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Goubaa Mohamed MD Djerba Tunisia

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--- Arabic
This 74-year-old female, was admitted for evaluation of intermittent diarrhea. Examination of the abdomen showed a surprising finding in her Spleen.Note the multiple tiny calcifications in the spleen. Patiente âgée de 74 ans consulte pour une diarrhée récidivante. L'échographie de l'abdomen nous révèle une surprise au niveau de la rate.

 

 

 

 
Patient has a history of tuberculosis since age 20. Multiple hyperechoic areas measuring between 3 mm and 5 mm were seen in the spleen (spleen calcification). Spleen measured 9 x 6 x 5 cm.
Diagnosis : Calcification after spleen tuberculosis. 		Le patient a une histoire de tuberculose depuis l'âge 20 ans. De multiples foyers hyperéchogènes mesurant entre 3 et 5 mm sont visibles dans la rate (calcification de rate). La rate mesure 9 x 6 x 5 cm.
Diagnostic: Calcification : séquelle de tuberculose de rate.
Spleen tuberculosis (after-effects) Tuberculose Splenique (Séquelles)

 

Spleen tuberculosis

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Arabic
Abdominal tuberculosis usually affects the gas­trointestinal tract, peritoneum, lymph nodes, liver or spleen. Tuberculosis of the spleen is uncommon, except in association with miliary dis­semination. Isolated tuberculosis of the spleen is rare and difficult to diagnose. The splenic lesion consists of epitheloid cells, lymphocytes and giant cells. These small caseating granulomas will usually calcify leading to multiple punctate calcification. Exceptionally, however, the tubercles may coalesce in the spleen to form large abscesses.

Sonography :
* Acute Tuberculosis : Ultrasonography demonstrated scattered hypoechogenic nodules within the spleen, but multiple hypoechoic intras­picnic lesions have been reported in many others conditions including myelopro­liferative disorders including leukaemias, metastasis, lymphoma and Hodgkin's disease.
* Chronic manifestation :
The ultasonography findings in spleen tuberculosis include multiple small rounded or punctate intraparenchymal calcification. On ultrasound these calcifications appear as small echogenic foci with acoustic shadowing.

differential diagnosis of Micronodular calcification :
* :histoplasmosis.
* brucelloses.
* sarcoidosis.
* toxoplasmoses.
* Pneumocystis carinii.
* fungal abscesses.

Traetment :
acute Spleen Tuberculosis is treated like any other extrapulmonary tuberculosis lesion. Chemotherapy with standard antituberculosis drugs remains the corner stone of traetment.

Conclusion :
Despite it's rarity, splenic tuberculosis must be considered in patients, with Micronodular calcification of the spleen.

References
* 1: Am J Gastroenterol. 2003 May;98(5):1022-7. Endoscopic ultrasound-guided biopsy for the diagnosis of focal lesions of the spleen. Fritscher-Ravens A, Mylonaki M, Pantes A, Topalidis T, Thonke F, Swain P. Royal London Hospital, London, United Kingdom.
* 2: J Radiol. 2002 Apr;83(4 Pt 1):479-81. [Isolated tuberculosis of the spleen. Report of a case] [Article in French] Mahi M, Chaouir S, Amil T, Hanine A, Benameur M. Services d'imagerie Medicale, Hopital Militaire d'Instruction Mohamed V, Rabat, Maroc, France. mahi.m@caramail.com
* 3: Int J Clin Pract. 1999 Jun;53(4):318-9. Splenic tuberculosis: an unusual sonographic presentation. Chandra S, Srivastava DN, Gandhi D. Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
* 4: Ann Radiol (Paris). 1995;38(7-8):403-7. [Splenic tuberculosis. Apropos of 12 cases] [Article in French] Adil A, Chikhaoui N, Ousehal A, Kadiri R. Service Central de Radiologie, CHU Ibn Rochd, CASABLANCA, Maroc.
* 5: Rev Infect Dis. 1991 Nov-Dec;13(6):1069-71. Related Articles, Links Splenic tuberculosis in patients with AIDS. Pedro-Botet J, Maristany MT, Miralles R, Lopez-Colomes JL, Rubies-Prat J. Department of Medicine, Hospital del Mar, Universidad Autonoma de Barcelona, Spain.
* 6: Clin Radiol. 1991 Feb;43(2):128-9. Related Articles, Links Ultrasound detection of tuberculomas of the spleen. Kapoor R, Jain AK, Chaturvedi U, Saha MM. Department of Radiology, LNJPN Hospital, New Delhi, India.

 

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