FDG PET/CT in Aseptic Splenic Abscess

Abstract

HomeRadiologyRecently Published PreviousNext Reviews and CommentaryFree AccessImages in RadiologyFDG PET/CT in Aseptic Splenic AbscessWeiting Liu, Xiaohong Ou Weiting Liu, Xiaohong Ou Author AffiliationsFrom the Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, People’s Republic of China.Address correspondence to X.O. (email: [email protected]).Weiting LiuXiaohong Ou Published Online:Mar 28 2023https://doi.org/10.1148/radiol.222955MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 32-year-old woman presented with fever and arthralgia for 1 month. She had a past medical history of rheumatoid arthritis with 2 years of glucocorticoid treatment. At physical examination, splenomegaly was found. Her laboratory data showed leukocytosis (15.86 × 109/L; reference range, 3.5–9.5 × 109/L) and a high erythrocyte sedimentation rate. Serial blood cultures were negative. Intravenous antibiotics and corticosteroid therapy did not relieve her symptoms. Fluorodeoxyglucose (FDG)-PET/CT examination was performed, showing abnormal standardized uptake values in the spleen (Figure). Primary splenic lymphoma was suspected, and the patient underwent laparoscopic splenectomy. At pathologic examination (Figure), the diagnosis of aseptic splenic abscesses as a complication of rheumatoid arthritis was made. Corticosteroids and supportive treatment were then initiated, and her clinical condition gradually improved.Images in a 32-year-old woman presenting with fever and arthralgia for 1 month. She had a past medical history of rheumatoid arthritis with 2 years of glucocorticoid treatment. A fluorodeoxyglucose (FDG)-PET examination was performed. (A) Maximum intensity projection whole body image shows intense diffuse splenic uptake and moderate bone marrow uptake. (B) Axial-fused PET/CT abdominal image shows an enlarged spleen with heterogeneously increased FDG standardized maximum uptake value (standardized maximum uptake value,13.94; liver standardized maximum uptake value, 3.76). At pathologic examination, macroscopic examination of the spleen showed many nonconfluent white nodules (not shown). (C) With use of hematoxylin and eosin, a photomicrograph with 400× magnification shows numerous areas of necrosis surrounded by intense polymorphonuclear cell infiltration (arrows) and fibroblastic proliferation at the periphery of the splenic nodules.Download as PowerPointOpen in Image Viewer Splenic abscesses generally occur in patients with immune dysfunction (1), presenting as solitary or multifocal lesions. Aseptic abscesses are most commonly associated with nonspecific inflammatory bowel disease and other autoimmune diseases (spondyloarthropathy, rheumatoid arthritis, lupus erythematosus, and nodular arteritis), or autoinflammatory (synovitis, acne, pustulosis, hyperostosis, and osteitis) and neoplastic ones (myeloma, monoclonal gammopathy) (2). Histopathologic examination helps to exclude other conditions. The cornerstones of aseptic abscesses are mature polymorphonuclear neutrophils in the center of the splenic nodules, with histiocytes and single giant cells present at the periphery (2). It is unclear whether glucocorticoids could be a factor that promotes the formation of aseptic splenic abscesses. The presence of disseminated sterile splenic microabscesses with intense FDG uptake related to rheumatoid arthritis is rare.Disclosures of conflicts of interest: W.L. No relevant relationships. X.O. No relevant relationships.