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. 2013 Mar 2;16(2):75-80.
doi: 10.1007/s40477-013-0013-1. eCollection 2013.

Pitfalls of contrast-enhanced ultrasound (CEUS) in the diagnosis of splenic sarcoidosis

C Tana  1 , G Iannetti, P D'Alessandro, M Tana, A Mezzetti, C Schiavone
Affiliations

Pitfalls of contrast-enhanced ultrasound (CEUS) in the diagnosis of splenic sarcoidosis

C Tana et al. J Ultrasound. .

Abstract
in English, German

By observing the real-time behavior of focal liver lesions at three vascular phases (arterial, portal-venous, and late), contrast-enhanced ultrasound (CEUS) has been successfully applied to differentiate benign from malignant hepatic nodules. In recent years, numerous studies highlighted the usefulness of CEUS also for other applications such as abdominal trauma, renal, pancreatic, thyroid, and inflammatory bowel diseases, supporting its role even in differentiating benign from malignant splenic nodules. Therefore, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recently updated the guidelines for the use of ultrasound contrast agents in clinical practice, pointing out the indication to characterize splenic parenchymal inhomogeneity or suspected lesions found on conventional ultrasound (BUS). We describe the case of a patient with a history of colon cancer and finding, at BUS and CEUS, of hypoechoic lesions with a highly suggestive pattern for metastases, subsequently histologically proved to be splenic localizations of a benign and multisystemic granulomatous disease such as sarcoidosis. We therefore reviewed the current literature focusing on the role of CEUS in differentiating benign from malignant splenic lesions, emphasizing on the lack of data and numerical shortage of sarcoidosis derived-lesions in the available studies. We conclude that sarcoidosis remains a diagnosis of exclusion and new studies are needed before defining precise indications of CEUS in these patients.

L’ecografia con mezzo di contrasto (CEUS) è una metodica diagnostica minimamente invasiva ed ampiamente utilizzata, negli ultimi decenni, per differenziare le lesioni epatiche benigne dalle maligne, valutandone l’aspetto contrastografico nelle tre fasi vascolari (arteriosa, portale-venosa e tardiva). Negli ultimi anni, numerosi studi hanno messo in evidenza ulteriori indicazioni della CEUS, tra cui il trauma addominale, le lesioni focali renali, pancreatiche, tiroidee e le malattie infiammatorie intestinali, supportandone un ruolo anche nella differenziazione tra lesioni spleniche benigne e maligne. Pertanto, la Federazione Europea delle Società di Ultrasonologia in Medicina e Biologia (EFSUMB), ha recentemente aggiornato le linee guida per l’utilizzo dell’ecografia con mezzo di contrasto nella pratica clinica, sottolineando, tra le varie indicazioni, quella di caratterizzare le lesioni spleniche o disomogeneità parenchimali sospette, riscontrate incidentalmente all’esame ecografico convenzionale. Nel seguente articolo descriviamo il caso di una paziente con anamnesi per carcinoma del colon e riscontro, all’esame ecografico convenzionale, di lesioni ipoecogene di non univoca interpetazione e caratterizzate, alla CEUS, da un pattern contrastografico altamente suggestivo per metastasi. Tali lesioni si sono poi rivelate essere, all’esame istologico, localizzazioni di una malattia benigna, multisistemica e granulomatosa quale la sarcoidosi. Abbiamo pertanto effettuato una revisione approfondita della letteratura focalizzando sul ruolo della CEUS nel differenziare le lesioni spleniche benigne dalle maligne, enfatizzando sulla carenza di studi riguardanti la caratterizzazione, attraverso la CEUS, delle lesioni derivate dalla sarcoidosi. Tale malattia rimane, pertanto, una diagnosi di esclusione e sono necessari ulteriori studi prima di definire precise indicazioni della CEUS nei pazienti affetti.

Keywords: CEUS; Guidelines; Sarcoidosis; Spleen.

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Figures

Fig. 1
Fig. 1
Enlarged and subverted spleen by the presence of multiple and roundish hypoechoic lesions at baseline gray-scale sonography
Fig. 2
Fig. 2
Color Doppler sonogram showed absence of vascularity inside the lesions
Fig. 3
Fig. 3
CEUS, arterial phase: slight and more peripherally located enhancement of the splenic lesions derived from sarcoidosis
Fig. 4
Fig. 4
CEUS, late phase: rapid and marked wash-out of the injected contrast resulting in a hypoechoic appearance of the splenic lesions derived from sarcoidosis
See this image and copyright information in PMC

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