Intrathoracic Splenosis Research Articles

Extensive intrathoracic and intraperitoneal splenosis mimicking mesothelioma: a case report

BackgroundSplenosis is the heterotopic autotransplantation of splenic tissue after severe splenic trauma and/or splenectomy. The epidemiology is elusive, but splenosis is frequently misdiagnosed as malignant tumors of gastrointestinal, gynecological, or hematological origin before the correct diagnosis is ultimately found. We herein report a rare case of combined, extensive intraabdominal and intrathoracic splenosis initially presenting as pleural mesothelioma.Case presentationA 63-year-old Caucasian male presented with dyspnea and recurring thoracic pain. Initial X-ray and computed tomography scans showed disseminated intrathoracic and intraabdominal lesions. Consequently, thoracoabdominal mesothelioma or a polytopically metastasized cancer of unknown origin was suspected. A thorough examination of the patient’s medical history and contrast-enhanced ultrasound by a skilled examiner revealed the diagnosis of extensive abdominal and thoracic splenosis as a consequence of an abdominal gunshot wound with a ruptured diaphragm several decades earlier. Timely diagnosis by noninvasive measures prevented the patient from potential complications of harmful diagnostic procedures, including nuclear imaging and biopsies. The patient is currently treated for hepatitis C and chronic obstructive lung disease, whereas no specific treatment for splenosis is required.ConclusionsWe present a case of rare intrathoracic and intraperitoneal splenosis mimicking mesothelioma. Contrast-enhanced ultrasound and thorough patient history were used for diagnosis and prevented this patient from having to undergo potentially harmful diagnostics. Splenosis can occur after splenic trauma and, consequently, needs to be considered as a rare differential diagnosis to malignant tumors of various origins when a matching patient history is obtained.

Utilización de hematíes marcados con <sup>99m</sup>Tc y desnaturalizados por calor en el diagnóstico gammagráfico de un caso infrecuente de esplenosis intratorácica

La esplenosis intratorácica es poco frecuente y se asocia con historia previa de ruptura del bazo y del diafragma causado por un traumatismo. Suele ser asintomática, presentándose como un hallazgo accidental en las imágenes radiográficas o de tomografía computarizada. El diagnóstico definitivo puede realizarse mediante estudios gammagráficos asociados con estudios funcionales de captación de partículas o células. Por su sensibilidad y especificidad, la gammagrafía con hematíes marcados con 99mTc y desnaturalizados por calor es la técnica de referencia que permite confirmar el diagnóstico de esplenosis y diferenciarla de otros procesos que requieren resección quirúrgica Se describe el caso de un varón de 52 años atendido por dolor de tipo pleurítico en hemitórax izquierdo. Las imágenes mostraron derrame pleural izquierdo e infarto pulmonar sin signos de tromboembolismo. Se evidenciaron múltiples focos sugestivos de esplenosis, que fue confirmada mediante gammagrafía esplénica con hematíes marcados con 99mTc y desnaturalizados por calor.

Combined Intrathoracic and Subcutaneous Splenosis Discovered 51 Years after Abdominal Trauma.

Splenosis is a rare condition that results from the autotransplantation of splenic parenchyma into unexpected locations such as the abdomen or subcutaneous tissue. In the presence of coexisting injury to the diaphragm intrathoracic transplantation can occur emerging as single or multiple pleural-based masses. This occurs after traumatic rupture of the spleen and is usually asymptomatic, only to be discovered incidentally on routine thoracic or abdominal imaging. To our knowledge this is the third documented case of combined intrathoracic and subcutaneous splenosis found in English literature. This occurred in a 71-year-old male involved in a motor vehicle accident at age 19 requiring urgent splenectomy. He has a significant cigarette smoking history and was referred to our hospital for further evaluation of an abnormality seen on shoulder X-ray.

Intrathoracic splenosis presenting as persistent chest pain

Thoracic splenosis is a rare entity resulting from splenic and diaphragmatic injury. Patients remain asymptomatic, and surgical intervention is not indicated in the majority of cases. We report a case of a 50-year-old male with a history of splenectomy due to a gunshot wound 30 years previously who presented with vague, progressively worsening chest pain. He was found to have a large intrathoracic splenosis. Unique features of our patient include the presence of symptoms, the significant interval growth of the splenic tissue, and the unprecedented size of the mass, which we believe to be the largest among those previously described.

Paraoesophageal splenosis: An unusual differential of mediastinal soft tissue deposits.

Ectopic splenic tissue can present as accessory spleens and splenosis. While accessory spleens are congenital and more common; splenosis occurs as a result of implantation of splenic tissue as a result of trauma or iatrogenic injury. Only up to 40 intrathoracic splenosis have been reported in the English language literature to date. Here we discuss a case in which Para oesophageal pre-aortic ectopic splenic tissue was identified through radionuclide imaging 20 years after splenic rupture in a 44-year-old male for work up of epigastric pain.Splenosis should be considered as differential diagnosis in all previously splenectomised patients who present with unexplained masses on imaging. Early diagnoses with preoperative non-invasive radionucleotide scanning with collateral histories can prevent unnecessary surgery and reduce expensive and invasive investigations.

Non-Invasive Diagnosis of Posttraumatic Thoracic Splenosis

Intrathoracic splenosis is a generally asymptomatic entity incidentally diagnosed after the completion of an Rx, CT scan or MRI for another reason. The performance of scintigraphy with 99mTc-labelled heat-denatured erythrocytes allows the noninvasive diagnosis of this entity and avoids more aggressive diagnostic techniques such as FNAP or thoracotomy. Because this splenic tissue may be partially or fully functioning and therefore may have some beneficial immune function for the patient, the management of this entity should be conservative. Radioisotopic scintigraphy with 99mTc labelled heat-denatured erythrocytes is the technique with the greatest specificity in the demonstration of splenic tissue. The presence of subpleural pulmonary nodules, associated or not with intra-abdominal nodules, together with the existence of previous partial or total splenectomy, traumatic or not, with or without associated rupture of the diaphragm, should raise suspicion of the presence of intrathoracic splenosis.

Diagnóstico no invasivo de la esplenosis torácica postraumática

Intrathoracic splenosis is a generally asymptomatic entity incidentally diagnosed after the completion of an Rx, CT scan or MRI for another reason. The performance of scintigraphy with 99mTc-labelled heat-denatured erythrocytes allows the noninvasive diagnosis of this entity and avoids more aggressive diagnostic techniques such as FNAP or thoracotomy. Because this splenic tissue may be partially or fully functioning and therefore may have some beneficial immune function for the patient, the management of this entity should be conservative. Radioisotopic scintigraphy with 99mTc labelled heat-denatured erythrocytes is the technique with the greatest specificity in the demonstration of splenic tissue. The presence of subpleural pulmonary nodules, associated or not with intra-abdominal nodules, together with the existence of previous partial or total splenectomy, traumatic or not, with or without associated rupture of the diaphragm, should raise suspicion of the presence of intrathoracic splenosis.

Intrathoracic splenosis: evaluation by 99mTc-labelled heat-denatured erythrocyte SPECT/CT

Intrathoracic splenosis: evaluation by 99mTc-labelled heat-denatured erythrocyte SPECT/CT

Intrathoracic splenosis: evaluation by superparamagnetic iron oxide-enhanced magnetic resonance imaging and radionuclide scintigraphy

Splenosis represents the heterotopic autotransplantation of splenic tissue after either splenic trauma or surgery. Intrathoracic splenosis is a rare condition resulting from concomitant rupture of the spleen and the left hemidiaphragm. We report a case of splenosis in a 41-year-old male patient who had experienced severe thoracoabdominal injury including rupture of the spleen and left hemidiaphragm and post-traumatic splenectomy 20 years previously. Abnormal opacities in the cardiac region were noted on a chest radiograph at an annual checkup. Computed tomography (CT) of the chest demonstrated multiple, well-circumscribed pleura-based nodules at the posterior base of the left hemithorax and the left subdiaphragmatic area. On magnetic resonance imaging (MRI), the lesions were hypointense on T1-weighted images and hyperintense on T2-weighted images. After administration of superparamagnetic iron oxide (SPIO), the lesions showed decreased signal intensity but remained slightly hyperintense relative to liver parenchyma on T2-weighted images. (99m)Tc-labeled Sn colloid scintigraphy revealed multiple areas of increased activity consistent with the lesions on the CT and MRI scans. In addition to the history of splenic trauma and left hemothorax, SPIO-enhanced MRI and radionuclide scintigraphy, which can demonstrate phagocytic ability in the ectopic splenic tissue, were useful for confirming the diagnosis.

Intrathoracic splenosis: A case report and an update of invasive and noninvasive diagnostic techniques

Intrathoracic splenosis is a rare condition resulting from autotransplantation of splenic tissue into the left side of the chest, usually after diaphragmatic and splenic rupture after blunt or penetrating abdominal trauma. Patients are often free of symptoms, and nodules are usually discovered at computed tomographic scan. Owing to the rarity of the condition (30 cases in the literature so far), most patients undergo thoracotomy before final diagnosis. We present a case of thoracic splenosis that recently came to our attention. Clinical Summary A 67-year-old man had a left upper lobe mass identified during workup for prostatectomy for benign prostate hypertrophy. Medical history was unremarkable except for an injury that had occurred 43 years earlier with rib fractures, pneumothorax, and spleen rupture; no diaphragmatic rupture was evidenced. A chest tube was inserted and a splenectomy was undertaken at that time. Preoperative workup for the lung lesion included a chest and upper abdominal computed tomographic scan (Figure 1) and fineneedle aspiration of the lesion, revealing a mixture of inflammatory cells comprising mostly lymphocytes, plasma cells, and some pigment-laden macrophages in a background of hemorrhage and endothelial cells. The lymphocytes showed mixed immunoreactivity for CD3 and CD20 whereas tests for pankeratin were negative. With the suspicion of a neoplastic lesion, the patient underwent a left muscle-sparing thoracotomy. The parietal pleura displayed multiple small (0.5‐1 cm) nodules particularly evident on the diaphragmatic surface. An identical nodule (3 2 cm) was located along the aorta, from which it could be easily dissected and sent for frozen section examination: grossly, the surgical specimen was soft and displayed, at the cut surface, a brown color with diffuse small white dots (Figure 2, g). Microscopically, it was consistent with a benign spleen, with lymphocytic aggregates and other leukocytes distributed in a highly vascular background of sinusoidal structures (Figure 2, i). No further resection was therefore carried out. The patient had an uneventful postoperative course and was discharged from the hospital on postoperative day 6.

Esplenosis intratorácica: a propósito de un caso

Splenosis is the implantation of functionally active splenic tissue in the serous membranes of the peritoneal cavity and different solid organs such as the lungs, kidneys, or liver. The presence of subpleural pulmonary nodules, whether associated or not to intraabdominal nodules, should raise the diagnostic possibility of intrathoracic splenosis in patients with a history of partial or total splenectomy and/or trauma affecting the spleen. We report the case of a patient splenectomized 16 years prior for splenic lesions suffered in a traffic accident who presented with subpleural nodules with a nonspecific appearance.

Intrathoracic Splenosis after Remote Trauma

A healthy 39-year-old man with persistent influenza-like symptoms underwent chest radiography, which showed two pericardial masses (Panels A and B, arrows). Computed tomography (CT) showed that the masses (one 3.3 by 3.3 cm and the other 2.9 by 2.0 cm) were along the lateral pericardium on the left side. Magnetic resonance imaging revealed the masses to be noncystic soft tissue (Panel C). The patient was referred for thoracoscopic resection. The patient had undergone laparotomy 20 years earlier after a motor vehicle accident. He reported that his spleen had been removed, his diaphragm had been repaired, and chest tubes had been . . .

Intrathoracic Splenosis

Intrathoracic splenosis is a rare condition involving autotransplantation of the splenic tissue into the pleural cavity. It is typically a result of diaphragmatic and splenic rupture after blunt or penetrating abdominal trauma. The diagnosis is usually determined by surgical biopsy of an incidental asymptomatic mass on a radiograph or computed tomography. The process is benign and can be generally followed with serial chest radiographs. We herein discuss a 34-year-old male who presented with sharp chest pains.

Intrathoracic Splenosis*: Superiority of Technetium Tc 99m Heat-Damaged RBC Imaging

Intrathoracic splenosis is a rare diagnosis that is usually made following an invasive procedure. Although radiographic and CT findings are nonspecific, these findings combined with a history of splenic injury should suggest the possibility of this diagnosis. We present a patient with intrathoracic splenosis diagnosed on the basis of a technetium Tc 99m heat-damaged RBC scan following false-negative technetium Tc 99m sulfur colloid scan results.

Intrathoracic Splenosis Mimicking Metastatic Lung Cancer

A case of posttraumatic intrathoracic splenosis mimicking lung cancer is presented. The diagnosis was made by a radiocolloid liver-spleen study followed by a heat-damaged Tc-99m labeled red cell scan. A favorable change in the staging of the patient's real contralateral lung cancer resulted.

Intrathoracic Splenosis: Report of a Case Simulating Esophageal Leiomyoma

Intrathoracic splenosis is a rare sequel of left thoracoabdominal injury. A case simulating esophageal leiomyoma is presented. As in most earlier cases, the diagnosis was established only at thoracotomy. As splenosis is asymptomatic and may have some beneficial immunologic effects, surgical removal is inadvisable. The 23 previously published cases and the possibility of nonsurgical diagnosis are discussed.

Thoracic Splenosis

Two rare cases of intrathoracic splenosis are reported. This phenomenon occurs almost exclusively in young men who have experienced splenic rupture and diaphragmatic laceration. The late occurrence of splenosis in the thoracic cavity poses problems in the differential diagnosis of solitary or multiple pleural-based nodules. It is important to recognize this entity from a clinical, radiographic, and therapeutic perspective.