Presentation
Dyspnea. No abdominal complaints. There has been no previous imaging of the abdomen.
Patient Data
Abdominal radiograph shows multiple micronodular calcified lesions with high density in the left hypochondrium. Vertebroplasty of T12 has previously been performed.
Multiple micronodular calcifications in the spleen with the same density (HU) as bony structures.
There are no calcifications in the liver. There are no signs of inflammation or infection in the abdomen.
A lymph node with multiple calcifications is seen in the peripancreatic region.
Two lymph nodes with multiple calcifications in the right hilum. Note the parenchymal nodularity particularly in the upper zones and in a subpleural distribution leading to a pseudoplaque like appearance.
Case Discussion
Incidental finding of multiple micronodular calcifications in the spleen in a patient with no abdominal complaints. There is no relevant medical history.
Also, there is a peripancreatic lymph node with multiple small calcifications visible on CT.
A plain chest x-ray and CT scan of the chest show subpleural nodularity and pseudoplaque formation and several calcified mediastinal and hilar lymph nodes. There is no evidence of a lung mass, pneumonia or cavitary lung lesion.
The combination of calcified thoracic and abdominal lymph nodes, pleural thickening and calcification, and multiple calcified lesions in the spleen are most suspicious for silicosis. An alternative diagnosis is a splenic granulomatosis due to an old infection, such as tuberculosis or histoplasmosis, although these do not usually cause this exuberant of splenic calcification.
Histopathological work-up was not performed since the splenic calcifications did not cause any complaints from the patient, and there was no ongoing infection.
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