Liver and Spleen

CT or ultrasonography is frequently abnormal in AIDS patients with hepatic dysfunction. There is often fatty degeneration and the liver may also be the site of bacterial of fungal abscesses (Fig. 8.54) or focal lesions resulting from disseminated cytomegalovirus infection, histoplasmosis, lymphoma, or Kaposi's sarcoma. Focal lesions in the liver or spleen are common in tuberculosis (Fig. 8.55). Bacillary angiomastosis may produce peliosis (multiple blood-filled cystic spaces) of both the liver and spleen (Fig. 8.56). Disseminated histoplasmosis may produce hepatosplenomegaly, foci of splenic hypoattenuation, adrenal masses, and enlarged lymph nodes, with or without low-density centers. Pneumocystis carinii may produce focal low-density liver or spleen lesions which may demonstrate rim calcification. Non-Hodgkin's lymphoma may produce multiple focal lesions in the liver which are low attenuation on CT and hypoechoic on ultrasonography. Hepatomegaly and splenomegaly are both common in AIDS patients. The spleen may be enlarged without invoking a secondary process in addition to AIDS, or it may be involved by lymphoma, Kaposi's sarcoma or infection. Nonspecific tropical splenomegaly must be excluded (see Chapter 46 on Fevers).

Fig. 8.54. The CT scan of an AIDS patient with multiple cryptococcal abscesses in the liver. There is surrounding enhancement after contrast injection.

....

Fig. 8.55 A, B. Mycobacterial infections in AIDS patients. (A) A sonogram shows multiple tuberculous splenic microabscesses (courtesy of Dr. William Brandt). (B) A CT scan of another patient shows splenomegaly and lymphadenopathy (arrow) due to Mycobacterium avium complex.

Fig 8.56 The CT scan of a patient with extensive bacillary angiomatosis, causing peliosis of the liver and spleen. The patient was mistakenly treated for Kaposi's sarcoma, without any benefit, and unfortunately died.

Next Page