Thoracic splenosis masquerading as bronchial cancer

Abstract

A 57-year-old woman presented with adhesional small bowel obstruction and required a laparotomy and adhesiolysis. The postoperative period was complicated by pulmonary embolism. In addition, computed tomography (CT) pulmonary angiogram also demonstrated several indeterminate pleural based pulmonary nodules suspicious of a primary malignancy. Review of this patient's past medical history revealed a road traffic collision 29 years previously which required a laparotomy, left nephrectomy, splenectomy, and repair of the left hemi-diaphragm. Radiological surveillance with follow-up chest CT demonstrated stable appearance of the indeterminate nodules, and a diagnosis of thoracic splenosis was considered the most likely explanation of the imaging findings. Thoracic splenosis must be considered in patients presenting with lung nodules and a past history of thoracoabdominal trauma. Radionuclide studies with technetium(99m) (Tc(99m)) sulfur colloid or Tc(99m) heat damaged red cell scans can help confirm or refute this diagnosis and thereby reassure both patient and clinician.

Figure 1

Contrast enhanced computed tomography (CT) scan of the thorax demonstrating an 18 mm left pleural nodule unchanged from a previous CT performed 1 month earlier (fig 2).

Figure 2

See fig 1 caption.