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| C | R | Score | PMID | Date | Au | Ab | Title | Journal |
|---|---|---|---|---|---|---|---|---|
| 1 | 91.62 | 10555669 | 1999.12.07 | + | + | A pattern-oriented approach to splenic imaging in infants and children. | Radiographics | |
| A Paterson, DP Frush, LF Donnelly, JN Foss, SM O'Hara, GS Bisset, | ||||||||
| 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. | ||||||||
| 2 | 85.33 | 7480744 | 1995.12.21 | + | + | HIV infection: analysis in 259 consecutive patients with abnormal abdominal CT findings. | Radiology | |
| R Radin, | ||||||||
| PURPOSE: To evaluate abdominal computed tomographic (CT) findings in patients with human immunodeficiency virus (HIV) infection. MATERIALS AND METHODS: CT scans with abnormal findings in 259 patients (247 men, 12 women; age range, 21-60 years) with HIV infection were analyzed. Diagnoses were mycobacterial infection (n = 87), lymphoproliferative disease (n = 63), Kaposi sarcoma (n = 17), fungal infection (n = 17), hepatocellular disease (n = 13), Pneumocystis carinii infection (n = 8), other disorders (n = 39), or unknown (n = 30). RESULTS: Abnormal findings included lymph-node enlargement (n = 159), hepatomegaly (n = 100), splenomegaly (n = 62), gastrointestinal mass or wall thickening (n = 61), and low-attenuation lesions in the liver (n = 50) or spleen (n = 55). Diagnoses thought to account for CT findings were made (n = 229) or suspected (n = 18) in 247 (95%) of the 259 patients. CONCLUSION: In most patients with HIV infection, abnormal abdominal CT findings are due to a second disease. Even relatively nonspecific findings should not be ascribed to HIV infection and should prompt a search for an opportunistic infection or neoplasm. | ||||||||
| 3 | 83.68 | 8190956 | 1994.06.23 | + | + | Imaging of the spleen: CT with supplemental MR examination. | Radiographics | |
| LS Rabushka, A Kawashima, EK Fishman, | ||||||||
| Splenic lesions tend to be small or infiltrating and vary in size and configuration, making detection difficult, particularly without use of an organ-specific contrast agent. The authors present a series of selected cases to show the value of computed tomography (CT) and magnetic resonance (MR) imaging in depiction of splenic disease. Six major categories are presented: (a) inflammatory disease, (b) splenic cysts, (c) infarction, (d) nonneoplastic and noninfectious diffuse splenic disease, (e) benign tumors, and (f) malignant tumors. CT attenuation of splenic tissue is homogeneous, typically measuring 40-60 HU on non-contrast material-enhanced scans. Splenic attenuation is normally 5-10 HU less than that of liver, a standard of reference used in evaluation of either hepatic or splenic disease. On T1-weighted MR images, the normal signal intensity of the spleen is less than that of hepatic tissue and slightly greater than that of muscle. On T2-weighted images, the spleen shows higher signal intensity, appearing brighter than the liver. CT is currently the choice for evaluation of the spleen; however, MR imaging may be increasingly used as newer pulse sequences and organ-specific contrast agents are developed. | ||||||||
| 4 | 80.70 | 15256634 | 2005.02.17 | + | + | From the archives of the AFIP: primary vascular neoplasms of the spleen: radiologic-pathologic correlation. | Radiographics | |
| RM Abbott, AD Levy, NS Aguilera, L Gorospe, WM Thompson, | ||||||||
| Primary vascular neoplasms of the spleen constitute the majority of nonhematolymphoid splenic tumors. The benign primary vascular tumors include hemangioma, hamartoma, and lymphangioma, whereas those of variable or uncertain biologic behavior include littoral cell angioma, hemangioendothelioma, and hemangiopericytoma. The primary malignant vascular neoplasm of the spleen is angiosarcoma. Peliosis is a rare lesion of unknown cause that is usually found incidentally in asymptomatic patients but may be associated with hematologic or metastatic disease. Although these vascular neoplasms of the spleen are uncommon, their importance lies in that they must be differentiated from the more common neoplastic disorders of the spleen, such as lymphoma and metastasis. The most common echogenic solid or complex cystic mass in an asymptomatic patient is splenic hemangioma. However, the imaging appearance of splenic hemangiomas may be complex, and differentiation of these lesions from malignant disease may not be possible. The diagnosis of splenic hamartoma may be suggested when findings of increased blood flow on color Doppler images are seen in association with a homogeneous solid echogenic mass. A large subcapsular solitary cystic abnormality discovered incidentally in a child in association with internal septations and tiny mural nodules favors the diagnosis of lymphangioma. Any invasion of the surrounding splenic parenchyma by a splenic lesion should indicate a more aggressive or malignant process. Evaluation of a focal splenic abnormality identified on sonograms should be followed up with computed tomography or magnetic resonance imaging with and without contrast material enhancement. Splenectomy may be required for definitive evaluation of a splenic mass with atypical features. | ||||||||
| 5 | 66.13 | 16272860 | 2005.12.23 | + | + | Hemolymphangiomatosis of the spleen: imaging features. | J Comput Assist Tomogr | |
| L Santoro, V Santini, SD Lollo, A Valeri, S Colagrande, | ||||||||
| Hemolymphangiomatosis is an extremely rare entity that has never been described in the diffuse form. Its main pathologic feature is proliferation of lymphatic and vascular cells inducing interstitial and hematic lakes and then splenomegaly. We report a complete imaging study, including magnetic resonance (MR) imaging, after administration of a superparamagnetic contrast agent. Ultrasonography (US), basal MR imaging, and late computed tomography (CT) contrastographic features are quite similar to those of other diffuse benign vascular neoplasms, without real hemangioma-like enhancement during the vascular phase. Its late contrastographic pattern could be considered specific if CT and iron oxide-enhanced MR imaging are applied as complementary diagnostic tools, however. | ||||||||
| 6 | 63.76 | 8988207 | 1997.01.29 | + | + | Splenic hemangiomas and hamartomas: MR imaging characteristics of 28 lesions. | Radiology | |
| M Ramani, C Reinhold, RC Semelka, ES Siegelman, L Liang, SM Ascher, JJ Brown, RN Eisen, PM Bret, | ||||||||
| PURPOSE: To determine the magnetic resonance (MR) imaging features of splenic hemangiomas and hamartomas, including their pattern of dynamic contrast material enhancement. MATERIALS AND METHODS: The appearance of 28 lesions in 18 patients was retrospectively reviewed on T2-weighted images (16 patients), unenhanced T1-weighted images (18 patients), and dynamic contrast-enhanced T1-weighted images (17 patients). Seventeen of 23 hemangiomas and all five hamartomas were proved at pathologic examination. RESULTS: Of the 22 hemangiomas imaged with T2-weighting, 19 were hyperintense, two were isointense, and one was hypointense relative to the spleen. Dynamic gadolinium-enhanced imaging demonstrated a progressive centripetal pattern of enhancement in 19 of 22 hemangiomas. On delayed images, 19 hemangiomas demonstrated uniform enhancement. Of the five hamartomas, four were imaged with T2-weighting; three were hyperintense and one was hypointense relative to the spleen. All hamartomas demonstrated diffuse heterogeneous enhancement on images obtained early after administration of contrast material and became more uniformly enhanced on delayed images. CONCLUSION: Splenic hemangiomas showed signal intensity characteristics and enhancement patterns similar to those described for hepatic hemangiomas. Since these features have been shown to reliably distinguish hemangiomas from other benign and malignant liver lesions, it may be reasonable to consider without histologic verification that lesions in the spleen with these imaging features represent hemangiomas. | ||||||||
| 7 | 61.66 | 15480032 | 2006.07.07 | + | + | Concurrent focal hepatic and splenic lesions: a pictorial guide to differential diagnosis. | J Comput Assist Tomogr | |
| MJ Bean, KM Horton, EK Fishman, | ||||||||
| Although medical literature and differential diagnoses discussions tend to be organ specific, systemic diseases more commonly manifest with multi-organ involvement. Detection of dual organ involvement combined with clinical history narrows the differential to provide a more specific diagnosis. Two organs closely linked are the liver and the spleen. Many processes affect both of these organs through their common denominator, the reticuloendothelial system (RES). This pictorial essay reviews the wide spectrum of benign and malignant pathologies to be considered when computed tomography (CT) demonstrates concurrent focal disease in the liver and spleen. | ||||||||
| 8 | 55.13 | 8911169 | 1996.12.26 | + | Gadolinium-enhanced MR imaging of the spleen: artifacts and potential pitfalls. | AJR Am J Roentgenol | ||
| K Ito, DG Mitchell, K Honjo, T Fujita, H Awaya, K Takano, S Koike, T Matsumoto, N Matsunaga, | ||||||||
| 9 | 49.82 | 16299797 | 2006.01.03 | + | + | Primary angiosarcoma of the spleen. | J Surg Oncol | |
| JT Hsu, HM Chen, CY Lin, CN Yeh, TL Hwang, YY Jan, MF Chen, | ||||||||
| BACKGROUND AND OBJECTIVES: Primary splenic angiosarcoma is a very rare and aggressive neoplasm with a high metastatic rate and dismal prognosis. Since only a few cases have been adequately reported in the medical literature, we report here a further six cases. METHODS: The records of all cases of primary splenic angiosarcoma treated at Chang Gung Memorial Hospital from April 1991 to July 2004 were retrospectively reviewed. RESULTS: Of the six cases identified (three men and three women; range, 7-69 years; median, 44 years), four presented with palpable abdominal masses or left upper quadrant abdominal pain. Other systemic symptoms, such as bleeding gums, fatigue, fever, body weight loss, and gastrointestinal bleeding were noted. An abnormal hematogram was found in five patients, with all of these five showing anemia, and three thrombocytopenia. Splenomegaly was present in all patients. Hemoperitoneum due to splenic rupture was noted in one patient. Three patients had distant metastasis to the liver (n = 2), bone (n = 1), bone marrow (n = 1), and small bowel (n = 1) at diagnosis. Liver (n = 3), bone (n = 1), and bone marrow (n = 1) metastases were found in four patients after initial therapy. Five of the six cases underwent a splenectomy, one underwent partial hepatectomy, and one received chemotherapy. The respective 1-, 3- and 5-year survival rates were 60%, 40%, and 40%, and the median survival time was 36 months. One patient was disease-free 162 months after splenectomy. CONCLUSIONS: The clinical presentations of splenic angiosarcoma were similar to those of previous reports apart from the higher rate of splenomegaly observed in this study. In contrast to reported pediatric cases, our patient achieved long-term disease-free survival after splenectomy alone. | ||||||||
| 10 | 49.37 | 15520901 | 2005.02.17 | + | Abdominal and pelvic CT in the HIV-positive population. | Abdom Imaging | ||
| LR Carucci, RA Halvorsen, | ||||||||
| 11 | 45.92 | 12438060 | 2002.12.19 | + | + | Percutaneous nonvascular splenic intervention: a 10-year review. | AJR Am J Roentgenol | |
| BC Lucey, GW Boland, MM Maher, PF Hahn, DA Gervais, PR Mueller, | ||||||||
| OBJECTIVE: We performed a retrospective review of our experiences with percutaneous splenic interventions to evaluate the safety and usefulness of these procedures. We examined both the success rate and the complication rate. MATERIALS AND METHODS: We used our electronic database to perform a retrospective analysis of patients treated from January 1990 to December 2000. Thirty-nine imaging-guided percutaneous splenic procedures were performed in 38 patients: 27 men and 11 women who ranged in age from 17 to 83 years (mean age, 56.5 years). For 28 procedures, sonographic guidance was used, and for 11, CT guidance was used. Procedures performed included splenic biopsy (n = 24), fluid aspiration (n = 8), and fluid drainage (n = 7). RESULTS: Splenic biopsy was successful in 91% of the procedures; fluid aspiration, in 100%; and fluid drainage, in 86%. The overall complication rate was 10.3%, with three patients requiring emergency splenectomy as a result of massive bleeding after the procedure. Two of these patients had previously unrecognized vascular tumors, and one had concomitant refractory thrombocytopenia. CONCLUSION: This study suggests that splenic biopsy can be performed safely and is of considerable value in diagnosis. Our findings also show that percutaneous catheter drainage of splenic abscesses is successful and that splenectomy should be reserved for failed percutaneous drainage. The complications that occur after procedures on vascular tumors emphasize the importance of requiring normal coagulation parameters before the procedure because the vascular nature of the lesion may be difficult to recognize on imaging before the procedure. | ||||||||
| 12 | 44.71 | 1950868 | 1991.12.19 | + | + | CT of acquired abnormalities of the spleen. | AJR Am J Roentgenol | |
| AJ Taylor, WJ Dodds, SJ Erickson, ET Stewart, | ||||||||
| Imaging considerations and features when assessing acquired abnormalities of the spleen with CT are described. Indexes of normal size and the implications of splenomegaly are discussed, as well as the CT appearances and types of neoplasia, cysts, traumatic injuries, infarction, and inflammatory changes. | ||||||||
| 13 | 42.76 | 12828616 | 2004.03.30 | + | + | Splenic lymphangioma with papillary endothelial proliferation: a case report and review of the literature. | Pathol Int | |
| A Takayama, O Nakashima, K Kobayashi, M Kojiro, | ||||||||
| A 76-year-old man complained of difficulty breathing. A solitary mass was found in the spleen by ultrasonography and the tumor was excised. Grossly, the tumor was 3.9 x 2.9 cm in size, solid and brownish in color. A stellate scar-like fibrosis was observed in the center of the tumor. Histologically, the tumor consisted of the proliferation of irregular and small lymph vessel-like spaces, with sclerotic change in the center. The lymph vessel-like spaces showed papillary projections of the lining cells. The lumen contained amorphous proteinaceous fluid. Immunohistochemically, the lining cells of lymph vessel-like spaces were positive for endothelial markers (CD31, CD34, factor VIII-related antigen), and bound Ulex europaeus agglutinin-1. The tumor was diagnosed as splenic lymphangioma, but its appearance was rather unusual for a typical splenic lymphangioma because of the presence of papillary endothelial proliferation and scar-like fibrosis. Splenic lymphangioma with papillary endothelial proliferation is uncommon, and there have been only four cases reported. | ||||||||
| 14 | 41.69 | 14628859 | 2003.12.23 | + | + | Disseminated mycobacterial infection in AIDS patients: abdominal US features and value of fine-needle aspiration biopsy of lymph nodes and spleen. | Abdom Imaging | |
| L Tarantino, A Giorgio, G de Stefano, N Farella, A Perrotta, F Esposito, | ||||||||
| BACKGROUND: We evaluated the efficacy of abdominal ultrasound (US) and fine-needle aspiration biopsy (FNAB) in the diagnosis of disseminated mycobacteriosis (DM) in acquired immunodeficiency syndrome (AIDS). METHODS: Twelve AIDS patients (nine male, three female; age range, 22-43 years) with DM underwent abdominal US within 2 days after admission with 3.5- to 5-MHz convex probes and a 7.5-MHz linear probe. All patients underwent FNAB of one or two enlarged abdominal lymph nodes. Eight patients underwent FNAB of the spleen. The aspirated specimens were stained with acid fast for quick examination and cultured for isolation of mycobacteria. RESULTS: Abdominal US showed enlarged, hypoechoic, round or oval, abdominal lymph nodes (diameter, 10-35 mm; mean, 18 mm) in all patients; splenomegaly (spleen diameter, 14-22 cm; mean, 16.8 mm) in all patients; numerous splenic abscesses (diameter, 3-20 mm) in nine patients; hepatomegaly (right hepatic lobe thickness, 14.5-17 cm) in all patients; small intestinal wall thickening in five patients (maximum bowel wall thickness, 7-15 mm); mild to moderate ascites in six patients; pleural effusion in four patients; bilateral enlargement of the kidneys with hyperechogenicity of the cortex in three patients; and a retroperitoneal tubercular abscess in one patient. No complication occurred after FNAB of lymph nodes and spleens. Fast-acid stain of spleen and/or lymph node FNAB specimens allowed early diagnosis of mycobacteriosis in 12 of 12 cases (100%). Cultures of lymph node aspirates grew mycobacteria in six of 12 patients (50%). Spleen aspirates grew mycobacteria in nine of nine patients (100%). Blood cultures were positive in four of 12 patients (33%). Mycobacterium tuberculosis was diagnosed in six patients and M. avium in five. CONCLUSION: Abdominal US features can suggest DM in AIDS patients. Spleen and/or lymph node FNAB indicated the specific diagnosis in 100% of patients. | ||||||||
| 15 | 41.43 | 14752189 | 2004.02.17 | + | + | Littoral cell angioma of the spleen: CT features with clinicopathologic comparison. | Radiology | |
| AD Levy, RM Abbott, SL Abbondanzo, | ||||||||
| PURPOSE: To evaluate the clinical, pathologic, and computed tomographic (CT) features of littoral cell angioma of the spleen in eight patients. MATERIALS AND METHODS: Two abdominal radiologists retrospectively reviewed the contrast material-enhanced CT images obtained in six, the contrast-enhanced and nonenhanced CT images obtained in two, and the photographs of gross pathologic specimens resected from seven patients. They also retrospectively reviewed clinical data (ie, demographic data, presenting signs and symptoms, physical findings, and medical histories). Histopathologic specimens from the eight patients were reviewed by a hematopathologist. The CT images were reviewed for the presence of splenomegaly. The number, size, and enhancement characteristics of the splenic masses at CT were compared with the histopathologic and gross pathologic specimen findings. RESULTS: All patients had laboratory evidence of hypersplenism. Seven patients (88%) had splenomegaly and innumerable splenic masses ranging from 0.2 to 6.0 cm in diameter at CT. The single patient with a normal spleen size had four splenic masses. The splenic masses were hypoattenuating relative to the normal spleen at CT in all patients and correlated with blood-filled nodules at gross pathologic examination and with blood-filled vascular channels of littoral cell angioma at histopathologic examination. The early and late portal venous phase CT images that were available in one case demonstrated progressive homogeneous contrast enhancement of the masses such that they were indistinguishable from the normal splenic parenchyma. CONCLUSION: Littoral cell angioma is a primary splenic neoplasm that most commonly manifests at CT as multiple hypoattenuating masses in an enlarged spleen. Histopathologically, these masses represent blood-filled vascular channels. | ||||||||
| 16 | 38.95 | 8208972 | 1994.07.12 | + | + | Abdominal CT findings in sarcoidosis: radiologic and clinical correlation. | Radiology | |
| DM Warshauer, SA Dumbleton, PL Molina, BC Yankaskas, LA Parker, JT Woosley, | ||||||||
| PURPOSE: To estimate the prevalence of abdominal computed tomographic (CT) findings in sarcoidosis and to correlate these findings with those at chest radiography, clinical status, and level of angiotensin converting enzyme (ACE). MATERIALS AND METHODS: Abdominal CT examinations in 59 patients with sarcoidosis were evaluated for adenopathy, liver and spleen size, and discrete lesions within the liver or spleen. RESULTS: Extensive adenopathy was seen in 10% of patients. Marked hepatic and splenic enlargement was seen in 8% and 6%, respectively. Nodules were seen in the spleen in eight (15%) patients and in the liver in three (5%). Although liver size, spleen size, and adenopathy were directly related (P < .0001), the presence of nodules was not strongly related to organ size. Abdominal CT findings were related to clinical status and elevated ACE levels but not to chest radiographic stage. CONCLUSION: Marked abdominal CT findings are uncommon in sarcoidosis and correlate with disease activity but not chest radiographic stage. | ||||||||
| 17 | 37.78 | 15310152 | 2005.01.06 | + | + | Isolated diffuse hemangiomatosis of the spleen: case report and review of literature. | Pathol Res Pract | |
| H Steininger, D Pfofe, L Marquardt, H Sauer, R Markwat, | ||||||||
| Small localized hemangiomas are common neoplasms of the spleen. Isolated diffuse splenic hemangiomatosis, however, is very rare. This lesion can be accompanied by severe hypersplenism and other complications. We report on a case with significant splenomegaly caused by diffuse hemangiomatosis, which was an incidental finding without any clinical disorders. After splenectomy, the normal parenchyma was found to be widely replaced by multiple spongy nodules. Histologically, cavernous vessels were distributed throughout the whole organ, with endothelial cells expressing vimentin, factor VIII and CD 31, but not CD8. Splenic sinus lining cells exhibited a strongly positive reaction with CD8, which became faint and disrupted in highly dilated sinuses in the vicinity of cavernous vessels. In some areas, there seemed to be a gradual transition from cystically dilated splenic sinuses to cavernous vessels. The differential diagnosis must consider other splenic vascular tumors, such as littoral cell angioma, lymphangioma, peliosis of the spleen, and hamartoma. The pathogenesis of diffuse splenic hemangiomatosis is controversial, and a malformative or neoplastic origin is under debate. A derivation from splenic sinusoidal cells was suggested by some authors, but was rejected by others. Our findings cannot exclude a neoplastic origin from splenic sinuses but, finally, the etiology and pathogenesis of this vascular lesion remain uncertain. | ||||||||
| 18 | 36.86 | 3871147 | 1985.01.14 | + | + | CT of splenic and perisplenic abnormalities in septic patients. | AJR Am J Roentgenol | |
| EJ Balthazar, S Hilton, D Naidich, A Megibow, R Levine, | ||||||||
| Splenic and perisplenic pathology, demonstrated by CT examination in 14 septic patients, was correlated with the clinical course and with surgical and pathologic findings available. Twelve patients were intravenous drug addicts and two patients developed bacteremia associated with bacterial endocarditis. The CT findings were divided into three groups: (1) Single wedge-shaped peripherally located defects were seen in five patients; there was good response to medical therapy without other complications. (2) Larger and/or multiple, rounded or oval lesions were present in five patients; two of these patients had splenic abscesses proven on subsequent splenectomy. (3) Multiple splenic lesions and fissures associated with perisplenic and subphrenic fluid collections were seen in four patients; infected splenic infarcts, splenic fractures, and infected perisplenic hemorrhagic fluid collections were found in this group of patients. The CT examination in septic patients can reliably demonstrate splenic and perisplenic pathology, and its appearance contributes greatly to the overall clinical assessment and surgical approach. | ||||||||
| 19 | 36.57 | 10390570 | 1999.09.14 | + | + | Splenic lymphangioma: US and CT diagnosis and clinical manifestations. | Abdom Imaging | |
| T Komatsuda, H Ishida, K Konno, Y Hamashima, H Naganuma, M Sato, J Ishida, O Masamune, | ||||||||
| BACKGROUND AND METHODS: We tried to determine the role and problems of gray-scale sonography (US), computed tomography (CT), and color Doppler sonography in the diagnosis of splenic lymphangioma on the basis of our experience with seven adult cases with this relatively rare tumor. RESULTS: (1) The whole spleen was replaced by a collection of cysts of different sizes with or without calcifications in six patients. In these patients, color Doppler sonography showed the intrasplenic arteries and veins running along the cyst walls. (2) The enlarged spleen occupied the whole upper abdomen and contained numerous small cysts in one patient. The patient was initially diagnosed as having a pancreatic tumor because of the location, but color Doppler sonography clearly demonstrated two vessels (artery and vein) running parallel from the center of the mass. This characteristic vascular structure led to the determination that the mass was the markedly enlarged spleen. (3) The splenic lesion was isolated in six patients but was associated with mesenteric and pleural lymphangioma in one symptomatic patient. CONCLUSIONS: (1) When US shows multiple cysts of different sizes in the spleen, the diagnosis of splenic lymphangioma is not difficult to make with US and CT alone. (2) Color Doppler sonography is a very useful tool to increase diagnostic confidence because it demonstrates the vasculature of the mass. (3) When examining patients with splenic lymphangioma, one should consider the possibility of multiorgan involvement. | ||||||||
| 20 | 36.45 | 10587123 | 1999.12.17 | + | + | Imaging-guided percutaneous biopsy of focal splenic lesions: update on safety and effectiveness. | AJR Am J Roentgenol | |
| MT Keogan, KS Freed, EK Paulson, RC Nelson, LG Dodd, | ||||||||
| OBJECTIVE: The purpose of this study is to determine the safety and effectiveness of percutaneous imaging-guided biopsy in the diagnosis of focal splenic lesions. MATERIALS AND METHODS: From May 1995 to November 1997, 20 imaging-guided biopsies of focal splenic lesions were performed in 18 patients, including seven patients with a prior diagnosis of extrasplenic malignancy (breast cancer, n = 3; lymphoma, n = 2; ovarian cancer, n = 1; and osteogenic sarcoma, n = 1), three immunosuppressed patients (cause of immunosuppression: AIDS, n = 1; liver transplantation, n = 1; and bone marrow transplantation, n = 1), two patients with anemia, one patient with a recent history of IV drug abuse, and five patients with incidentally discovered splenic lesions. Biopsies were performed with an 18-gauge (n = 1), a 20-gauge (n = 8), or a 22-gauge (n = 14) self-aspirating needle or an 18-gauge cutting needle (n = 1). Biopsies were considered successful if a specific diagnosis of benign or malignant disease was made. RESULTS: A specific diagnosis was made in 16 (88.9%) of 18 patients, and no complications occurred. Malignancy was diagnosed in six patients including three patients with lymphoma. Benign conditions were diagnosed in 10 patients: a cyst in two patients; hamartoma in one; lipogranuloma in one; infarct in one; and infection in four, including one case each of Candida albicans, Pneumocystis carinii, Mycobacterium tuberculosis, and mixed flora. The tenth benign diagnosis was a pseudotumor of the spleen related to a bulbous tail of the pancreas that was inseparable from the splenic hilum. Biopsy did not establish a diagnosis in one patient with lymphoma and in one patient with presumed splenic candidiasis. A mean of 1.5 needle passes was made per biopsy. CONCLUSION: Imaging-guided splenic biopsy is a safe technique that provides a specific diagnosis in most patients with focal splenic lesions. | ||||||||
| 21 | 35.24 | 9754100 | 1998.10.15 | + | + | The spotted spleen: CT and clinical correlation in a tertiary care center. | J Comput Assist Tomogr | |
| DM Warshauer, PL Molina, S Worawattanakul, | ||||||||
| PURPOSE: 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. METHOD: 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. CONCLUSION: 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. | ||||||||
| 22 | 34.71 | 14510633 | 2003.11.10 | + | + | Splenic and adrenal lymphangiomatosis. | Rev Esp Enferm Dig | |
| C Castellón Pavón, I Lanchas Alfonso, MA González Núñez, ML Amigo Lozano, E del Amo Olea, | ||||||||
| Lymphangiomatosis is a rare syndrome that can affect different organs, although simultaneous splenic and adrenal involvement is exceptional. We report the case of a young female with a symptomatic massive splenomegaly and no-nhypersecreating bilateral adrenal masses incidentally discovered that represented a diagnostic challenge. The management of adrenal incidentalomas is controversial, as the presence of large sized bilateral masses are highly indicative of malignancy. Despite the different diagnostic techniques available, it is sometimes impossible to reach an accurate preoperative diagnosis. Elective splenectomy and left adrenalectomy were performed, preserving the functioning of the right adrenal gland, radiologically similar to the left one, to prevent the development of definitive adrenal insufficiency. Postoperative evolution has been favourable without initial increase of the size of the right adrenal lesion. However, the persistence of this mass obligated long-term follow-up and shall assist us in better understanding the behavior of this bening lesion. | ||||||||
| 23 | 34.66 | 8615251 | 1996.06.06 | + | CT findings in primary vascular tumors of the spleen. | AJR Am J Roentgenol | ||
| F Ferrozzi, D Bova, F Draghi, G Garlaschi, | ||||||||
| 24 | 34.03 | 3279735 | 1988.04.08 | + | + | MR imaging of focal splenic tumors. | AJR Am J Roentgenol | |
| PF Hahn, R Weissleder, DD Stark, S Saini, G Elizondo, JT Ferrucci, | ||||||||
| This study was undertaken to define the MR appearance of splenic tumors in 16 cancer patients with focal splenic lesions; 50 volunteers and liver cancer patients without splenic abnormalities served as controls. In 14 patients with focal splenic lesions, differences between splenic and lesion signal intensities permitted detection of splenic lesions on MR images, either because of cystic or necrotic areas lengthening T2 within the tumor, because of T1 shortening from tumor-associated hemorrhage, or because of T2 shortening of surrounding spleen in two cases of suspected transfusional iron overload. In one spleen, a lesion appeared isointense on both T1- and T2-weighted pulse sequences and was detected only by gross splenic deformity. In one other case, CT defined splenic metastases not visible on MR images. Measurements of signal intensity of normal spleens and tumor are so similar that spin-echo MR imaging can underestimate the size and extent of focal splenic disease or may miss lesions entirely. We conclude that MR imaging is a less sensitive technique for detecting focal lesions of the spleen than for detecting focal hepatic lesions. | ||||||||
| 25 | 33.97 | 16344746 | 2006.03.02 | + | + | Spleen and retroperitoneum: the essentials. | Ultrasound Q | |
| AM Fried, | ||||||||
| This is a survey of normal variants and pathologic conditions involving the spleen and retroperitoneum. The study focuses on the various sonographic appearances of trauma, infection, and neoplasm involving these areas in an attempt to complement works dealing specifically with the pancreas, kidneys, and great vessels. Ultrasound-guided intervention (biopsy, drainage) is included. | ||||||||
| 26 | 31.54 | 12945936 | 2004.03.16 | + | + | Splenic vascular tumors. | Semin Diagn Pathol | |
| JL Kutok, CD Fletcher, | ||||||||
| Splenic vascular tumors are uncommon and are more typically encountered as benign incidental findings. By contrast, splenic angiosarcoma may present acutely and dramatically and typically pursues a very aggressive clinical course. Vascular tumors in the spleen may show conventional endothelial, specialized endothelial (sinusoidal/littoral cell) or lymphatic differentiation and there is morphologic overlap between some of the currently defined diagnostic categories, within which benign, intermediate, and malignant subsets are recognized. The greatest problem in trying to better define and analyze these tumors is the availability of only relatively small case numbers. This overview describes the diagnosis and differential diagnosis of splenic vascular tumors as presently understood. | ||||||||
| 27 | 30.61 | 4040300 | 1985.08.01 | + | Tumors of the spleen. | World J Surg | ||
| L Morgenstern, J Rosenberg, SA Geller, | ||||||||
| 28 | 30.57 | 7034554 | 1982.03.13 | + | + | Surgical pathology of the spleen: an approach to the differential diagnosis of splenic lymphomas and leukemias. Part I. Diseases of the white pulp. | Am J Surg Pathol | |
| JS Burke, | ||||||||
| In order to facilitate diagnostic accuracy in the pathologic examination of the spleen, the differential diagnosis of the various splenic lymphomas and leukemias are divided into those diseases which primarily affect the white or red pulp. Enlargement of the splenic white pulp is due to either lymphoid hyperplasia, with or without the formation of germinal centers, or lymphomas and other lymphoproliferative disorders including chronic lymphocytic leukemia. Differentiation depends on recognition of germinal centers and the polymorphous nature of the lymphoid proliferation in reactive conditions, in comparison to the general monomorphous type of white pulp expansion found in the majority of lymphomas and lymphoproliferative disorders. Many of the reactive conditions are associated with a clinical hypersplenic state, while splenic lymphomas and lymphoproliferative disorders are frequently asymptomatic and discovered only at laparotomy. Macroscopic and microscopic evidence of enlargement of the white pulp may be absent in spleens of normal weight that are involved by lymphoma. In that situation, diagnosis requires meticulous examination of the white pulp for the demonstration of cytologic atypia. | ||||||||
| 29 | 29.81 | 16488085 | 2006.07.06 | + | + | Splenic metastases in a large unselected autopsy series. | Pathol Res Pract | |
| CA Schön, C Görg, A Ramaswamy, PJ Barth, | ||||||||
| We analyzed the files of all autopsies performed at the Institute of Pathology of the Philipps-University Marburg between 1980 and 1999 with respect to the presence of splenic metastasis. The total number of autopsies within the study period was 8,563. In 1,898 cases, a solid malignant tumor (1,774 carcinomas, 36 sarcomas, 27 malignant melanomas) was diagnosed. Metastasis to the spleen occurred in 57 cases (3.0%). Compared to the whole study population, patients with splenic metastasis were significantly younger (59 years vs. 67 years, p<0.05) and had significantly more metastastic sites (median: 6 vs. median:1, p<0.05). This underlines the assumption that splenic metastasis is associated with a worse prognosis. Lung cancer, cutaneous malignant melanoma, and breast cancer were the most frequent primary tumors, accounting for 24.6%, 15.8%, and 12.3% of all spleen metastases, respectively. Patients with testicular germ cell tumors (patients: 9, spleen metastasis: 4), malignant melanoma (patients: 27, spleen metastasis: 9, 33%), and small cell lung cancer (patients: 106, spleen metastasis: 8, 7.5%) had the highest frequency of splenic involvement. Most (n=48) metastases were detected macroscopically, the remaining ones were micrometastases (n=2), small tumor cell clusters, and single tumor cells within sinusoids (n=7). The present study underlines the importance of spleen metastasis as an indicator of poor prognosis. There are, however, various aspects as to the detection and morphology of spleen metastasism, which merit further scrutiny. | ||||||||
| 30 | 29.73 | 8988208 | 1997.01.29 | + | + | Splenic lymphangiomatosis in children. | Radiology | |
| DT Wadsworth, B Newman, SJ Abramson, BL Carpenter, RL Lorenzo, | ||||||||
| PURPOSE: To study the clinical and imaging features of splenic lymphangiomatosis. MATERIALS AND METHODS: The clinical and abdominal imaging data of 10 children with splenic lymphangiomatosis were retrospectively reviewed. The modalities used in the study included computed tomography (CT) (10 patients), sonography (five patients), and magnetic resonance (MR) imaging (two patients). Pathologic confirmation of lymphangiomatosis was obtained in nine patients. RESULTS: Splenic lymphangiomatosis was discovered incidentally in all cases and was a key finding in enabling the correct diagnosis in six children with extrasplenic disease as well. Only two children had clinical splenomegaly. Sonograms and MR images showed multiple, wEll-defined cysts. Multiple, low-attenuation lesions that did not enhance with intravenous administration of contrast material (n = 8) or a mottled spleen (n = 2) were seen at CT. One of the mottled spleens had target lesions on an early (arterial) image obtained after administration of a bolus of contrast material. One child underwent a splenectomy; one child underwent therapeutic embolization. Eight patients remained asymptomatic with respect to the spleen 1-20 years later. CONCLUSION: Splenic lymphangiomatosis is often an incidental imaging finding that frequently has a characteristic imaging appearance. The recognition of this appearance helps in diagnosis of this disease and may prevent the need for further invasive procedures. Splenic changes can be isolated or can coexist with bone or soft-tissue lymphangiomas. | ||||||||
| 31 | 29.41 | 10747308 | 2000.05.31 | + | + | Metastatic tumors to the spleen: a 25-year clinicopathologic study. | Arch Pathol Lab Med | |
| KY Lam, V Tang, | ||||||||
| OBJECTIVE: The clinicopathologic features of splenic metastases have seldom been investigated. The aim of this study was to evaluate the clinical and pathological impact of splenic metastases. CASE MATERIAL: We reviewed the clinical/autopsy records and pathologic features of 92 Chinese patients (58 men, 34 women) with secondary nonlymphoid splenic tumors recorded during a 25-year period. RESULTS: The incidence of splenic secondary tumors at autopsy was 0. 6% and at splenectomy, 1.1%. The lesions were often seen in elderly patients (mean age, 60 years). Seven (8%) of the splenic lesions were symptomatic. The symptomatic splenic lesions, as compared with asymptomatic lesions, were bigger and were found more often in women and younger patients. Two patients experienced spontaneous splenic rupture because of metastatic carcinoma. Eighty-seven (95%) of the secondary splenic tumors were carcinomas. Lung was the most common primary tumor site (21%), followed by the stomach (16%), pancreas (12%), liver (9%), and colon (9%). Rarely reported sources of primary tumor, such as esophageal carcinomas, nasopharyngeal carcinoma, and choriocarcinoma, were also found. Splenic metastases could be identified macroscopically in 74 (80%) of our patients. Grossly, splenic metastases involved the splenic capsule (n = 8) or were solitary (n = 31), multiple (n = 30), or diffuse (n = 8) lesions in the splenic parenchyma. Isolated splenic metastases were noted in 5.3% of the metastases found at autopsy. Many of the metastatic lesions in the spleen were identified shortly after primary tumors were detected (mean latent period, 6.7 months). The time from diagnosis of the primary tumor to metastasis to the spleen was more than 2 years in 14 patients. CONCLUSIONS: Splenic metastases are uncommon. A variety of clinical and pathologic patterns were noted in our series. | ||||||||
| 32 | 29.16 | 6783686 | 1981.06.25 | + | Cystic hamartoma of the spleen: CT and sonographic findings. | J Clin Ultrasound | ||
| AA Brinkley, JK Lee, | ||||||||
| 33 | 28.01 | 3840980 | 1985.12.23 | + | + | Malignant lymphoma with primary presentation in the spleen. A study of 20 patients. | Arch Pathol Lab Med | |
| CM Spier, CR Kjeldsberg, HJ Eyre, FG Behm, | ||||||||
| We describe 20 adult patients with malignant lymphoma with primary presentation in the spleen. The most common presenting symptoms were fever, malaise, and weight loss. Physical examination revealed prominent splenomegaly without palpable lymphadenopathy. Small lymphocytic lymphoma was the most frequent histologic type (11/20), followed by large cell lymphoma and mixed cell lymphoma (3/20 each). Bone marrow involvement was found in ten of 17 patients. At laparotomy, lymph node involvement, usually retroperitoneal, was found in six of 13 patients. There was liver involvement in seven of 15 patients. Follow-up has been relatively short, with an average of 24 months (range, one to 48 months). Four patients died as a result of progressive disease, one died of sepsis after splenectomy, and one died two years after diagnosis of a stroke. The prognosis in primary splenic lymphoma appears to be similar to that in nodal lymphoma. | ||||||||
| 34 | 27.74 | 15717221 | 2005.08.23 | + | Vascular pathology of the spleen, part II. | Abdom Imaging | ||
| AM De Schepper, F Vanhoenacker, BO de Beeck, J Gielen, P Parizel, | ||||||||
| 35 | 26.92 | 9922200 | 1999.03.03 | + | + | Littoral cell angioma of the spleen. | Abdom Imaging | |
| M Grantham, D Einstein, K McCarron, A Lichtin, D Vogt, | ||||||||
| Littoral cell angioma (LCA) is a rare benign vascular tumor of the spleen. LCA most commonly presents with constitutional symptoms (low grade fever and fatigue) and signs of hypersplenism (anemia and thrombocytopenia). Radiographically and at gross pathology an enlarged spleen containing multiple nodules is most commonly seen. Currently the radiological findings are nonspecific and correlation with clinical findings is necessary to narrow the differential while tissue is required for a definitive diagnosis. | ||||||||
| 36 | 26.20 | 3416282 | 1988.10.18 | + | + | Primary lymphoma of the spleen. Clinical features and outcome after splenectomy. | Cancer | |
| J Kehoe, DJ Straus, | ||||||||
| A retrospective review was made of patients with primary splenic non-Hodgkin's lymphoma (PSL) diagnosed at surgery at Memorial Hospital between 1970 and 1981. Four patients had splenic involvement only (Group I), three patients had splenic and splenic hilar nodal involvement (Group II), and 14 had involvement of the spleen and other sites including liver (11 patients), bone marrow (eight patients), and distant abdominal lymph nodes (five patients) (Group III). Three of the seven Group I and II patients are alive without disease at 24, 42, and 144 months. There was a trend toward a longer survival for the Group I and II patients as compared with the Group III patients. Patients with truely localized PSL seem to have the same outlook as other Stage I non-Hodgkin's lymphoma patients. | ||||||||
| 37 | 25.80 | 16415460 | 2006.02.07 | + | An elderly man with fever and hypodense lesions in the spleen and liver. | CMAJ | ||
| A Schattner, A Bassevitch, J Diment, | ||||||||
| 38 | 25.54 | 15718419 | 2005.07.13 | + | + | Gaucher disease and cancer incidence: a study from the Gaucher Registry. | Blood | |
| BE Rosenbloom, NJ Weinreb, A Zimran, KA Kacena, J Charrow, E Ward, | ||||||||
| Patients with Gaucher disease (GD) are alleged to be at an increased risk of malignant disorders, possibly due to potential chronic stimulation of the immune system and lymphoproliferation associated with storage of glucocerebroside in tissue macrophages. Because previous reports of increased risk of malignancy in GD may have been affected by small patient numbers and ascertainment bias, 2742 patients with GD from the International Gaucher Registry were studied. The number of cancers identified among patients in the registry was compared with that expected in the US population of similar attained age and sex. The majority of patients were young or middle-aged adults at the time of last follow-up, with only 14% older than age 60. There were 10 patients with multiple myeloma, yielding an estimated relative risk of 5.9 (95% confidence interval [95% CI]: 2.8, 10.8). The relative risk of cancer overall was 0.79 (95% CI: 0.67, 0.94), and the subgroups for cancers of the breast, prostate, colon and rectum, lung, and hematologic malignancies other than myeloma did not yield statistically significant higher risks. This study suggests that, in general, patients with Gaucher disease are not at highly increased risk of cancer, at least during early and middle age. However, there appears to be a significantly higher risk of multiple myeloma of which physicians should be aware when caring for these patients. | ||||||||
| 39 | 24.71 | 16189163 | 2005.11.15 | + | + | Pseudo-Gaucher cells in mycobacterial infection: a report of two cases. | J Clin Pathol | |
| P Dunn, MC Kuo, CF Sun, | ||||||||
| This report describes two cases of mycobacterial infection with pseudo-Gaucher cells. Both patients had no clinical evidence of inherited Gaucher disease. The first case was a patient with AIDS and Mycobacterium avium intracellulare involving the lung, spleen, and bone marrow. The bone marrow aspirates showed many histiocytes with needle-like inclusions. Acid fast staining showed that these histiocytes contained acid fast bacilli. Bone marrow biopsies revealed granulomatous lesions with aggregates of foamy histiocytes. The second case was an alcoholic patient with Mycobacteriumkanasassi infection involving the lung and lymph nodes. The lymph node aspirates showed infiltration of the same cells with acid fast bacilli in the cytoplasm. | ||||||||
| 40 | 24.40 | 3275982 | 1988.02.23 | + | + | Hepatosplenic candidiasis: wheels within wheels. | Radiology | |
| B Pastakia, TH Shawker, M Thaler, T O'Leary, PA Pizzo, | ||||||||
| Eight immunocompromised cancer patients with tissue-proved candidiasis underwent serial abdominal ultrasound (US) and computed tomography (CT). At US, four patterns of hepatic and splenic candidiasis were recognized, one of which the authors call a "wheels-within-wheels" pattern. In addition, periportal linear areas of increased attenuation, possibly calcified, were identified at follow-up, nonenhanced CT. Some abscesses were better seen on nonenhanced CT scans, while others became visible only with enhancement. Although lesions not seen at US were often seen at CT, the opposite was also true. In two cases, pathologic proof of candidiasis was established even when all imaging studies were normal. For maximum imaging sensitivity, patients should be studied with US and nonenhanced and enhanced CT. Even when both US and CT scans are negative, if there is a strong clinical suggestion of candidiasis, open biopsy is recommended. | ||||||||
| 41 | 23.48 | 14700161 | 2004.02.05 | + | + | Splenic lymphangioma and presentation with frequent urination: a case report. | J Med Assoc Thai | |
| R Niramis, L Tanvichien, V Hemsrichart, | ||||||||
| Lymphangioma of the spleen is a rare disorder with a clinical manifestation ranging from incidental findings of an abdominal mass to symptomatic abdominal pain. The authors reported a case of splenic lymphangioma with the presenting symptom of frequent urination in a 9-year-old boy. A large firm mass was found at the left upper quadrant, 12 cm in diameter. The diagnosis was confirmed by ultrasonography and computerized tomographic (CT) scan. The symptoms of frequent urination disappeared after operative splenectomy. No evidence of recurrence occurred over a 3-year follow-up. | ||||||||
| 42 | 23.35 | 6856834 | 1983.07.15 | + | + | Large-cell lymphoma of the spleen: CT appearance. | Radiology | |
| JE Meyer, NL Harris, A Elman, PC Stomper, | ||||||||
| CT and histopathological findings were correlated in 5 patients with large-cell lymphoma who presented with splenic enlargement. Prominent CT findings included splenomegaly with large solitary or multiple areas of low attenuation. The clinical presentation and operative findings are reviewed. | ||||||||
| 43 | 21.68 | 1727362 | 1992.01.16 | + | Splenic and hepatic peliosis: MR findings. | AJR Am J Roentgenol | ||
| CK Maves, KH Caron, GS Bisset, R Agarwal, | ||||||||
| 44 | 21.39 | 2731700 | 1989.07.20 | + | + | Hepatosplenic tuberculosis with hypersplenism: CT evaluation. | Gastrointest Radiol | |
| BI Choi, JG Im, MC Han, HS Lee, | ||||||||
| Hepatosplenic tuberculosis of macronodular form is extremely rare. We present one case of hepatosplenic tuberculosis with its appearance on computed tomography (CT). The CT findings of hepatosplenic tuberculosis were multiple, well-defined, round or ovoid, low-density masses with a range of +35 to +45 HU. Lymphadenopathy in the abdominal and mediastinal area and pleural effusion were also found. Although CT does not confirm a diagnosis of hepatosplenic tuberculosis, it is a valuable examination to support the diagnosis and define the extent of disease. | ||||||||
| 45 | 21.14 | 1899742 | 1991.03.20 | + | + | Intraabdominal Mycobacterium tuberculosis vs Mycobacterium avium-intracellulare infections in patients with AIDS: distinction based on CT findings. | AJR Am J Roentgenol | |
| DR Radin, | ||||||||
| Abdominal CT scans of 71 patients with AIDS who had proved disseminated infection due to Mycobacterium tuberculosis (27 patients) or Mycobacterium avium-intracellulare (44 patients) were reviewed retrospectively to identify radiologic features that can be used to distinguish the two infections. CT findings in patients with disseminated M. tuberculosis included focal lesions in the liver (11%), spleen (30%), kidneys (19%), pancreas (7%), and gastrointestinal tract (15%) and lymph nodes with central or diffuse low attenuation (93%). CT findings in patients with disseminated M. avium-intracellulare included marked hepatomegaly (20%); marked splenomegaly (14%); focal lesions in the liver (9%), spleen (7%), and kidneys (2%); diffuse jejunal wall thickening (18%); lymph nodes with central low attenuation (14%); and enlarged lymph nodes exclusively of homogeneous soft-tissue density (55%). The presence of focal visceral lesions and low-attenuation lymph nodes suggests disseminated M. tuberculosis, whereas marked hepatic and splenic enlargement, diffuse jejunal wall thickening, and enlarged soft-tissue-density lymph nodes suggest disseminated M. avium-intracellulare. Recognition of these CT features can lead to a tentative diagnosis so that appropriate therapy can be instituted before the results of mycobacterial cultures become available. | ||||||||
| 46 | 21.11 | 1592926 | 1992.07.02 | + | + | CT and MR appearances of splenic hamartoma. | J Comput Assist Tomogr | |
| K Ohtomo, H Fukuda, K Mori, M Minami, Y Itai, Y Inoue, | ||||||||
| The MR and CT appearances of two cases of splenic hamartoma are presented. Computed tomography showed a well demarcated low-density mass without calcification. Dense spreading enhancement was seen in one case on dynamic CT, and prolonged enhancement was noted in both. The masses were demonstrated as areas of isointensity on T1-weighted MR images and of high intensity on T2-weighted images. On gadolinium-enhanced T1-weighted images they were shown as areas of high intensity. Prolonged enhancement on postcontrast CT and MR imaging was a useful finding in differentiation of splenic hamartoma from malignant lesions of the spleen, especially from nodular lesions of malignant lymphoma. | ||||||||
| 47 | 20.76 | 2406785 | 1990.03.27 | + | + | Splenic infarction: sonographic patterns, diagnosis, follow-up, and complications. | Radiology | |
| C Goerg, WB Schwerk, | ||||||||
| Forty splenic infarcts in 23 patients were examined with ultrasound (US). At clinical presentation, splenic infarction was associated with severe left upper quadrant pain (n = 10) or diffuse abdominal pain (n = 4) or was asymptomatic (n = 9). In this retrospective study, predominantly wedge-shaped (n = 17) or round (n = 23), irregularly delineated (n = 33) or smooth (n = 7), hypoechoic (n = 40) and anechoic (n = 5) lesions were found at first examination. During follow-up observation, four patients died because of complications unrelated to infarct, and five patients underwent splenectomy as a consequence of US findings. Expanding intralienal liquefaction, increasing subcapsular hemorrhage, free peritoneal blood (even in spleens shown to have an intact surface at sonography), and flow phenomena in the area of infarction demonstrated at B-mode pulsed Doppler US were identified as infarct-related complications associated with the risk of splenic rupture. Despite the high self-healing tendency in splenic infarction, short-term follow-up with US is recommended for early recognition of these possible complications. | ||||||||
| 48 | 20.39 | 8316667 | 1993.07.26 | + | + | CT of congenital and acquired abnormalities of the spleen. | Radiographics | |
| JL Freeman, SZ Jafri, JL Roberts, DG Mezwa, A Shirkhoda, | ||||||||
| Computed tomography (CT) is an excellent imaging modality for demonstrating the size, shape, and position of the spleen, as well as for depicting intrasplenic pathologic features. However, it has limited value in the diagnosis of splenic involvement by lymphoma. Greater accuracy in diagnosing splenic lymphoma may be obtained by demonstrating adenopathy in the splenic hilum or by showing focal splenic defects, in addition to splenomegaly. In discussing the normal anatomy of the spleen, congenital variations (eg, accessory spleen, polysplenia, asplenia, and wandering spleen), and acquired abnormalities such as those resulting from trauma, infection, infarction, cysts, and neoplasms, this article provides evidence that CT is valuable in showing a wide variety of splenic variations and abnormalities while simultaneously allowing evaluation of the remaining intraabdominal structures. The cases presented demonstrate both the value and limitations of CT in the examination of patients with congenital and acquired abnormalities of the spleen. | ||||||||
| 49 | 19.86 | 15351243 | 2004.10.18 | + | + | Splenic abnormalities: a comparative review of ultrasound, microbubble-enhanced ultrasound and computed tomography. | Clin Radiol | |
| P Peddu, M Shah, PS Sidhu, | ||||||||
| The ultrasound appearances of abnormalities of the spleen are reviewed and images compared with computed tomography. Focal lesions, both benign and malignant, trauma, infarction and congenital abnormalities are presented. The use of microbubble ultrasound contrast media as an aid to identifying and characterizing abnormalities is discussed. | ||||||||
| 50 | 19.77 | 1928554 | 1991.11.07 | + | + | Littoral cell angioma. A novel splenic vascular lesion demonstrating histiocytic differentiation. | Am J Surg Pathol | |
| S Falk, HJ Stutte, G Frizzera, | ||||||||
| Seventeen cases of a novel type of vascular tumor of the spleen are described. The lesions, whose size ranges from minute foci to large nodules almost completely replacing the splenic tissue, are composed of anastomosing vascular channels resembling splenic sinus and have irregular lumina, often featuring papillary projections and cyst-like spaces; they are lined by tall endothelial cells that slough off into the vascular lumina and show hemophagocytosis. Atypical cells are absent and mitotic activity very low. In contrast to normal sinus endothelia, which express only FVIIIag, neoplastic cells express both endothelial (FVIII-AG, BMA 120) and histiocytic (KP1, lysozyme) antigens; occasionally S-100 protein is also present. The morphologic and immunohistochemical findings in this tumor reflect the dual differentiation potential of the reticuloendothelial cells lining the splenic sinus, justifying the term littoral cell angioma, and recognize a distinct entity that is different from other vascular lesions of the spleen, notably angiosarcoma. This distinction is all the more important because the clinical behaviour of this lesion is apparently benign. | ||||||||
| 51 | 18.90 | 9922201 | 1999.03.03 | + | + | Littoral cell angioma of the spleen: US and MR imaging findings. | Abdom Imaging | |
| JM Oliver-Goldaracena, A Blanco, M Miralles, MA Martin-Gonzalez, | ||||||||
| In this article, we describe the ultrasound and magnetic resonance imaging findings of a littoral cell angioma of the spleen. This benign vascular neoplasm of the spleen has been described, but to our knowledge there has been no case published in the literature that describes its imaging features. | ||||||||
| 52 | 18.56 | 10702822 | 2000.08.16 | + | + | Lymphangioma of the spleen in an elderly patient. | Haematologica | |
| M Vezzoli, E Ottini, M Montagna, A La Fianza, M Paulli, R Rosso, A Mazzone, | ||||||||
| Splenic cystic lymphangioma is a very rare condition, and is classified among cystic proliferations of the spleen. It is considered to be the result of a developmental malformation of the lymphatic system and can involve the spleen alone or be a part of multiorgan disease. It is usually seen in children, often found incidentally. We describe a case of cystic lymphangioma of the spleen in an elderly woman putting emphasis on the rarity of the case in old age, and on the problems of differential diagnosis with the other cystic proliferations of the spleen, in particular hydatid disease, in the absence of histologic information. | ||||||||
| 53 | 18.32 | 1984330 | 1991.01.24 | + | + | Sarcoidosis: abdominal manifestations at CT. | Radiology | |
| AR Britt, IR Francis, GM Glazer, JH Ellis, | ||||||||
| There are few data in the literature on the abdominal manifestations of sarcoidosis at computed tomography (CT). To determine whether differences in nodal distribution and appearance can be reliably used to distinguish between sarcoidosis and non-Hodgkin lymphoma (NHL), the authors retrospectively reviewed the abdominal and pelvic CT scans of 16 patients with biopsy-proved sarcoidosis and 20 patients with biopsy-proved NHL. Eleven of the 16 patients with sarcoidosis had abdominal and/or pelvic lymphadenopathy, which was common at all nodal sites except for the retrocrural and pelvic locations. There was a statistically significant lower frequency of retrocrual adenopathy in sarcoidosis than in NHL. Mean nodal size was significantly greater in NHL. Nodes tended to be confluent in NHL and discrete in sarcoidosis. Hepatomegaly was seen in six of the 16 patients (38%) with sarcoidosis and splenomegaly was present in nine of 15 (60%). CT depicted hepatic lesions in only three of eight patients (38%) with biopsy-proved hepatic involvement. Splenic lesions were seen at CT in five of the 15 patients (33%). The authors believe that the overlap in nodal appearance and distribution poses a limitation for use of these criteria in accurate disease characterization. | ||||||||
| 54 | 17.97 | 5327041 | 1966.07.30 | + | Malignant lymphoma of the spleen. A review of 49 cases in which the diagnosis was made at splenectomy. | Cancer | ||
| DL Ahmann, JM Kiely, EG Harrison, WS Payne, | ||||||||
| 55 | 17.75 | 2806818 | 1989.12.21 | + | + | MRI of splenic hemangioma associated with thrombocytopenia. | Gastrointest Radiol | |
| RD Harris, W Simpson, | ||||||||
| In contrast to the only previously published description, the magnetic resonance appearance of a splenic hemangioma was markedly heterogeneous on T2-weighted images due to extensive infarction and large vascular pools. Magnetic resonance images correlated precisely with the pathological findings. The hemangioma caused thrombocytopenia, a well-documented albeit rare hematologic phenomenon associated with visceral hemangioma. | ||||||||
| 56 | 15.99 | 8372948 | 1993.10.12 | + | + | Primary angiosarcoma of the spleen. A clinicopathologic study of 40 cases. | Am J Surg Pathol | |
| S Falk, J Krishnan, JM Meis, | ||||||||
| Forty primary splenic angiosarcomas occurring in 21 men and 19 women, 19-84 years old (median 59 years) are reported. Patients presented with splenomegaly (35 of 38, 92%), abdominal pain (33 of 40, 83%), and systemic symptoms such as fatigue (2 of 40, 5%), fever (4 of 40, 10%), and/or weight loss (16 of 40, 40%). Five (13%) experienced splenic rupture associated with hemoperitoneum. Abnormal laboratory findings included cytopenia (31 of 34, 91%), leukocytosis (8 of 21, 38%), and thrombocytosis (1/39, 3%). Most spleens weighed 500-1,000 g (mean, 1,180 g). The cut splenic surfaces showed multiple hemorrhagic nodules that were frequently associated with infarction, although some had a diffuse pattern of involvement. Microscopically, there were a variety of histologic patterns displayed by the vasoformative component. A honeycomb or sponge-like pattern was common in some, whereas others simulated a cavernous hemangioma or normal splenic sinuses (pseudosinusoidal pattern). Papillary endothelial tufts and solid proliferations of spindled to round to epithelioid cells were also seen. Factor VIII-related antigen was detected in 19 of 23 cases, BMA-120 in 18 of 23, UEA-1 receptor in 18 of 23, and vimentin in 23 of 23 as well as CD68 antigen in 1 of 23 cases. S-100 protein and cytokeratin were not found in any of the 23 cases studied. Metastases in 22 of 32 patients (69%) were to the liver (13 patients), bone or bone marrow (7 patients), lymph nodes (1 patient), and brain (1 patient). Three patients had concomitant malignancies and one had a prior history of a mixed B-cell lymphoma 5 years previously that had been treated with chemotherapy. Follow-up in 38 patients revealed that 30 (79%) are dead at a median interval of 6 months (range 0-48 months) and 8 are alive 5-21 months after diagnosis. These findings indicate that splenic angiosarcoma is an aggressive neoplasm with a high metastatic rate and an abysmal prognosis. Recognition of the wide range of histologic patterns is of diagnostic value but no apparent prognostic significance. | ||||||||
| 57 | 15.97 | 11092485 | 2000.12.07 | + | + | US and CT findings in splenic focal lesions in AIDS. | Acta Radiol | |
| V Schininà, EB Rizzi, G Mazzuoli, V David, C Bibbolino, | ||||||||
| PURPOSE: To evaluate the role of US and CT in focal splenic lesions in AIDS patients in relation to etiology. MATERIAL AND METHODS; A total of 66 patients with AIDS and focal splenic lesions were examined with sonography. CT with administration of contrast medium was performed in 12 cases. RESULTS: Of the focal splenic lesions, 67% were correlated with an infective pathology with prevalence of Mycobacteria tuberculosis (75%), 26% were neoplastic and 6% splenic infarcts. The lesions were hypoechoic in 60% of the cases, while 10% were hypoanechoic and 1% anechoic. At CT, all lesions appeared hypodense, even after i.v. administration of contrast medium. CONCLUSION: The combination of echographic reports and clinical and laboratory data allows for a diagnosis that can be confirmed, and making a decision for effective therapy of AIDS is possible. CT does not provide any additional information. | ||||||||
| 58 | 14.63 | 12216754 | 2003.01.22 | + | + | Multiple hypoechoic hepatic lesions in a patient with Gaucher disease. | J Ultrasound Med | |
| M Patlas, I Hadas-Halpern, C Reinus, A Zimran, D Elstein, | ||||||||
| The most common symptoms of Gaucher disease include hepatosplenomegaly and anemia and thrombocytopenia due to hypersplenism. We describe the case of a patient with Gaucher disease who had cachexia, massive hepatomegaly, and multiple focal hepatic lesions. The clinical and radiologic findings suggested malignancy. A biopsy specimen was taken from a hepatic lesion and revealed infiltration by Gaucher cells. We discuss our findings in light of the putative increased incidence of hematologic malignancies in patients with Gaucher disease. | ||||||||
| 59 | 14.49 | 16019460 | 2005.09.14 | + | + | Multiple littoral cell angioma of the spleen in a case of myelodysplastic syndrome. | Hematology | |
| C Erçin, Y Gürbüz, A Hacihanefioğlu, A Turgut Karakaya, | ||||||||
| Littoral cell angioma (LCA) of the spleen is a relatively recently described rare entity, which is associated with haemophagocytosis. In this case report, we will present a case of myelodysplastic syndrome with multiple LCA of the spleen.The patient presented with pancytopenia and multiple haemangiomas were observed in spleen during diagnostic abdominal ultrasound. She required a transfusion of one to two units of packed blood every 4-6 weeks and she eventually underwent a splenectomy in order to decrease the transfusion requirement. Although the patient's pancytopenia improved after surgery, the patient did not achieve a normal haemoglobin level in the two years following the splenectomy. Following further studies, bone marrow aspiration was undertaken and demonstrated minimal dysplasia in erythroid series including nuclear abnormalities, irregular cytoplasmic borders and irregular staining of the cytoplasm. The patient was diagnosed as myelodysplastic syndrome.As LCA of the spleen and myelodysplastic syndrome may both cause cytopenia their co-existence may complicate the clinical presentation leading to an incomplete or inappropriate diagnosis. In cases of haematological disorders with an atypical course, the radiological examination of the spleen should be considered and the possibility of angiomas must be included to the differential diagnosis. | ||||||||
| 60 | 14.13 | 12708922 | 2003.05.08 | + | + | Splenic lymphoma arising in a patient with Gaucher disease. A case report and review of the literature. | Arch Pathol Lab Med | |
| HC Bertram, M Eldibany, J Padgett, LH Dragon, | ||||||||
| Patients with Gaucher disease have an increased risk of malignancies, especially the lymphoreticular type. To our knowledge, this is the first reported case of Gaucher disease diagnosed during the workup and diagnosis of a splenic marginal-zone lymphoma with progression to diffuse large B-cell lymphoma. There are several theories as to how Gaucher disease leads to malignancies. The accumulated glucocerebroside in the reticuloendothelial organs, histologically visible as Gaucher cells, is thought to provide chronic antigenic stimulus to the immune system. Polyclonal hypergammaglobulinemia develops, and monoclonal populations of lymphocytes and plasma cells may arise from this premalignant proliferative state. How Gaucher disease is related to nonlymphoid malignancies remains unclear. | ||||||||
| 61 | 13.13 | 6497634 | 1984.11.30 | + | + | Hamartomas of the spleen. | Arch Surg | |
| L Morgenstern, L McCafferty, J Rosenberg, SL Michel, | ||||||||
| A study of 12 cases of splenic hamartomas, rare benign lesions of the spleen, included one case of spontaneous rupture of a hamartoma that required emergency operation and two cases of hamartomatosis with splenomegaly. An increased incidence of accessory spleens was also noted. Therefore, although rarely symptomatic, hamartomas may occasionally be of clinical importance. Surgeons should be aware of these lesions in the differential diagnosis of splenic tumors that appear as filling defects on scintiscan or as splenic masses on abdominal exploration. Since it may also be a source of spontaneous splenic rupture, it should be considered as one of the rare causes of such an occurrence. | ||||||||
| 62 | 12.71 | 11812973 | 2002.02.22 | + | Lymphangiomatosis of the spleen and 2 accessory spleens. | Surgery | ||
| A Barrier, F Lacaine, P Callard, M Huguier, | ||||||||
| 63 | 12.41 | 10658726 | 2000.02.17 | + | Littoral cell angioma of the spleen: imaging features. | AJR Am J Roentgenol | ||
| LL Kinoshita, J Yee, SR Nash, | ||||||||
| 64 | 11.99 | 16009818 | 2006.03.31 | + | + | MR imaging of the spleen: spectrum of abnormalities. | Radiographics | |
| KM Elsayes, VR Narra, G Mukundan, JS Lewis, CO Menias, JP Heiken, | ||||||||
| The spleen has the same relationship to the circulatory system that the lymph nodes have to the lymphatic system. A wide range of diseases can affect the spleen. Pathologic conditions of the spleen can be classified into the following categories: congenital diseases (accessory spleen, polysplenia, and asplenia); trauma; inflammation (abscess, candidiasis, histoplasmosis, and sarcoidosis); vascular disorders (infarction, diseases affecting the splenic vasculature, and arteriovenous malformation); hematologic disorders (sickle cell disease and extramedullary hematopoiesis); benign tumors (cysts, hemangioma, diffuse hemangiomatosis of the spleen, and hamartoma); malignant tumors (sarcoma, lymphoma, and metastases); and other disease processes that affect the spleen diffusely (portal hypertension, Gaucher disease, and sickle cell disease) or focally (Gamna-Gandy nodules). New magnetic resonance (MR) imaging techniques have increased the role of MR imaging in detection and characterization of splenic diseases. MR imaging is an excellent tool for diagnosis and evaluation of focal lesions and pathologic conditions of the spleen. | ||||||||
| 65 | 5.64 | 16154823 | 2006.03.31 | + | + | Tumours of the spleen. | Cancer Imaging | |
| A Giovagnoni, C Giorgi, G Goteri, | ||||||||
| The spleen has been considered a 'forgotten organ' even if it is included and well demonstrated on every CT and MRI of the abdomen. Tumours of the spleen are rare; however, radiologists need to be aware of the main tumoral features and patterns in order to try to distinguish between benign and malignant masses often discovered incidentally. The principal tumoral masses, benign (cysts, haemangiomas, litteral cell angioma, lymphangioma) and malignant (lymphoma, metastases haemangiosarcoma), are described. | ||||||||
| 66 | 2.46 | 5368340 | 1970.03.16 | + | Effect of carcinostatic agents on carcinomatous metastasis in the spleen. | Gann | ||
| T Watanabe, K Tanaka, | ||||||||
| 67 | -15.45 | 15405683 | 2004.09.30 | + | Metastases in carcinoma; analysis of 1000 autopsied cases. | Cancer | ||
| HL ABRAMS, R SPIRO, N GOLDSTEIN, | ||||||||