Multiple splenic calcifications

Abstract

A 71-year-old patient with Sjögren’s syndrome presented with intrapulmonary lesions that were found, following open lung biopsy, to be diffuse large B-cell lymphoma. A staging computed tomography (CT) scan revealed multiple calcified lesions within the spleen and, to a lesser extent, calcified lesions within the liver. On further questioning, the patient revealed a history of tuberculosis as a teenager in the early 1950s. On repeat imaging, as expected, the splenic/hepatic lesions were found unchanged. Multiple splenic calcifications are a relatively common incidental finding on CT imaging although calcification to this extent is very unusual. The causes of splenic calcification are numerous; histoplasmosis (Histoplasma capsulatum, predominately found in soil around the Mississippi river), tuberculosis, brucellosis (Brucella abortus), candidiasis, Pneumocystis jiroveci and sickle cell disease. Single or smaller numbers of calcified lesions can also be seen following trauma, ischaemia/infarction. Calcification can also be associated with splenic haemangiomas and cysts. Rarely, splenic calcification can be associated with non-Hodgkin lymphoma of the spleen. Thorotrast (thorium dioxide), an alpha particle emitting contrast medium used until 1960, can also cause radio-opacification of the spleen although in a more diffuse, higher intensity appearance than that seen here.