Splenic and hepatic tuberculous granulomatosis
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Massive splenomegaly filled with rounded ow-attenuation nodules. Mass effect on the left kidney.
Subtle small nodules throughout the liver (perhaps best appreciated on liver windows).
Borderline upper abdominal retroperitoneal lymph nodes.
Few small nodules at the lung bases (somewhat hard to see because of motion).
FINAL DIAGNOSIS: Spleen, core biopsy - Granulomatous inflammation.
ADDENDUM: ZN stain positive for acid-fast bacilli.
The imaging features in this case greatly overlap with sarcoidosis, the other major consideration for granulomatous inflammation of the spleen of this size/extent:
- small pulmonary nodules (incompletely imaged)
- splenic and hepatic involvement (the most common sites of abdominal sarcoidosis)
- mild retroperitoneal adenopathy
Ultimately, pathologic diagnosis with AFB staining was necessary to distinguish these two diagnoses. The patient was treated with splenectomy due to risk of rupture.