GI Radiography


Case 3 :
 
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A 26 year old male presented with chief complaints of PUO and weight loss of 4 months duration. Clinical examination revealed splenomegaly. Lab studies showed hemoglobin of 9 gm% and negative for HIV. CT scan of the abdomen was performed.
What is the diagnosis?




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Imaging Findings

Relevant scan picture shows multiple hypodense lesions in the spleen. A small subcapsular subcentimetre lesion was seen in the right lobe of liver. Scans taken at a lower level revealed presence of rim enhancing para aortic lymph nodes. Chest radiograph taken earlier had shown miliary tuberculosis.

Diagnosis
Tuberculosis involving the spleen

Discussion
Abdominal tuberculosis usually affects the gastrointestinal tract, peritoneum, lymph nodes, liver or spleen. Tuberculosis of the liver or spleen is uncommon, except in association with miliary dissemination (1).
Similar hypoechoic lesions have been reported on ultrasound in many conditions including tuberculosis, and myeloproliferative disorders including leukemia, metastasis, lymphoma and Hodgkin's disease (2,3), and also in AIDS-related lymphomatous involvement of the spleen (4).

Contribution : Dr Sanjeev Mani, Mumbai, India

References
1. Thoeni RF, Margulis AR. Gastrointestinal tuberculosis. Sem Roentgenol 1979; 14: 283-94.
2. Mittelstaedt CA, Partain CL. Ultrasonic-pathologic classification of splenic abnormalities; gray scale patterns. Radiology 1980; 134: 697-702.
3. Kapoor R, Jain AK, Chaturvedi U, Saha MM. Case report: Ultrasound detection of tuberculomas of the spleen. Clin Radiol 1991; 43: 719-24.
4. Nyberg DA, Jeffrey RB, Federle MP, Bottles K, Abrams DL. AIDS-related lymphoma: evaluation by abdominal CT. Radiology 1986; 159: 59-63.