Letter to the Editor Splenic Sarcoidosis Remains a Diagnostic Challenge
e read with interest the reply of Bauones et al to our letter, “Splenic Sarcoidosis Remains a Diagnostic Challenge, ” regarding the behavior that splenic sarcoidosis can exhibit on contrast-enhanced ultrasound. We agree with the authors that the most observed pattern is characterized by an absence of enhancement in the arterial and parenchymal phases. However, as discussed above, we found a case of splenic sarcoidosis that exhibited a tumor-like pattern at contrast-enhanced ultrasound (peripheral enhancement in the arterial phase followed by a rapid and marked washout).1 Stang et al2 previously described two patients with slight but diffuse enhancement of the lesions in the arterial phase followed by progressive hypoenhancement in the parenchymal phase, as compared with adjacent splenic tissue. We would like to remark that, in these cases, splenic sarcoidosis can mimic neoplastic disease and that a proper diagnosis can be reached with histologic examination. The origin of these abnormal patterns may be related to a different vascularization of the lesions.
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More studies are needed before drawing definite conclusions. Claudio Tana Unit of Internistic Ultrasound, “G. d’Annunzio” University, Chieti-Pescara, Italy Department of Medicine and Science of Aging, “G. d’Annunzio” University, Chieti, Italy Giovanni Iannetti Unit of Internistic Ultrasound, “G. d’Annunzio” University, Chieti-Pescara, Italy Andrea Mezzetti Department of Medicine and Science of Aging, “G. d’Annunzio” University, Chieti, Italy Cosima Schiavone Unit of Internistic Ultrasound, “G. d’Annunzio” University, Chieti-Pescara, Italy Department of Medicine and Science of Aging “G. d’Annunzio” University, Chieti, Italy REFERENCES 1. Tana C, Iannetti G, D’Alessandro P, et al. Pitfalls of contrast-enhanced ultrasound (CEUS) in the diagnosis of splenic sarcoidosis. J Ultrasound 2013;16:75. 2. Stang A, Keles H, Hentschke S, et al. Differentiation of benign from malignant focal splenic lesions using sulfur hexafluoride-filled microbubble contrast-enhanced pulse-inversion sonography. AJR Am J Roentgenol 2009;193:709.
J Clin Ultrasound 42:156, 2014; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/jcu. 22131 C 2014 Wiley Periodicals, Inc. V
156
JOURNAL OF CLINICAL ULTRASOUND
e read with interest the reply of Bauones et al to our letter, “Splenic Sarcoidosis Remains a Diagnostic Challenge, ” regarding the behavior that splenic sarcoidosis can exhibit on contrast-enhanced ultrasound. We agree with the authors that the most observed pattern is characterized by an absence of enhancement in the arterial and parenchymal phases. However, as discussed above, we found a case of splenic sarcoidosis that exhibited a tumor-like pattern at contrast-enhanced ultrasound (peripheral enhancement in the arterial phase followed by a rapid and marked washout).1 Stang et al2 previously described two patients with slight but diffuse enhancement of the lesions in the arterial phase followed by progressive hypoenhancement in the parenchymal phase, as compared with adjacent splenic tissue. We would like to remark that, in these cases, splenic sarcoidosis can mimic neoplastic disease and that a proper diagnosis can be reached with histologic examination. The origin of these abnormal patterns may be related to a different vascularization of the lesions.
W
More studies are needed before drawing definite conclusions. Claudio Tana Unit of Internistic Ultrasound, “G. d’Annunzio” University, Chieti-Pescara, Italy Department of Medicine and Science of Aging, “G. d’Annunzio” University, Chieti, Italy Giovanni Iannetti Unit of Internistic Ultrasound, “G. d’Annunzio” University, Chieti-Pescara, Italy Andrea Mezzetti Department of Medicine and Science of Aging, “G. d’Annunzio” University, Chieti, Italy Cosima Schiavone Unit of Internistic Ultrasound, “G. d’Annunzio” University, Chieti-Pescara, Italy Department of Medicine and Science of Aging “G. d’Annunzio” University, Chieti, Italy REFERENCES 1. Tana C, Iannetti G, D’Alessandro P, et al. Pitfalls of contrast-enhanced ultrasound (CEUS) in the diagnosis of splenic sarcoidosis. J Ultrasound 2013;16:75. 2. Stang A, Keles H, Hentschke S, et al. Differentiation of benign from malignant focal splenic lesions using sulfur hexafluoride-filled microbubble contrast-enhanced pulse-inversion sonography. AJR Am J Roentgenol 2009;193:709.
J Clin Ultrasound 42:156, 2014; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/jcu. 22131 C 2014 Wiley Periodicals, Inc. V
156
JOURNAL OF CLINICAL ULTRASOUND
