Thorotrast Accumulation in the Upper Abdomen

Vivek David, MD
Stuart G Silverman, MD

Presentation

A 68-year-old woman with no known medical problems presented with abdominal pain.

Imaging Findings

Radiograph of the chest, PA view

CT of the abdomen

A posteroanterior (PA) radiograph of the chest shows a high density mass (arrow) projecting over the left upper quadrant of the abdomen.

Abdominal computed tomography (CT), obtained without intravenous contrast material, shows that the mass is the patient's shrunken and very dense spleen (arrow). In addition, the liver is hyperdense and contains multiple linear densities in a reticular pattern. Numerous, dense lymph nodes are visible in the upper abdomen (arrows).

Differential Diagnosis

The differential diagnosis of a hyperdense liver on CT includes iron overload, treatment with iodine-containing compounds (eg, amiodarone), hemochromatosis, and glycogen storage disease. However, the additional findings of a shrunken, high-density spleen and high-density lymph nodes are highly characteristic of prior administration of thorium dioxide (Thorotrastsee discussion).

Diagnosis

Thorotrast accumulation in the liver, spleen, and lymph nodes of the upper abdomen.

Discussion

Thorotrast is a colloidal suspension of thorium dioxide that was used until the 1950s as an intravascular contrast agent. The agent is retained by the reticuloendothelial system and is thus found in the liver, spleen, lymph nodes, and bone marrow years after it is administered. Thorotrast is no longer used because thorium is an alpha emitter and has a very long half-life (400 years). These characteristics make Thoratrast carcinogenic, and this agent can cause angiosarcomas of the spleen and liver.

References

1. Levy DW, Rindsberg S, Friedman AC, et al. Thorotrast-induced hepatosplenic neoplasia: CT identification. AJR 1986; 150: 997-1004.

2. Gore RM, Levine MS, Laufer I. Textbook of gastrointestinal radiology. Philadelphia: WB Saunders, 1994: 2263-2266.

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