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Focal splenic defect
GAMUT Edited by Robert C. Stadalnik
Focal Splenic Defect E. Edmund Kim
A
64-yr-old female was referred with 3 wk of constant sharp pain in the left upper quadrant of the abdomen. She denied any significant history of trauma or cardiovascular disease, and physical examination was essentially negative. The liver-spleen scan with Tc-99m sulfur colloid demonstrated a large focal defect in the upper portion of the moderately enlarged spleen (Fig. 1). Abdominal images made by Anger longitudinal multiplane tomoscanner showed clearly the filling of Ga-67 citrate activity in the area corresponding to the large defect seen on the liver-spleen scan (Fig. 2). Splenic arteriogram revealed a large hypovascular mass with multiple pathologic vessels, and histologic diagnosis by splenectomy was a primary immunoblastic lymphoma. The incidence of splenic defect (0.9%) on routine liver-spleen scan excluding the evaluation for trauma and staging lymphoma is very low, I and the etiology is sometimes difficult to establish. The liver-spleen scan has been enhanced by combining the Tc-99m sulfur colloid scan with the Ga-67 citrate imaging since the sensitivity of Ga-67 in detecting lymphoma and abscess (70%-80%) appears relatively high. An area that appears as a filling defect with the colloid and that concentrates Ga-67 as well as or better than surrounding tissue most likely represents a tumor or abscess, thus excluding infarction or cyst as a cause of a cold area in the colloid scan. 2
q
! ANT
POST.
R LAT
L LAT
Fig. 1. The liver-spleen scan with T c - 9 9 m sulfur colloid shows a large focal defect in the upper portion of the spleen.
CAUSES OF FOCAL SPLENIC DEFECTS Common
From the University of Kentucky and Veterans Administration Medical Centers, Lexington, Kentucky. Address reprint requests to Dr. E. Kim, Div. of Nuclear Medicine, University of Kentucky Medical Center, 800 Rose St., Lexington, Ky. 40536. 9 1979 by Grune & Stratton, Inc. 0001-2998/79/0904-000550100/0
1. infarction a. pancreatitis--alcoholism b. subacute bacterial endocarditis c. sarcoidosis d. sickle cell anemia e. leukemia f. malaria g. arteritis--polyarteritis nodosa, acute infection 2. lymphoma--Hodgkin disease, histiocytic lymphoma 3. hematoma a. trauma
320
Seminars in Nuclear Medicine, Vol. IX, No. 4 (October), 1979
GAMUT
321
r"
A Fig. 2. Ga-67 scan by Anger longitudinal multiplane tomoscanner shows the filling of the radioactivity in the area corresponding to the large defect seen on Fig. 1. (Tomoplane numbers 4 and 8 are in supine position, and 5 and 6 are in lateral position)
5
b. surgery 4. splenic artery aneurysm 5. anatomical variation--splenic hilus
9
'6
9
4. artifacts
a. metallic object b. barium contrast m the bowel c. overlying breast or left arm
Uncommon
Rare ]. primary tumors
l. metastatic tumors a. malignant melanoma b. islet cell tumor c. lung carcinoma d. breast carcinoma 2. splenic or perisplenic abscess 3. pancreatic pseudocyst
a. hemangioma b. fibroma c. hamartoma o primary cyst 3. splenic arteriovenous malformation 4. amyloidosis
REFERENCES
1. Freeman MH, Tonkin AK: Focal splenic defects. Radiology 121:689 692, 1976 2. Silberstein SB: Cancer diagnosis. The role of tumorimaging pharmaceuticals. Am J Med 60:226-237, 1976 3. MacPherson AIS: The Spleen. Springfield, Ilk CC Thomas, 1973, pp135 141,1973 4. Berge T: Splenic metastases. Frequencies and patterns. Acta Pathol Microbiol Scand 82:499-506, 1974 5. Morgan H, Johnson PM: Splenic masses detected by scintillation imaging and contrast tomography. Radiology 97:301 306, 1970
6, Ramer M, Diznoff SB, Hewes AC: Intrasplenic pancreatic pseudocyst. Clin Radiol 25:525-529, 1974 7, Catanzaro FP, Abiri M, Allegra S: Spontaneous rupture of the spleen and pleural effusion complicating pancreatitis. RIMed J 51:328 329, 1968 8. Kim E, Mattar AG: Scan findings in a case of splenic infarction due to amyloidosis. J Nucl Med 17:902 903, 1976 9. Nelp WB, Kuhn IN: Splenic infarction diagnosed preoperatively in photoscanning. JAMA 197:369-371, 1966 10. Kay S: Sarcoidosis of the spleen. Am J Pathol 26:427 443, 1950
Focal Splenic Defect E. Edmund Kim
A
64-yr-old female was referred with 3 wk of constant sharp pain in the left upper quadrant of the abdomen. She denied any significant history of trauma or cardiovascular disease, and physical examination was essentially negative. The liver-spleen scan with Tc-99m sulfur colloid demonstrated a large focal defect in the upper portion of the moderately enlarged spleen (Fig. 1). Abdominal images made by Anger longitudinal multiplane tomoscanner showed clearly the filling of Ga-67 citrate activity in the area corresponding to the large defect seen on the liver-spleen scan (Fig. 2). Splenic arteriogram revealed a large hypovascular mass with multiple pathologic vessels, and histologic diagnosis by splenectomy was a primary immunoblastic lymphoma. The incidence of splenic defect (0.9%) on routine liver-spleen scan excluding the evaluation for trauma and staging lymphoma is very low, I and the etiology is sometimes difficult to establish. The liver-spleen scan has been enhanced by combining the Tc-99m sulfur colloid scan with the Ga-67 citrate imaging since the sensitivity of Ga-67 in detecting lymphoma and abscess (70%-80%) appears relatively high. An area that appears as a filling defect with the colloid and that concentrates Ga-67 as well as or better than surrounding tissue most likely represents a tumor or abscess, thus excluding infarction or cyst as a cause of a cold area in the colloid scan. 2
q
! ANT
POST.
R LAT
L LAT
Fig. 1. The liver-spleen scan with T c - 9 9 m sulfur colloid shows a large focal defect in the upper portion of the spleen.
CAUSES OF FOCAL SPLENIC DEFECTS Common
From the University of Kentucky and Veterans Administration Medical Centers, Lexington, Kentucky. Address reprint requests to Dr. E. Kim, Div. of Nuclear Medicine, University of Kentucky Medical Center, 800 Rose St., Lexington, Ky. 40536. 9 1979 by Grune & Stratton, Inc. 0001-2998/79/0904-000550100/0
1. infarction a. pancreatitis--alcoholism b. subacute bacterial endocarditis c. sarcoidosis d. sickle cell anemia e. leukemia f. malaria g. arteritis--polyarteritis nodosa, acute infection 2. lymphoma--Hodgkin disease, histiocytic lymphoma 3. hematoma a. trauma
320
Seminars in Nuclear Medicine, Vol. IX, No. 4 (October), 1979
GAMUT
321
r"
A Fig. 2. Ga-67 scan by Anger longitudinal multiplane tomoscanner shows the filling of the radioactivity in the area corresponding to the large defect seen on Fig. 1. (Tomoplane numbers 4 and 8 are in supine position, and 5 and 6 are in lateral position)
5
b. surgery 4. splenic artery aneurysm 5. anatomical variation--splenic hilus
9
'6
9
4. artifacts
a. metallic object b. barium contrast m the bowel c. overlying breast or left arm
Uncommon
Rare ]. primary tumors
l. metastatic tumors a. malignant melanoma b. islet cell tumor c. lung carcinoma d. breast carcinoma 2. splenic or perisplenic abscess 3. pancreatic pseudocyst
a. hemangioma b. fibroma c. hamartoma o primary cyst 3. splenic arteriovenous malformation 4. amyloidosis
REFERENCES
1. Freeman MH, Tonkin AK: Focal splenic defects. Radiology 121:689 692, 1976 2. Silberstein SB: Cancer diagnosis. The role of tumorimaging pharmaceuticals. Am J Med 60:226-237, 1976 3. MacPherson AIS: The Spleen. Springfield, Ilk CC Thomas, 1973, pp135 141,1973 4. Berge T: Splenic metastases. Frequencies and patterns. Acta Pathol Microbiol Scand 82:499-506, 1974 5. Morgan H, Johnson PM: Splenic masses detected by scintillation imaging and contrast tomography. Radiology 97:301 306, 1970
6, Ramer M, Diznoff SB, Hewes AC: Intrasplenic pancreatic pseudocyst. Clin Radiol 25:525-529, 1974 7, Catanzaro FP, Abiri M, Allegra S: Spontaneous rupture of the spleen and pleural effusion complicating pancreatitis. RIMed J 51:328 329, 1968 8. Kim E, Mattar AG: Scan findings in a case of splenic infarction due to amyloidosis. J Nucl Med 17:902 903, 1976 9. Nelp WB, Kuhn IN: Splenic infarction diagnosed preoperatively in photoscanning. JAMA 197:369-371, 1966 10. Kay S: Sarcoidosis of the spleen. Am J Pathol 26:427 443, 1950