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MRI Features of Focal Splenic Lesions in Patients with Disseminated Tuberculosis

Adelard I. De Backer1,2, Filip M. Vanhoenacker1, Koenraad J. Mortelé3, Ilse J. Vanschoubroeck4, Bart L. De Keulenaer4,5 and Paul M. Parizel1

1 Department of Radiology, Universitair Ziekenhuis Antwerpen, University of Antwerp, B-2650 Edegem, Belgium.
2 Present address: Department of Radiology, General Hospital Sint-Lucas, Groenebriel 1, Ghent B-9000, Oost-Vlaanderen, Belgium.
3 Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
4 Department of Internal Medicine, Ziekenhuisnetwerk Antwerpen, B-2060 Antwerp, Belgium.
5 Present address: Intensive Care Unit, Royal Darwin Hospital, Rocklands, Tiwi, Northern Territory, Australia.


Figure 1
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Fig. 1A —36-year-old man with miliary tuberculosis, splenic volume of 371 cm3, and tuberculous focal splenic lesions (patient 4 in Table 1). T2-weighted image shows multiple nodular lesions (arrows) of variable size that are hyperintense compared with adjacent splenic tissue.

 

Figure 2
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Fig. 1B —36-year-old man with miliary tuberculosis, splenic volume of 371 cm3, and tuberculous focal splenic lesions (patient 4 in Table 1). T1-weighted image shows lesions (arrow) as hyperintense.

 

Figure 3
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Fig. 1C —36-year-old man with miliary tuberculosis, splenic volume of 371 cm3, and tuberculous focal splenic lesions (patient 4 in Table 1). Arterial phase gadolinium-enhanced T1-weighted image with fat suppression shows peripheral enhancement (arrows).

 

Figure 4
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Fig. 1D —36-year-old man with miliary tuberculosis, splenic volume of 371 cm3, and tuberculous focal splenic lesions (patient 4 in Table 1). Equilibrium phase image shows lesions with peripheral enhancement and central nonenhancing area (arrow) and lesion with gradual complete fill-in (arrowhead). Associated tuberculous lymphadenopathy is noted at liver hilum.

 

Figure 5
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Fig. 2A —50-year-old man presenting with signs and symptoms of miliary tuberculosis as manifestation of AIDS disease. Tuberculous splenic involvement is characterized by mild splenomegaly and multiple small focal splenic lesions. Portal venous phase image shows lesions as sharply delineated hypointense lesions.

 

Figure 6
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Fig. 2B —50-year-old man presenting with signs and symptoms of miliary tuberculosis as manifestation of AIDS disease. Tuberculous splenic involvement is characterized by mild splenomegaly and multiple small focal splenic lesions. On equilibrium phase image, gradual peripheral contrast enhancement is noted.

 

Figure 7
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Fig. 3A —54-year-old man with AIDS with splenomegaly (splenic volume: 876.5 cm3) and splenic lesions diffusely scattered throughout spleen (patient 3 in Table 1). T2-weighted (A) and T1-weighted (B) images with fat suppression show spleen as heterogeneous.

 

Figure 8
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Fig. 3B —54-year-old man with AIDS with splenomegaly (splenic volume: 876.5 cm3) and splenic lesions diffusely scattered throughout spleen (patient 3 in Table 1). T2-weighted (A) and T1-weighted (B) images with fat suppression show spleen as heterogeneous.

 

Figure 9
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Fig. 3C —54-year-old man with AIDS with splenomegaly (splenic volume: 876.5 cm3) and splenic lesions diffusely scattered throughout spleen (patient 3 in Table 1). Dynamic gadolinium-enhanced images show heterogeneous enhancement of spleen with focal lesions characterized by peripheral enhancement.

 

Figure 10
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Fig. 3D —54-year-old man with AIDS with splenomegaly (splenic volume: 876.5 cm3) and splenic lesions diffusely scattered throughout spleen (patient 3 in Table 1). Dynamic gadolinium-enhanced images show heterogeneous enhancement of spleen with focal lesions characterized by peripheral enhancement.

 

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