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Case 60

Contrast in the sponge mattress

An unusual liver

This patient presented with epigastric pain, and a barium meal was performed at the request of the General Practitioner. This was one of the images obtained during the study.

Findings

There is a speckled pattern of calcific or contrast density overlying the liver. It appears round rather than conforming to the outline of the liver, and there is a regular diagonal band through it, all of which raises the possibility of artefact.

Diagnosis

Water soluble contrast had been spilled on the plastic coated sponge mattress that rests on the barium table at a previous examination. The mattress had been cleaned, but unfortunately there was a small tear in the plastic and contrast had soaked into the sponge producing the round area of contrast/air density. The mattress had to be discarded.

Differential

Other cuases of speckled high density in the liver might include calcified metastases, most commonly mucinous adenocarcinoma such as from breast or GI tract.

An appearance similar to that shown may be seen following administration of "Thorotrast", although the spleen would also be affected. Thorotrast was a contrast agent based on Thorium, used in the first half of the 20th Century, but was radioactive, producing alpha radiation. It was taken up permanently by the reticuloendothelial system (liver and spleen), producing a characteristic appearance, but also, sadly, producing malignancy in these organs due to the prolonged exposure to radiation. It was abandoned in favour of other agents, and you are only likely to see a case in a teaching museum these days.

Discussion

This is not a unique occurence of the "sponge mattress sign". Whenever an abnormality is seen that does not correspond to anatomical boundaries or a typical pathological appearance, think artefact. Similarly if an abnormality moves from film to film, think artefact.

An common example is the "renal stone" that appears intermittently, because it is contrast spilled on one of the film cassettes, and only appears when that cassette is reused. Alternatively, it appears on every film, but moves relative to the kidney, because it is contrast on the bucky tray, which always appears in the same place, even when the patient is moved. Cases have occured where the problem was identified only when the same calculus appeared on both IVPs in two successive patients!

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