Splenic hypoperfusion as a sign of systemic amylidosis

Background: The spleen is frequently involved in systemic
amyloidosis; however, the computed tomographic
(CT) or magnetic resonance (MR) pattern of splenic
amyloidosis is not sufficiently described in the literature.
This study evaluated the contrast-enhanced CT and MR
findings of the spleen in patients with systemic amyloidosis.
Methods: Data were extracted by reviewing pathology
and radiology department records of the teaching hospital
of Naples over 10 years, from 1 January 1993 to 31
December 2002. Thirty-three patients with amyloidosis
were identified, 10 of whom had a CTscan and two of
whom had an MR study. The population-based study
was composed of 12 patients with histologically proved
amyloidosis who underwent contrast-enhanced CTor
MR scan of the abdomen. The spleen and liver were
evaluated for organ size and perfusion.
Results: The spleen was hypoperfused in nine of 12 patients.
Mild splenomegaly was present in only one case.
Hepatomegaly was associated with markedly acute left
lobe margin in nine patients and with rounded anterior
profile of segments 3 and 4 in four patients. Moreover, a
large area of low attenuation with indefinite geographic
margins involving the right hepatic lobe was observed in
three patients.
Conclusion: The finding of splenic hypoperfusion may be
a marker of systemic amyloidosis, which represents a
useful clue when clinical findings fail to suggest the
proper diagnosis.