Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

LETTER TO EDITOR
Year
: 2000  |  Volume : 10  |  Issue : 4  |  Page : 268--269

Splenic calcification in primary hemochromatosis mimicking hydatid cyst


S Singh, A Mukhopadhya, GM Chandy, IP Korah 
 Christian Medical College and Hospital, Vellore, Tamilnadu, India

Correspondence Address:
S Singh
Christian Medical College and Hospital, Vellore, Tamilnadu
India




How to cite this article:
Singh S, Mukhopadhya A, Chandy G M, Korah I P. Splenic calcification in primary hemochromatosis mimicking hydatid cyst.Indian J Radiol Imaging 2000;10:268-269


How to cite this URL:
Singh S, Mukhopadhya A, Chandy G M, Korah I P. Splenic calcification in primary hemochromatosis mimicking hydatid cyst. Indian J Radiol Imaging [serial online] 2000 [cited 2019 Jul 19 ];10:268-269
Available from: http://www.ijri.org/text.asp?2000/10/4/268/30582


Full Text

Sir,

Primary hemochromatosis is caused due to the presence of excess of iron deposits in the reticuloendothelial system [1]. In primary hemochromatosis, CT demonstrates diffuse increase in liver parenchymal attenuation with normal splenic attenuation. This does not happen in an advanced stage [1]. We report peripheral splenic (eggshell) and rounded intrasplenic calcification mimicking calcified hydatid cyst, in primary hemochromatosis.

A thirty-seven-years-old man presented with the classic triad of primary hemochromatosis; cirrhosis, diabetes mellitus and hyperpigmentation of one-year's duration. Examination showed hepatosplenomegaly. Investigations revealed serum ferritin level of 1000 ng/ml, serum calcium of 8.1 mg% and phosphorus of 3.1 mg%. An abdominal radiograph showed faint peripheral and intra-splenic calcifications. Ultrasound revealed moderate splenomegaly and increased peripheral echogenecity with a central rounded lesion that showed acoustic shadowing. On CT scan, there was increased hepatic parenchymal attenuation value (an average of 95 HU) with prominent hepatic and portal veins as low-density structures on plain scans [Figure 1]. There was peripheral splenic (eggshell) and rounded intrasplenic calcifications [Figure 1]. Fine needle aspiration cytology of the splenic lesion excluded the possibility of hydatid cyst or tumor. Immunological tests for hydatid were normal.

The differentials for peripheral and intrasplenic calcifications are few; echinococcal cysts, infection-pyogenic or tuberculous abscess, infarction, splenic artery aneurysm, dermoid, epidermoid, simple cyst and old hematoma [2],[3]. Hydatid cysts are often multiple and tend to have a thicker and coarser rim or solid calcification seen in end-stage hydatid disease [2],[3]. Visualization of daughter cysts can help in the diagnosis. In infection and abscess, plaques of calcification in a thickened and fibrotic splenic capsule are usually seen. On CT, presence of small amount of gas, density differences among necrotic tissue, collections and the capsule and pattern of enhancement may help in diagnosis. Giant splenic artery aneurysm, splenic cyst, dermoid, epidermoid cyst and old hematoma may show peripheral or curvilinear calcification [2],[3].

Multiple small rounded or ovoid calcified nodules distributed throughout the spleen may represent healed calcified tuberculous nodules or histoplasmosis. The size, number and shape may be clues to their diagnosis [2]. If punctate calcifications are larger and more than six, they are said to be due to previous histoplasmosis [2]. This is not true when seen in a patient from a region endemic for tuberculosis [3]. Multiple calcified granulomata and chronic abscesses of the spleen can be demonstrated in chronic brucellosis. Unlike the lesions in histoplasmosis and tuberculosis, the lesions in chronic brucellosis tend to be suppurating even in the presence of calcifications. The calcified nodules in chronic brucellosis are larger (1-3 cm) and consist of a flocculent calcified centre in a radiolucent area that is surrounded by a laminated calcified rim [3]. In Pneumocystis carinii infection, the formation of splenic calcification is also associated with calcification in kidneys and lymph nodes [2]. The splenic infarct calcification is usually triangular or wedge shaped with a broad capsular base [3]. Case reports of splenic calcifications in other diseases have been described in literature [1],[2],[3],[4]. The exact mechanism of unique peripheral splenic (eggshell) and a rounded intra splenic calcification in primary hemochromatosis is not known.

References

1Gore MR. Diffuse liver disease. In: Gore RM, Levine SM and Laufer I. Textbook of Gastrointestinal Radiology, Philadelphia: W.B.Saunders 1994: 1968-2017.
2Chintapalli KN. Diseases of the spleen. In: Freeny PC, Stevenson GW. Margulis and Burhenne's Alimentary Tract Radiology, Vol. 2. 5th ed. St. Louis: Mosby-Yearbook: 1994; 1763-1794
3Eisenberg RL. Gastrointestinal Radiology: A Patterson's Approach. 3rd ed, Philadelphia: Lippincott-Raven, 1996: 982-1064.
4Jacobs JE, Birnbaum BA, Furth EE. Abdominal visceral calcification in primary amyloidosis:CT findings. Abdom Imaging 1997; 22: 519-21.