Diagnosis of Hepatosplenic Sarcoidosis by Contrast-Enhanced Ultrasound Guided Needle Biopsy

Abstract

Sarcoidosis is a systemic disease characterised by non-caseating multiple granulomas involving virtually any organ in the body. The aetiology and natural history of sarcoidosis remains obscure. Hepatosplenic sarcoidosis is rare with image-based diagnosis difficult if no other organ is already involved. This case report describes a patient with asymptomatic liver and spleen involvement in which a final diagnosis was achieved with contrast enhanced ultrasound (CEUS) guided liver biopsy.

Characterization of nontraumatic focal splenic lesions using contrast‐enhanced sonography

“…The spleen is particularly suitable for CEUS studies because of its location, small size, homogeneous parenchyma, rich vascularization, and intense and long‐lasting contrast enhancement 1–13. Several reports have shown that CEUS of the spleen significantly improves the diagnosis of parenchymal lacerations by enhancing the detection of avascular areas during the late phase of the examination 9–11.…”

“…The splenic lymphoma appeared as a constantly hypoechoic lesion, more easily defined during the late phase but without clear intralesional microcirculation or rim enhancement in the early phase. Our findings indicated that a persistent hypoenhancing pattern of nodular splenic lesions may also be seen in benign lesions such as small abscesses or granulomas, so that differentiation of these lesions from malignant diseases is often not possible 8. To date, however, there have been no studies comparing CEUS with CT in the assessment of focal lesions of the spleen.…”

“…We identified three CEUS patterns, hypoenhancement, isoenhancement, and hyperenhancement, compared to the surrounding splenic parenchyma taken as an in vivo reference during the early phase (from 0 to 50 seconds after injection), during the parenchymal phase (between 50 seconds and 120 seconds), and during the late phase (between 120 seconds and 4 minutes after injection). According to previous reports,1–8 cystic lesions were considered to be malignant if enhancement of the cyst wall or septa was noted. Focal solid lesions were considered to be hemangiomas or hamartomas if we detected isoenhancement in all phases or if we detected hyperenhancement during the early phase (from 0 to 50 seconds) and isoenhancement during the late phase.…”

“…Contrast‐enhanced CT is considered the primary imaging modality for assessing splenic abnormalities and sonography is generally not considered useful for determining the nature of these lesions 1. The usefulness of contrast‐enhanced ultrasound (CEUS) with a second‐generation sonographic contrast agent for differential diagnosis of benign and malignant focal abnormalities of the splenic parenchyma was recently described, but the actual usefulness of CEUS in a nontraumatic clinical setting remains controversial 1–8…”