“Sponge pattern” of the spleen: a rarely described high-frequency ultrasound pattern in HIV-positive patients

Heller, Tom; Taccari, Francesco; Rambiki, Kelvin; Kumwenda, Tapiwa; Brunetti, Enrico; Wallrauch, Claudia

doi:10.1186/s13089-022-00297-z

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…Finally, we found a sponge-like pattern of the spleen, which has only recently been described in adult HIV positive patients [ 10 ]. This sponge pattern can be mistaken for spleen micro-abscesses, although the hypoechoic structures are generally smaller [1–2 mm] then lesions caused by TB (> 5 mm).…”

Section: Conclusion and Discussionsupporting

confidence: 56%

“…Our data presented here suggest that the sponge pattern may be seen in about 10% of KS patients, although our absolute patient number was small (95% confidence interval: 0–21%). The pattern was originally described in association with a variety of opportunistic illnesses, including KS, disseminated MAC infection, pneumococcal infection, Hodgkin lymphoma and MCD as well as with HIV itself—still almost half of the reported cases were associated with HHV-8 associated diseases, such as KS or MCD [ 10 ]. A recent radiological review states that KS tends to “surround the arteries of the Malpighian corpuscles and has a stringy appearance”[ 4 ]—which could explain the sponge pattern in ultrasound—but actual histo-pathological evidence for this in newer literature is scarce.…”

Section: Conclusion and Discussionmentioning

confidence: 99%

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Ultrasound findings in Kaposi sarcoma patients: overlapping sonographic features with disseminated tuberculosis

et al. 2023

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Background Focused Assessment with Sonography for HIV-associated TB (FASH) is a diagnostic tool for extra-pulmonary tuberculosis (TB) in symptomatic patients with advanced HIV. As Kaposi’s sarcoma (KS) is also prevalent in this patient population, changes due to KS may mimic TB findings and clinical interpretation of target FASH findings can be challenging. We aimed to describe sonographic findings in patients with KS. Methods We performed a prospective observational study at Lighthouse clinic at Kamuzu Central Hospital, Lilongwe, Malawi, in consecutive patients with newly diagnosed KS, without known diagnosis of TB, referred for paclitaxel treatment. All patients underwent FASH and abdominal ultrasound to assess for effusions and changes in liver and spleen, as well as systematic sonographic assessment for lymphadenopathy. Results We included 30 patients. We found inguinal lymph nodes using ultrasound in 20 patients; in 3 (10%) additionally abdominal lymph nodes were found. Pathological effusions were seen in eight patients (27%): pericardial effusion in one (3%), pleural effusion in six (20%) and ascites in four (13%) patients. We found focal spleen lesions in three (10%) patients. Most of these lesions were echogenic, but in one patient, we saw hypoechoic lesions with an echogenic center. In three (10%) patients an unusual “sponge-like pattern” of the splenic vasculature was found. Six (20%) patients had echogenic focal lesions in the liver resembling hemangiomas, individual lesions showing a hypoechoic center. In two patients echogenic portal fields were seen. Conclusions The majority of patients with newly diagnosed KS demonstrate sonographic features of disease, predominantly lymphadenopathy. Effusions were observed in a significant minority, as well as focal lesions in liver or spleen, which commonly resemble hemangiomas, but hypoechoic lesions were also observed and can easily be mistaken for extra-pulmonary TB. A 'sponge-like pattern' of the spleen should not be confused with micro-abscesses. In conclusion, this case series illustrates the diverse nature of ultrasound features in patients with KS, which can be difficult to distinguish from other opportunistic diseases, including TB.

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Section: Conclusion and Discussionsupporting

confidence: 56%

Section: Conclusion and Discussionmentioning

confidence: 99%

Ultrasound findings in Kaposi sarcoma patients: overlapping sonographic features with disseminated tuberculosis

et al. 2023

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Point-of-care ultrasound for tuberculosis and HIV—revisiting the focused assessment with sonography for HIV-associated tuberculosis (FASH) protocol and its differential diagnoses

Belard,

Taccari,

Kumwenda

et al. 2024

Clinical Microbiology and Infection

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Focal spleen lesions in loiasis: A pilot study in Gabon

Adegbite,

Gobbi,

Mazzi

et al. 2024

PLoS Negl Trop Dis

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Background Infection with the filarial nematode Loa loa, endemic in Central and Western Africa, has been associated with increased morbidity and mortality. A number of reports described the presence of spleen nodules, originating from degenerating microfilariae, in humans and animals infected with L. loa. The long-term consequences of this process on individuals chronically exposed to infection in terms of spleen function and possible link with excess mortality are unknown. The aim of this study was to evaluate the prevalence of focal spleen lesions, their evolution over time, and markers of spleen function, in individuals with L. loa infection living in highly endemic areas of Gabon. Methodology/principal findings This was a cross-sectional study followed by a longitudinal study of the subset of individuals with spleen nodules. Two hundred sixteen participants from Ngounié and Moyen-Ogooué provinces of Gabon, reporting a history of eyeworm migration and/or Calabar swelling, were included. Participants were categorized into infected microfilaraemic with low (N = 74) and high (N = 10) microfilaraemia, and symptomatic amicrofilaraemic (N = 132), based on blood microscopy. Howell-Jolly bodies in erythrocytes, as indirect marker of spleen functional impairment, were within normal ranges. On ultrasound, no evident signs of spleen fibrosis or hypotrophy were observed. Multiple spleen hypoechoic centimetric macronodules were observed in 3/216 participants (1.4%), all with microfilaraemic L. loa infection (3.4% of microfilaraemics); macrondules disappeared at the 6-months follow-up examination in 2/3 individuals. Spleen hypoechoic micronodules, persisting at the 6-months follow-up, were detected in 3/216 participants (1.4%), who were all amicrofilaraemic. Conclusions/significance Transitory spleen macronodules are present in a small but consistent proportion of individuals with microfilaraemic loiasis, appearing a rather benign phenomenon in terms of impact on spleen morphology and function. Their occurrence should be taken into consideration to avoid misdiagnosis and mistreatment. Prevalence and significance of spleen micronodular ultrasound patterns in the general population would be also worth evaluating.

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“Sponge pattern” of the spleen: a rarely described high-frequency ultrasound pattern in HIV-positive patients

Cited by 3 publications

References 16 publications

Ultrasound findings in Kaposi sarcoma patients: overlapping sonographic features with disseminated tuberculosis

Ultrasound findings in Kaposi sarcoma patients: overlapping sonographic features with disseminated tuberculosis

Point-of-care ultrasound for tuberculosis and HIV—revisiting the focused assessment with sonography for HIV-associated tuberculosis (FASH) protocol and its differential diagnoses

Focal spleen lesions in loiasis: A pilot study in Gabon

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