Sclerosing angiomatoid nodular transformation of the spleen

Case contributed by Dr Amr Farouk


Incidentally discovered splenic mass on ultrasound (not shown)

Patient Data

Age: 50 years
Gender: Female

Postcontrast CT examination of the abdomen 2 years later shows a stable size of the splenic mass with marginal and septal contrast enhancement.

A well-circumscribed splenic mass is seen eliciting heterogeneous low to intermediate signal intensity on T1WI, a low signal on T2WI with T2 blackout on DWI and ADC.  Post-contrast T1 shows peripheral and septal heterogenous enhancement. 

Case Discussion

An incidentally discovered splenic mass showed characteristic low signal intensity on T1 and T2WI, suggestive of sclerosing angiomatoid nodular transformation (SANT) of the spleen. In contrast, most of the differential diagnoses for splenic masses, such as splenic hemangioma or hamartoma, elicit high T2 signal, and splenic lymphoma elicits low to iso-intensity compared to the background parenchyma of the spleen. The increased prominence of low-signal-intensity foci on in-phase image is compatible with the presence of hemosiderin with numerous low-signal-intensity foci throughout the lesion in T2-weighted fat-saturated axial images. 

Stability of the size at the CT done two years after the MRI was in keeping with the benign nature of the mass confirming the diagnosis of SANT.

SANT often displays characteristic CT and MRI findings, including arterial or portal venous phase peripheral enhancing radiating lines, progressive enhancement, and hypointense T2 signal intensity. 

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