Splenic hemangioma with steroid induced avascular necrosis

Case contributed by Ahmed Abdrabou
Diagnosis certain


Patient with abdominal pain and history of thrombocytopenia.

Patient Data

Age: 55 years
Gender: Female

The spleen is enlarged with a large ill-defined hypodense lesion that contains central foci of calcification. The lesion displays progressive centripetal filling after contrast administration.

Innumerable other small lesions are seen throughout the splenic parenchyma with hyperenhancement in arterial and venous phases with complete fill-in at delayed phase, suggestive of small splenic hemangiomata.

A note is made of severe bilateral avascular necrosis of femoral heads with secondary osteoarthritic changes.

Cardiomegaly is also noted.

Diagnosis: splenic hemangioma causing thrombocytopenia and complicated by steroid-induced femoral head avascular necrosis.

Case Discussion

The patient had thrombocytopenia and was thought to be autoimmune and hence she was treated with corticosteroids. The corticosteroids caused bilateral femoral head avascular necrosis and secondary osteoarthritis. The real cause for the thrombocytopenia was large splenic hemangioma which sequestrated and destroyed the platelets and though the accurate treatment should be splenectomy.

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