Hepatic and splenic sarcoidosis

Case contributed by Dr Ben Hudson

Presentation

Patient presented following routine blood tests with their general practitioner. Abnormal liver function tests led to a routine abdominal ultrasound which was abnormal.

Patient Data

Age: Adult
Gender: Male

Post-contrast portal venous phase CT abdomen

  • multiple nodular foci of hypoenhancement/hypoattenuation within the spleen
  • multiple nodular foci of hypoenhancement/hypoattenuation within the liver
  • no upper abdominal nodal enlargement or free fluid
  • limited views of the lung bases are clear

Case Discussion

This case demonstrates an example of the abdominal manifestations of sarcoidosis. In this case the two organs involved are the liver and spleen.

The CT demonstrates nodular heterogeneity of both organs. In terms of abdominal involvement of sarcoidosis, the liver and spleen are the most commonly involved.

Alternative considerations include metastatic disease (no known primary and none demonstrated on CT), lymphoma (no organomegaly and no nodal enlargement) and opportunistic infection/microabscesses (no history of sepsis or immunocompromise, no recent foreign travel).

The patient underwent a liver biopsy which confirmed the presence of non-caseating granulomatous disease, in keeping with hepatic sarcoidosis.

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