J Korean Med Sci.  2011 Mar;26(3):457-460. 10.3346/jkms.2011.26.3.457.

A Case of Mass-Forming Splenic Tuberculosis: MRI Findings with Emphasis of Diffusion-Weighted Imaging Characteristics

• Lim J
• Yu JS
• Hong SW
• Chung JJ
• Kim JH
• Kim KW

• KMID: 2157889
• DOI: http://doi.org/10.3346/jkms.2011.26.3.457

Abstract

Tuberculosis remains one of the most prevalent and fatal infectious diseases in spite of considerable improvements in medical science. The diagnosis and treatment of extrapulmonary tuberculosis involving the abdomen is still complicated owing to vague or non-specific clinical features. Although rare, isolated splenic involvement is one of the important manifestations of extrapulmonary tuberculosis, and imaging suspicion of the disease is essential. We report a case of surgically confirmed mass-forming splenic tuberculosis showing a layered pattern consisting of caseous necrosis with profound restriction of water molecules surrounded by an irregular rind of granulation tissue with less diffusion restriction on diffusion-weighted magnetic resonance imaging (DWI). In the differential diagnosis of neoplastic or non-neoplastic mass-forming lesions involving the spleen, this unique DWI feature could be helpful in characterizing splenic tuberculosis. The patient has been in clinically disease free status for nearly 20 months after splenectomy.

Keyword

Tuberculosis; Spleen; Magnetic Resonance Imaging; Diffusion

MeSH Terms

Diffusion Magnetic Resonance Imaging/*methods
Female
Humans
Middle Aged
Necrosis
Splenectomy
Tuberculosis, Splenic/*pathology

Figure

• 

  Fig. 1 Abdominal MRI of a 45 yr-old female shows an isolated splenic lesion. (A) Irregular conglomerated splenic lesion shows internal hyperintensity with peripheral hypointensity (arrowheads) on fat-suppressed T2-weighted image. (B) Contrast enhancement of peripheral rim (arrowheads) with non-enhancing central portion is noted on the gadolinium-enhanced T1-weighted image. (C) Diffusion-weighted MRI (b=800 sec/mm2) shows a prominent internal hyperintensity surrounded by rather hypointense rind. (D) Profound diffusion restriction is demonstrated in the internal component (arrowhead) with low ADC value (0.580 × 10-3 mm2/sec). (E) Gross specimen shows an irregularly marginated yellowish mass (arrowheads) filled with cheesy necrotic material (asterisks). (F) Corresponding outer granulomatous component (white asterisks) with internal caseous necrosis (black asterisk) is confirmed on high power field microscopy with hematoxylin and eosin stain.

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