provides good soft tissue contrast that is useful for detecting sarcoidosis in some body parts, including skeletal muscle. Signal intensity on pre- and postcontrast T(1)- and T(2)-weighted imaging may reflect disease activity and the pathological appearance of sarcoidosis. In this review, we demonstrate these conventional MR imaging findings of hepatosplenic and muscular sarcoidosis and describe the usefulness of diffusion-weighted imaging for detecting sarcoidosis.
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Affiliation(s)
- Tetsuro Sekine
- Department of Radiology, Nippon Medical School, Tokyo, Japan.
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17
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Dastoori M, Fedele S, Leao JC, Porter SR. Sarcoidosis - a clinically orientated review. J Oral Pathol Med 2012; 42:281-9. [DOI: 10.1111/j.1600-0714.2012.01198.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2012] [Indexed: 01/15/2023]
Affiliation(s)
- Mahmoud Dastoori
- Department of Maxillofacial Medicine and Surgery; Oral Medicine unit; UCL Eastman Dental Institute; London; UK
| | - Stefano Fedele
- Department of Maxillofacial Medicine and Surgery; Oral Medicine unit; UCL Eastman Dental Institute; London; UK
| | | | - Stephen R. Porter
- Department of Maxillofacial Medicine and Surgery; Oral Medicine unit; UCL Eastman Dental Institute; London; UK
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Tan CB, Rashid S, Rajan D, Gebre W, Mustacchia P. Hepatic sarcoidosis presenting as portal hypertension and liver cirrhosis: case report and review of the literature. Case Rep Gastroenterol 2012; 6:183-9. [PMID: 22679408 PMCID: PMC3364039 DOI: 10.1159/000338355] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Systemic sarcoidosis is a disease of unknown etiology, with the liver being the third most commonly affected organ. Most cases of hepatic sarcoidosis are not clinically apparent, but a few can progress to liver cirrhosis, portal hypertension and ultimately liver failure. The diagnosis of hepatic sarcoidosis is difficult, considering that no single laboratory test or radiographic finding can definitively diagnose this systemic disease. Diagnosis of hepatic sarcoidosis relies heavily on histopathologic evaluation of two or more organs, a diagnostic modality that is invasive and may not be applicable to all patients. The treatment of hepatic sarcoidosis is challenging, with no large randomized controlled trials done to date. Physicians must be aware of the complications of hepatic sarcoidosis, and must include the same in the differential diagnosis of liver cirrhosis. We present a case of hepatic sarcoidosis complicated by portal hypertension and liver cirrhosis.
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Affiliation(s)
- Christopher B Tan
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, N.Y., USA
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Wang YT, Han YP, Li Q, Chen HZ. Recurrence of sarcoidosis: the follow-up of splenic involvement. Heart Lung 2011; 41:e44-8. [PMID: 22018598 DOI: 10.1016/j.hrtlng.2011.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 08/22/2011] [Accepted: 09/12/2011] [Indexed: 10/16/2022]
Abstract
We report the case of a 53-year-old woman who initially presented with an intermittent dry cough that had lasted for 6 months. An investigation into these symptoms with thoracic computed tomography demonstrated hyperdense shadows in her lungs, and ultrasonography showed the presence of multiple hypoechoic nodules on her spleen. A lung biopsy was then performed, which revealed noncaseating epithelioid cell granulomas. Magnetic resonance imagining of her spleen was performed, which showed low signal intensity. The patient was treated with glucocorticoids, and 3 months later the lesions in her lungs had disappeared completely. Five months later, the lesions in her spleen had disappeared also. However, after 13 months of low-dose prednisone, a miliary pattern was observed on the patient's chest x-ray, although no lesions were observed in her spleen. Laboratory tests demonstrated that her blood level of angiotensin-converting enzyme had increased to 96 IU/L. The dose of prednisone was then increased, and the lung images returned to normal after 2 months of therapy.
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Affiliation(s)
- Ying-Ting Wang
- Department of Neurology, Nanjing General Hospital of Nanjing Military Command, Nanjing, China
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Abstract
OBJECTIVE The objective of this article is to provide a practical review of the conditions other than cirrhosis that can result in diffuse surface nodularity of the liver or portal hypertension. CONCLUSION Conditions that can mimic cirrhosis on imaging include pseudocirrhosis of treated breast cancer metastases to the liver, fulminant hepatic failure, miliary metastases, sarcoidosis, schistosomiasis, congenital hepatic fibrosis, idiopathic portal hypertension, early primary biliary cirrhosis, chronic Budd-Chiari syndrome, chronic portal vein thrombosis, and nodular regenerative hyperplasia.
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Joglekar SP, Hudson RL, Logasundaram R, Pereira JH. 'Surgical cure' for non-parathyroid hypercalcemia. World J Surg Oncol 2009; 7:23. [PMID: 19254358 PMCID: PMC2662839 DOI: 10.1186/1477-7819-7-23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 03/02/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sarcoidosis is a granulomatous disease of unknown aetiology. Over 90% patients of sarcoidosis present with pulmonary findings. Other organs such as lymph nodes, skin, and joints may be involved. Isolated granulomatous disease confined to the spleen is rare. CASE PRESENTATION This report documents a rare case of isolated granulomatous disease of spleen presenting as hypercalcemia. After all possible causes for hypercalcemia were ruled out, splenectomy was done which proved diagnostic and therapeutic, as calcium levels returned to normal. CONCLUSION We propose that sarcoidosis should be kept in mind as a cause of unexplained hypercalcemia. Increased awareness of radiological features of splenic involvement in sarcoidosis, would help in diagnosis. We believe that we are reporting 9th case in the literature while writing this report.
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Abstract
Sarcoid affecting the skin, eye, or liver can be symptomatic of or cause significant morbidity. When disease is sever, alternative therapies may be needed.
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Affiliation(s)
- Anthony S Rose
- Division of Pulmonary and Critical Care Medicine, Indiana University, Richard L. Roudebush VA Medical Center, 1481 W. 10th Street, Indianapolis, IN 46202, USA
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Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown cause that can produce either homogeneous splenomegaly or multiple splenic nodules. Systemic symptoms can accompany splenic involvement. Although the chest radiograph may be suggestive of sarcoidosis, a normal chest radiograph is seen in one quarter to one third of patients with splenic sarcoidosis. The imaging appearance of splenic sarcoidosis can mimic more ominous neoplastic or infectious disease. Biopsy of the spleen or other involved organ may be indicated for definitive diagnosis.
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Affiliation(s)
- David M Warshauer
- Dept. of Radiology, University of North Carolina School of Medicine, 2016 Old Clinic Bldg., CB #7510, Chapel Hill, NC 27599-7510, USA.
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Affiliation(s)
- Michael C Iannuzzi
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, USA.
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Pérez-Grueso MJ, Repiso A, Gómez R, Gonzalez C, de Artaza T, Valle J, García A, Carrobles JM. Splenic focal lesions as manifestation of sarcoidosis: Characterization with contrast-enhanced sonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:405-8. [PMID: 17354246 DOI: 10.1002/jcu.20322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We report the case of a 74-year-old woman with elevated liver enzyme levels in whom abdominal sonographic examination revealed a diffusely heterogeneous liver parenchyma and multiple hypoechoic subcentimetric splenic nodules. Contrast-enhanced sonography (CEUS) revealed that the splenic focal lesions did not enhance. CT examination revealed a low-density, multinodular pattern both in the liver and in the spleen. Core biopsy of 1 hepatic nodule revealed noncaseating epithelioid cell granuloma, and the patient was diagnosed with systemic sarcoidosis. CEUS has shown to be useful in the diagnosis of focal hepatic lesions, but studies referring to splenic lesions are lacking.
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Affiliation(s)
- María José Pérez-Grueso
- Department of Gastroenterology, Virgen de la Salud Hospital, Avda Barber no. 30, Toledo 45004, Spain
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Abstract
Primary diseases of the spleen are relatively rare. More frequently, the spleen is involved secondarily in hematological, oncological, infectious, immunological, vascular, and other systemic diseases. The spleen is the most commonly injured organ in blunt abdominal trauma. Anatomical and physiological basics are explained, in addition to embryological facts with resulting abnormalities, such as accessory and "wandering" spleen, and polysplenia. The most frequent primary and secondary diseases of the spleen, including rare diagnoses, are presented and illustrated. Hemangioma represents the most common primary benign tumor, and lymphoma the most common primary malignant tumor of the spleen. Diagnostic imaging does not a allow safe differentiation between Hodgkin's and non-Hodgkin's lymphoma. One section deals with the clinical value and diagnostic workup of incidentally detected lesions. Simple cysts and calcifications need neither clarification nor a follow-up examination. Atypical cysts should be controlled within 3-6 months. Additional clarification using CT or MRT should be reserved for cases with a strong suspicion of clinically relevant primary or secondary splenic disease.
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Affiliation(s)
- M Völk
- Abteilung VIII (Radiologie), Bundeswehrkrankenhaus, Ulm.
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Kang M, Kalra N, Gulati M, Lal A, Kochhar R, Rajwanshi A. Image guided percutaneous splenic interventions. Eur J Radiol 2007; 64:140-6. [PMID: 17374470 DOI: 10.1016/j.ejrad.2007.02.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 02/11/2007] [Accepted: 02/13/2007] [Indexed: 11/29/2022]
Abstract
AIM The objective of this study is to evaluate the efficacy and safety of image-guided percutaneous splenic interventions as diagnostic or therapeutic procedures. MATERIALS AND METHODS We performed a retrospective review of our interventional records from July 2001 to June 2006. Ninety-five image-guided percutaneous splenic interventions were performed after informed consent in 89 patients: 64 men and 25 women who ranged in age from 5 months to 71 years (mean, 38.4 years) under ultrasound (n=93) or CT (n=2) guidance. The procedures performed were fine needle aspiration biopsy of focal splenic lesions (n=78) and aspiration (n=10) or percutaneous catheter drainage of a splenic abscess (n=7). RESULTS Splenic fine needle aspiration biopsy was successful in 62 (83.78%) of 74 patients with benign lesions diagnosed in 43 (58.1%) and malignancy in 19 (25.67%) patients. The most common pathologies included tuberculosis (26 patients, 35.13%) and lymphoma (14 patients, 18.91%). Therapeutic aspiration or pigtail catheter drainage was successful in all (100%) patients. There were no major complications. CONCLUSIONS Image-guided splenic fine needle aspiration biopsy is a safe and accurate technique that can provide a definitive diagnosis in most patients with focal lesions in the spleen. This study also suggests that image-guided percutaneous aspiration or catheter drainage of splenic abscesses is a safe and effective alternative to surgery.
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Affiliation(s)
- Mandeep Kang
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
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28
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Dourakis SP, Cokkinos DD, Soultati AS, Alexopoulou A, Nezi V, Archimandritis AJ. A case of liver sarcoidosis mimicking cirrhosis. Clin Imaging 2007; 31:47-9. [PMID: 17189848 DOI: 10.1016/j.clinimag.2006.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2006] [Revised: 09/10/2006] [Accepted: 09/25/2006] [Indexed: 11/22/2022]
Abstract
Although autopsy series report liver granulomas in up to 70% of patients, computed tomography detection of hepatic and splenic lesions is described in 5% and 15% of sarcoidosis cases, respectively. A rather rare case of liver sarcoidosis mimicking macronodular cirrhosis is presented by this current article. Imaging findings in our patient were in compliance with the diagnosis of liver cirrhosis, although liver biopsy findings eventually revealed sarcoid granulomas located in the portal and lobular areas without fibrotic lesions. Histological and imaging modalities in liver sarcoidosis are discussed.
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Affiliation(s)
- Spyridon P Dourakis
- 2nd Department of Internal Medicine, University of Athens Medical School, Hippocration General Hospital, 114 Vas Sofias Avenues, 11527, Athens, Greece.
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Kim TH, Joo JE. Spontaneous resolution of systemic sarcoidosis in a patient with chronic hepatitis C without interferon therapy. World J Gastroenterol 2006; 12:150-3. [PMID: 16440437 PMCID: PMC4077494 DOI: 10.3748/wjg.v12.i1.150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 39-year-old male patient complaining of bilateral hand joint arthralgia was evaluated and found to have chronic hepatitis C and systemic sarcoidosis involving lung, skin, liver, and spleen. Hepatic and cutaneous sarcoidoses were confirmed by the presence of numerous noncaseating granulomas on histological examination. Pulmonary and splenic involvements were diagnosed by imaging studies. Fifteen months later, the sarcoidotic lesions in lung, liver, and spleen were resolved by radiological studies and a liver biopsy showed no granuloma but moderate to severe inflammatory activity. systemic sarcoidosis is a rare comorbidity of chronic hepatitis C which may spontaneously resolve.
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Affiliation(s)
- Tae-Hun Kim
- Department of Internal Medicine and Medical Research Institute, Ewha Womans University Hospital, 911-1 Mok-Dong, Yangchun-Gu, Seoul 158-710, Mokdong South Korea.
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30
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Pérez-Solís D, Luyando LH, Callejo-Ortea A, Crespo-Hernández M. Case 90: disseminated tuberculosis. Radiology 2005; 238:366-70. [PMID: 16373779 DOI: 10.1148/radiol.2381031758] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David Pérez-Solís
- Department of Pediatrics, Hospital Universitario Central de Asturias, Celestino Villamil, s/n, 33006 Oviedo, Spain.
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31
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Roberts SD, Mirowski GW, Wilkes D, Kwo PY, Knox KS. Sarcoidosis. Part II: extrapulmonary and systemic manifestations. J Am Acad Dermatol 2005; 51:628-30. [PMID: 15389200 DOI: 10.1016/j.jaad.2004.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Scott D Roberts
- Pulmonary Division at Indiana University School of Medicine, Indianapolis, Indiana, USA
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Affiliation(s)
- David M Warshauer
- Both authors: Department of Radiology, University of North Carolina School of Medicine, Manning Dr., Old Clinic Bldg., Rm. 2016, Box 7510, Chapel Hill, NC 27599-7510, USA
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Sartori S, Galeotti R, Calia N, Gualandi M, Nielsen I, Trevisani L, Ceccotti P, Abbasciano V. Sonographically guided biopsy and sonographic monitoring in the diagnosis and follow-up of 2 cases of sarcoidosis with hepatic nodules and inconclusive thoracic findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:1035-1039. [PMID: 12216751 DOI: 10.7863/jum.2002.21.9.1035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To report 2 cases in which abdominal sonography played a useful role in diagnosing sarcoidosis with early nodular hepatosplenic manifestations. METHODS In the first case, an asymptomatic woman with increased liver enzyme values underwent sonography, which showed multiple hypoechoic nodules in the liver and spleen. Computed tomography confirmed the hepatosplenic findings and showed micronodular infiltrates of both lung fields, without hilar and mediastinal lymphadenopathy. In the second case, in a woman with a cough, dyspnea, and increased liver enzyme levels, thoracic computed tomography showed right pleural effusion causing partial atelectasis of the lower and middle lobes and mediastinal lymphadenopathy. RESULTS Sonography and computed tomography showed multiple nodules of the liver and spleen and retroperitoneal lymphadenopathy. In both cases, bronchoscopy, bronchial and bronchioloalveolar lavages, and transbronchial and mediastinal biopsies had negative results. Sonographically guided biopsy of the hepatic nodules was carried out and sarcoid granulomas were detected in the portal areas. After 3 months of steroid therapy, liver enzyme values nearly normalized, and sonography showed the disappearance of all abdominal lesions. The first patient underwent control computed tomography, which confirmed the regression of the disease; the second patient refused control computed tomography. CONCLUSIONS Sarcoidosis can occur with atypical onset, and in selected cases sonography may play a useful role in its diagnosis and follow-up.
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Affiliation(s)
- Sergio Sartori
- Department of Internal Medicine, St Anna Hospital, Ferrara, Italy
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35
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Thanos L, Zormpala A, Brountzos E, Nikita A, Kelekis D. Nodular hepatic and splenic sarcoidosis in a patient with normal chest radiograph. Eur J Radiol 2002; 41:10-1. [PMID: 11750146 DOI: 10.1016/s0720-048x(01)00375-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Almost all the patients with sarcoidosis have an abnormal chest radiograph, while nodular lesions of both the liver and the spleen is an unusual manifestation of abdominal sarcoidosis. We report a case of a patient with numerous hypodense nodular hepato-splenic lesions on abdominal CT and a normal chest X-ray. Biopsy of an hepatic lesion revealed sarcoidosis.
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Affiliation(s)
- Loukas Thanos
- Second Department of Radiology, Eugenidion Hospital and School of Medicine, National and Kapodistrian University of Athens, Papadiamantopoulou 20, Athens, GR-115 28, Greece
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Abstract
Hepatopulmonary syndrome is the most widely recognized of the processes associated with end-stage liver disease. Chronic liver dysfunction is associated with pulmonary manifestations due to alterations in the production or clearance of circulating cytokines and other mediators. Hepatopulmonary syndrome results in hypoxemia due to pulmonary vasodilatation with significant arteriovenous shunting and ventilation-perfusion mismatch. Hepatic hydrothorax may develop in patients with cirrhosis and ascites. Rarely, pulmonary hypertension occurs in the setting of portal hypertension. A second group of disorders may primarily affect the lungs and liver (the hepatopulmonary axis). Among these are the congenital conditions alpha(1)-antitrypsin deficiency and cystic fibrosis. Autoimmune liver disease may be associated with lymphocytic interstitial pneumonitis, fibrosing alveolitis, intrapulmonary granulomas, and bronchiolitis obliterans with organizing pneumonia. Sarcoidosis affects the lung and liver in up to 70% of patients. Medications such as amiodarone can result in a characteristic radiologic appearance of pulmonary and hepatic toxic effects. Knowledge of these associations will assist the radiologist in forming a meaningful differential diagnosis and may influence treatment decisions.
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Affiliation(s)
- C A Meyer
- Departments of Radiology and Medicine , University of Cincinnati, 234 Goodman St, ML 0742, Cincinnati, OH 45219-2316, USA.
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Paterson A, Frush DP, Donnelly LF, Foss JN, O'Hara SM, Bisset GS. A pattern-oriented approach to splenic imaging in infants and children. Radiographics 1999; 19:1465-85. [PMID: 10555669 DOI: 10.1148/radiographics.19.6.g99no231465] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The spleen in infants and children is commonly involved in a variety of pathologic processes. Some of these processes cause isolated splenic disease, whereas others involve the spleen as part of a systemic illness. To facilitate differential diagnosis of splenic abnormalities, a pattern-oriented approach to the imaging evaluation of the pediatric spleen was developed. With this approach, splenic anomalies are categorized as anomalies of splenic shape (clefts, notches, lobules), location (eg, wandering spleen), number (polysplenia, asplenia), or size (splenomegaly, splenic atrophy); solitary lesions (eg, cysts, lymphangiomas, hemangiomas, hamartomas); multiple focal lesions (eg, trauma, infection and inflammation, neoplasms, storage disorders); and diffuse disease without focal lesions (eg, infarction, heavy metal deposition, hemangioendotheliomas, peliosis). A variety of imaging modalities can be used in splenic assessment, including computed tomography, magnetic resonance imaging, ultrasound, and technetium-99m scintigraphy. The imaging appearance of the pediatric spleen depends on the patient's age and the modality used; however, familiarity with the spectrum of radiologic patterns of splenic involvement will facilitate correct diagnosis and prompt treatment.
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Affiliation(s)
- A Paterson
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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