The spotted spleen: CT and clinical correlation in a tertiary care center.
OBJECTIVE
The goal of our study was to examine the prevalence of multiple hypodense splenic nodules and their associated diagnoses and to correlate CT appearance with clinical presentation and diagnosis.


METHODS
Records of all patients undergoing contrast-enhanced CT from July 1994 through September 1997 were reviewed. Charts and CT scans of patients with multiple (more than five) hypodense splenic nodules were then evaluated.


RESULTS
During the search period, there were 8,764 patients examined. Multiple hypodense splenic nodules were identified in 45 patients. Sixteen patients had malignant neoplasia as an etiology, with two patients having a benign tumor. Ten patients had an infectious etiology; nine patients had an inflammatory but noninfectious etiology; in eight patients, a diagnosis was not established; five of these patients were followed for > 18 months.


CONCLUSIONS
Multiple hypodense splenic nodules are uncommon. Lymphoma, infection, and sarcoid were the three most common disorders in the symptomatic patient, with infection strongly correlated with a compromised immune system. In the asymptomatic patient, nonlymphomatous metastatic disease, benign tumor, and sarcoid were most common. Although overlap exists between diagnostic groups, lymphoma tends to have larger, more variable nodules, whereas infection tends to occur with smaller, more uniform nodules. Sarcoid is intermediate in appearance.
Warshauer
D M
DM
Department of Radiology, University of North Carolina School of Medicine, Chapel Hill 27599-7510, USA.
Molina
P L
PL
Worawattanakul
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008099:Liver / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013154:Spleen / Q000000981:diagnostic imaging*; D013158:Splenic Diseases / Q000000981:diagnostic imaging*; D013163:Splenomegaly / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods
D003287:Contrast Media