Splenic and hepatic tuberculous granulomatosis

Discussion:

The imaging features in this case greatly overlap with sarcoidosis, the other major consideration for granulomatous inflammation of the spleen of this size/extent:

  • small pulmonary nodules (incompletely imaged)
  • splenic and hepatic involvement (the most common sites of abdominal sarcoidosis)
  • mild retroperitoneal adenopathy

Ultimately, pathologic diagnosis with AFB staining was necessary to distinguish these two diagnoses. The patient was treated with splenectomy due to risk of rupture. 

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