Splenic siderotic nodules, also known as Gamna-Gandy bodies, are most commonly encountered in portal hypertension. The pathophysiological process is the result of microhaemorrhage resulting in haemosiderin and calcium deposition followed by fibroblastic reaction.
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Epidemiology
Associations
Recognised associations include 4
-
per se, or caused by portal or splenic vein thrombosis
leukaemia 10
lymphoma 10
patients receiving blood transfusions 10
acquired haemochromatosis
diffuse splenic haemangiomatosis
Pathology
Grossly, Gamna-Gandy bodies are characterised by many well-circumscribed nodules measuring several millimetres, with a dark haemorrhagic centre surrounded by a pale inner hyperaemic rim and a dark outer rim. This gives an appearance resembling "tobacco flecks". Histologically, there is deposition of haemosiderin and calcium within the connective tissue stroma and vessels with a fibroblastic reaction, leading to microarchitectural distortion.
Radiographic features
Ultrasound
Demonstrates multiple tiny echogenic foci without acoustic shadowing.
CT
Gamna-Gandy bodies appreciable on CT have been reported as high-attenuation foci not distinguishable from splenic granulomas. They are rarely well demonstrated by CT 2.
MRI
Siderotic foci (often less than 1 cm 4) are punctate foci within the spleen. The high magnetic susceptibility effect of haemosiderin typically renders the siderotic foci markedly hypointense on certain sequences. Hence, signal characteristics of the nodules include:
T2: very low-signal
GRE/SWI: low-signal (considered the most sensitive sequence for detection of siderotic nodules 1)
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