THE SPOTTED SPLEEN - CT AND CLINICAL CORRELATION IN A TERTIARY CARE CENTER

Purpose: The goal of our study was to examine the prevalence of multip le hypodense splenic nodules and their associated diagnoses and to cor relate CT appearance with clinical presentation and diagnosis. Method: Records of all patients undergoing contrast-enhanced CT from July 199 4 through September 1997 were reviewed. Charts and CT scans of patient s with multiple (more than five) hypodense splenic nodules were then e valuated. Results: During the search period, there were 8,764 patients examined. Multiple hypodense splenic nodules were identified in 45 pa tients. Sixteen patients had malignant neoplasia as an etiology, with two patients having a benign tumor. Ten patients had an infectious eti ology; nine patients had an inflammatory but noninfectious etiology; i n eight patients, a diagnosis was not established; five of these patie nts were followed for >18 months. Conclusion: Multiple hypodense splen ic nodules are uncommon. Lymphoma, infection, and sarcoid were the thr ee most common disorders in the symptomatic patient, with infection st rongly correlated with a compromised immune system. In the asymptomati c patient, nonlymphomatous metastatic disease, benign tumor, and sarco id were most common. Although overlap exists between diagnostic groups , lymphoma tends to have larger, more variable nodules, whereas infect ion tends to occur with smaller, more uniform nodules. Sarcoid is inte rmediate in appearance.