Abstract
IntroductionSplenosis is the heterotopic autotransplantation of splenic tissue, mostly found after splenic trauma or surgery in the abdominal, pelvic or thoracic cavity. Here we report a patient with a history of splenectomy after polytrauma with chronic hepatitis C and liver cirrhosis presenting with an hepatic mass of unknown origin.Case presentationThe lesion could not be exactly classified by ultrasound, computed tomography, angiography and biopsy, classical features of malignancy were not fulfilled, and on the other hand a neoplastic process could neither be excluded. After revision of a MRI performed in our centre it appeared that the liver mass contrasted in the same way as the remaining accessory spleens in the left upper quadrant. A selective Tc-99m-labelled heat-denatured autologous red blood cells scintigraphy of the spleen was performed and showed both the accessory spleens in the left upper quadrant and spleen-typical tissue in projection to the left liver lobe and confirmed the diagnosis of splenosis.ConclusionAlthough intrahepatic splenosis represents an extremely rare condition, this diagnosis should always be taken into consideration in patients with history of abdominal trauma with splenic involvement presenting with an indeterminate focal liver lesion. The diagnosis of splenosis may then be reliably confirmed by Tc-99m-DRBC scintigraphy.
Highlights
Splenosis is the heterotopic autotransplantation of splenic tissue, mostly found after splenic trauma or surgery in the abdominal, pelvic or thoracic cavity
Conclusion: intrahepatic splenosis represents an extremely rare condition, this diagnosis should always be taken into consideration in patients with history of abdominal trauma with splenic involvement presenting with an indeterminate focal liver lesion
The diagnosis of splenosis may be reliably confirmed by Tc-99m-heat-denatured autologous red blood cells (DRBC) scintigraphy
Summary
Transfemoral intraarterial angiography of the liver was performed as a primarily diagnostic and potentially therapeutic procedure It showed regular branches of the hepatic artery but no pathologic vessels or parenchymal foci of hypervascularity. Subsequent abdominal MRI confirmed the presence of multiple confluent nodular lesions in the left liver lobe measuring 2.5 × 7.0 cm. These lesions showed hypervascularity on contrast-enhanced liver MRI and malignancy was suspected. Facing a similar arterial contrast enhancement behaviour of the intrahepatic nodules on MRI when compared to the residual and accessory splenic tissue observed in the left subdiaphragmatic region, a selective scintigraphy with Tc-99m-labelled heat-denatured autologous red blood cells (Tc-99m-DRBC) was performed in the attempt to investigate for the rare differential diagnosis of intrahepatic splenosis in this context. As there was no need for further treatment with regards to the splenosis, the patient has restarted therapy with pegylated interferon and ribavirine
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