Introduction
We present two pediatric patients with AIDS whose
ultrasound examinations demonstrated bright linear
structures in the spleen.
We believe that this unusual echopattern, resulting
from diffuse calcifications in the splenic parenchymal
arteries, represents an ultrasonographic demonstration
of HIV-associated vasculopathy.
Case reports
Case 1
The patient was a 7-year-old girl with an HIV infection acquired at
birth. She had a history of recurrent respiratory infections, in-
cluding Pneumocystis carinii pneumonia at the age of 1.5 years. Her
anti-HIV therapy included reverse transcriptase inhibitors, stavu-
dine, and the protease inhibitors indinavir and squinavir. She
gradually developed hepatomegaly with abnormal liver function
tests over 1 year. Laboratory workup revealed high serum levels of
transaminases, lactate dehydrogenase (LDH), and alkaline phos-
phatase. The CD4 T cell count was 694 cells/mm
3
, in the lower
limits of the normal range.
The patient was referred for an ultrasound examination of her
upper abdomen with a presumed diagnosis of hepatitis. The ab-
dominal ultrasound showed a normal size spleen with multiple, thin
echogenic lines scattered over the relatively hypoechoic, but oth-
erwise normal, splenic parenchyma. These bright lines were bifur-
cating towards the periphery of the splenic parenchyma (Fig. 1a,
b). Associated findings were abdominal lymphadenopathy in the
splenic hilum and in the porta hepatis, and a mildly enlarged liver
with heterogeneous echotexture.
A non-contrast-enhanced CT, performed following the ab-
dominal ultrasound examination, showed bright linear densities in
the splenic parenchyma consistent with linear calcifications
(Fig. 2).
Case 2
The patient was a 6-year-old girl with an HIV infection acquired at
birth. She had a history of Mycobacterium avium-intracellularis
(MAI) infection in her lungs and blood starting at the age of
3 years. She has been treated constantly for that with a specific
antimycobacterial multidrug treatment. Her anti-HIV therapy in-
cluded reverse transcriptase inhibitors, stavudine, abacavir and
efavirez. At the age of 4 years, she developed hepatitis associated
with hepatomegaly and persistent elevated serum levels of bilirubin,
HIV CASE BOOK
Pediatr Radiol (2002) 32: 387–389
DOI 10.1007/s00247-001-0630-2
Eduard Ghersin
Berta M. Montalvo
Arterial splenic calcifications in children
with AIDS: two case reports
Received: 18 June 2001
Accepted: 23 October 2001
Published online: 14 February 2002
Ó Springer-Verlag 2002
E. Ghersin Æ B.M. Montalvo (&)
Department of Diagnostic Radiology
(R-109), Division of Body Imaging,
University of Miami School of Medicine,
P.O. Box 016960, Miami, FL 33101, USA
E-mail: bmontalv@med.miami.edu
Tel.: +1-305-5855057
Fax: +1-305-5855965
Abstract Splenic calcifications in
AIDS patients are usually round and
result from infections with opportu-
nistic pathogens such as Pneumo-
cystis carinii, Mycobacterium avium-
intracellulare and Cytomegalovirus.
We describe here a remarkable
echopattern of the spleen in two
pediatric patients, resulting from
linear, branching calcifications in the
splenic parenchymal arteries. We
believe this echopattern represents
the ultrasonographic manifestation
of an HIV-associated vasculopathy.
Key words AIDS Æ Human
immunodeficiency virus Æ
HIV-associated vasculopathy Æ
Splenic calcifications Æ Arterial
calcifications Æ Ultrasound