Parenchymal thoracic splenosis: history and nuclear imaging without invasive procedures may provide diagnosis

Abstract

Splenosis is a rare finding of ectopic splenic tissue found within the thoracic cavity, abdomen or peritoneal cavity. Most cases occur in the abdomen and the thoracic location is a comparatively rare finding. In thoracic splenosis the splenic tissue most often grows in the form of a nodule and the autotransplantation is usually caused by a previous operation and/or most commonly a penetrating or blunt trauma to the thoracoabdominal region, resulting in splenic rupture and in some cases left diaphragmatic tear. In majority of the cases the patients are asymptomatic and are incidentally diagnosed with left hemithorax pulmonary lesions found via chest radiography or thoracic computed tomography. We present a 45-year-old Caucasian male who was incidentally diagnosed with parenchymal thoracic splenosis secondary to a gunshot wound to the abdomen 13 years ago that resulted in distal pancreatectomy, splenectomy and gastrorrhaphy. In this case report we will briefly discuss the current updates in the literature regarding thoracic splenosis, and highlight the fact that the findings raise the suspicion of malignancy requiring numerous investigations yet early recognition of thoracic splenosis can prevent unnecessary tests and procedures. Preoperative diagnosis of splenosis should be made with the use of nuclear imaging studies such as the (99m)Tc heat-damaged erythrocyte study rather than computed tomography-guided biopsy or invasive surgery.

Keywords: Thoracic splenosis; Computed tomography; Ppancreatectomy; Splenectomy; Gastrorrhaphy.

Figure 1.

CT scan of the chest and abdomen revealed presence of a 3.4 cm mass adjacent to the left hemidiaphragm.

Figure 2.

CT-guided biopsy of the mass which subsequently ruled out malignancy.

Figure 3.

Video-assisted thoracoscopic surgery (VATS) revealed presence of the mass in the thoracic area.