Presence Of Splenic Tissue Research Articles

SPLENULE FREQUENCY ON COMPUTED TOMOGRAPHY SCANS IN CHILDREN, PRESENTING TO THE EMERGENCY DEPARTMENT

Objectives: Accessory spleen, also known as “splenule”, is the presence of splenic tissue in ectopic localisations. The presence of splenule is important, especially in patients planned for splenectomy, as it may cause refractory symptoms. The aim of the present study is to define the frequency of splenule(s) in children (0-17 years) who received non-contrast and contrast enhanced computed tomography (NECT and CECT) protocols in the emergency department.
 Material and methods: 748 children (aged 0 to 17 years) who were admitted to the emergency department between May 2015 – September 2022 and had NECT and CECT abdominal scans were included in the study. Patients whose CT protocols were incomplete and cases with traumatic splenic injury and / or cases with poor image quality and patients with a history of splenectomy or hematologic pathology were excluded from the study (n: 100). A total of 648 patients were included in the cohort. NECT and CECT scans of all patients were assessed; the localisation of splenules as well as the antero-posterior (AP), medio-lateral (ML) and cranio-caudal (CC) dimensions of each splenule were measured.
 Results: A total of 648 cases with 467 males (72.1%) and 181 females (27.9%) were included in the study. Splenules were observed in 131 (20.2%) cases. More than one splenule was observed in 21 of these 131 cases. A total number of 159 splenules were observed in total, with a mean volume of 0,72 ±0,95 ml. The most common location was found to be the splenic hilus (n=55, 41.9%). 
 Conclusion: Our study have stated that splenules are common anatomical variants, seen at a rate of 20,2% in this age cohort. A cross-sectional imaging should be performed to determine the presence, location, and number of the splenules before a planned splenectomy.

Congenital intrathoracic accessory spleen is a very rare trick of nature: a case report

BackgroundCongenital intrathoracic accessory spleen (CIAS) refers to a developmental anomaly resulting in the presence of splenic tissue within the chest. The differential diagnoses for the resulting mass are pulmonary malformations, or lesions with malignant potential. To our knowledge, only four cases of presumed CIAS have been described in literature to date, and no cases were reported in the United States.Case presentationWe report on a 14-year-old Caucasian female with a left chest mass discovered incidentally on a CT scan performed following an all-terrain vehicle accident. Following resection, the mass was diagnosed as a CIAS.ConclusionsFrom our review of literature, we found that CIAS can pose a diagnostic dilemma as it is rare, difficult to distinguish from pulmonary sequestration, or malignancy, and biopsy is often inconclusive. Resection is required to rule out malignancy and determine the diagnosis. Pediatric thoracic surgeons should consider CIAS in their differential for an intrathoracic mass with an inconclusive biopsy.

Splenogonadal fusion associated with delayed skeletal maturation: A case report and review of the literature

In this report of a 13-year old boy, we describe the first case of splenogonadal fusion (SGF) associated with growth hormone deficiency, delayed skeletal maturation and stunting, and provide a review of the literature on SGF based on a search in major medical indexes using the descriptors splenogonadal, splenogonadal fusion and congenital anomalies of the spleen. Predominant in males (15:1), SGF is a rare congenital anomaly with only around 200 cases described involving the presence of splenic tissue in the gonads and, in some cases, a fibrous cord connecting the two structures. SGF may be associated with severe limb anomalies, micrognathism and testicle cancer. Despite frequently increased testicle volume, the condition is usually asymptomatic. Knowledge of SGF is important in the differential diagnosis of malignancies, avoiding unnecessary orchiectomy. Nevertheless, SGF has been observed in association with malignant tumors, especially in patients with cryptorchidism.

Subcutaneous Splenosis of the Abdominal Wall: Report of a Case and Review of the Literature

Splenosis is a common benign condition that occurs after splenic rupture via trauma or surgery. The mechanism behind splenic cell autotransplantation begins with the splenic rupture, either from trauma or surgical removal. Splenosis is usually found incidentally and, unless symptomatic, surgical therapy is not indicated. Subcutaneous splenosis is an extremely rare form of splenosis, mostly observed in abdominal surgical scars. We report a case of subcutaneous splenosis, as well as a comprehensive review of the literature. In our case, a 43-year-old woman who had splenectomy after traumatic splenic rupture at the age of 7 years old presented for plastic reconstruction of her postoperative scar. Upon surgery, two asymptomatic subcutaneous nodules were incidentally discovered. The presence of splenic tissue was confirmed by the histological study. The nodules were not excised, as the patient was not symptomatic.

Improved detection of splenosis in patients with haematological disorders: the role of combined transmission-emission tomography

The purpose of this study was to evaluate the use of combined transmission and emission tomography (TET) for correct localisation of heterotopic splenic tissue and differentiation of splenosis from other masses. The TET technique comprises the fusion of SPET and CT data obtained using the same imaging device to allow perfect overlap of anatomical and functional images. TET was performed in seven patients who either had haematological disorders and relapsing anaemia or thrombocytopenia after splenectomy or were under immunosuppression for different reasons. These patients presented 20 equivocal lesions on CT or MRI. Presence of splenic tissue was investigated using technetium-99m labelled colloids or heat-damaged red blood cells. Findings of spleen scintigraphy, TET and CT or MRI were compared with respect to localisation of splenosis and correct classification of lesions by CT or MRI. Histological validation was achieved by surgery or biopsy in all cases. All 20 lesions demonstrated by CT or MRI were correctly classified by TET as splenosis. Three additional lesions initially overlooked by CT or MRI could be detected. Diagnostic relevance was highest for intrahepatic, intrapulmonary or pleural splenic implants. It is concluded that TET allows exact localisation of heterotopic splenic tissue in patients with suspected splenosis.

EVALUATION OF UNIVENTRICULAR ATRIOVENTRICULAR CONNECTION BY NMR IMAGING

Twelve patients (pts), ages 7 mos. to 23 yrs. (mean 11 yrs.), with known univentricular atrioventricular (AV) connection (“Single ventricle”) were evaluated by ECG-gated magnetic resonance imaging (MRI). Multiple sections were obtained in transverse, coronal and oblique planes using a 0.3T or LOT magnet and SE 30 pulsing techniques. MRI studies were evaluated using a segmental approach prior to reviewing the echocardiograms and angiograms which were available on all pts. MRI accurately depicted: 1) cardiovisceral and atrial situs 2) presence of splenic tissue 3) systemic and pulmonary venous connections 4) the mode of AV connection (i.e. absent right, double inlet, etc.) 5) the morphology and spatial relationships of the main and rudimentary ventricular chambers (6) the ventriculoarterial (VA) connections and 7) surgical procedures (i.e. shunts, PA bands). Seven pts had absent right AV connection, 4 had double inlet anatomy and 1 had an absent left AV connection. The absent AV connection was true atresia in 6 with invagination to the cardiac crux of fat-containing sulcus tissue which appears bright on MRI and an imperforate valve in 1. In 11 pts, the rudimentary chamber could be visualized. VA discordance was demonstrated in 2 pts with absent right AV connection, in all 5 with double inlet LV's and the 1 with absent left AV connection. We conclude that MRI accurately depicts cardiac morphology in pts with univentricular AV connection, often providing information not available with other imaging techniques.

Return of splenic function after splenectomy: how much tissue is needed?

Ninety patients whose spleen had been removed either because of trauma (41 cases) or as an elective procedure (49) were investigated for return of splenic function by counting pitted red cells and examining spleen scans made after injection of heat damaged 99mTc labelled red cells. There was no significant difference in the proportion of pitted red cells between the two groups of patients. Evidence of splenic tissue in scintiscans was not invariably associated with low pitted red cell values, suggesting that the presence of splenic tissue did not necessarily mean return of splenic function. In every patient whose proportion of pitted red cells was less than 16.2% the scintiscan showed splenic uptake. The proportion of patients with pitted red cell values below 16.2% was significantly higher in the group operated on for trauma, and it is concluded that this was due to splenosis. A high inverse correlation between pitted red cell counts and computed splenic volumes was found. Patients with pitted red cell values of less than 16.2% had computed volumes of 22-133 cm3; below this range the proportion of pitted red cells rose very sharply. These results confirm that splenosis occurs in adults, though less often than in children, and suggest that when splenic tissue is to be implanted a graft of at least 20-30 cm3 is needed to ensure satisfactory return of splenic function.

Monocyte Cytotoxicity after Splenectomy

Antibody-dependent cell-mediated cytotoxicity (ADCC) by monocytes was determined in 45 adults approximately 4 years after splenectomy for either abdominal trauma or accidental injury during operation for benign gastroduodenal ulcer. Compared to controls, both groups of splenectomized persons showed increased numbers of monocytes and decreased monocyte ADCC. The decrease of monocyte ADCC was only significant in those splenectomized persons in whom accessory splenic tissue was not detectable by isotope scanning. Addition of the spleen-dependent peptide tuftsin to monocytes in vitro did not augment their ADCC. An increase serum concentration of immune complexes was neither related to the presence of splenic tissue nor to the monocyte cytotoxicity. Vaccination with pneumococcal polysaccharide had no effect on monocyte ADCC. It is suggested that the defective monocyte cytotoxicity observed in splenectomized persons without detectable splenic tissue might be relevant to post splenectomy infectious susceptibility.

ECTOPIC SPLENIC TISSUE FAILED TO PREVENT FATAL PNEUMOCOCCAL SEPTICÆMIA AFTER SPLENECTOMY FOR TRAUMA

Despite heterotopic splenic tissue, fatal fulminating pneumococcal septicæma occurred in 2 patients who had had splenectomy for trauma. A girl aged 12 who died 8 years after splenectomy had over a hundred nodules, the largest weighing 3 g. A man of 19 who died 9 years after splenectomy had splenic tissue weighing 92 g. The presence of splenic tissue did not itself protect these patients from overwhelming infection and its ectopic situation with the consequent alteration in blood-supply may be of greater importance than the amount of splenic tissue present.