1
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Choi MG, Woo W, Chang JY, Kim BJ, Kim Y, Moon DH, Lee S. Combined Intrathoracic and Abdominal Splenosis. Am J Case Rep 2022; 23:e937902. [PMID: 36435962 PMCID: PMC9713598 DOI: 10.12659/ajcr.937902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Splenosis refers to autotransplantation of splenic tissue after splenic injury or splenectomy, most frequently occurring in the abdominal and pelvic cavities. Thoracic splenosis is a rare condition associated with a history of simultaneous rupture of the spleen and diaphragm resulting from trauma. To the best of our knowledge, only a limited number of cases have been reported for combined intrathoracic and abdominal splenosis. CASE REPORT We present a case of a 50-year-old man with a history of splenectomy and left nephrectomy 15 years ago due to an accident, who had experienced chest pain for the past month. A 1-cm focal pleural thickening in the left posterior pleura was revealed on the chest computed tomography (CT) scan. We found this to be suspicious for a solitary fibrous tumor. Based on this information, surgery was performed for tumor removal, and the pathologic examination confirmed splenic tissues. The patient was then discharged without any complications. Further abdominopelvic CT showed several contrast-enhanced lesions, suggestive of intraperitoneal splenosis. CONCLUSIONS We would like to emphasize the importance of thorough history-taking to avoid misdiagnosis and unnecessary procedures with respect to the rarity of splenosis. Moreover, appropriate use of diagnostic tools, including radionuclide imaging studies, is recommended to establish an accurate diagnosis of thoracic splenosis.
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2
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Tian S, Cai Y, Tian W. Thoracic splenosis mimicking Castleman's disease: A case report and review of the literature. Asian J Surg 2022; 45:1480-1481. [PMID: 35365392 DOI: 10.1016/j.asjsur.2022.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Surong Tian
- Department of cardiology, the First People's Hospital of Jiangxia District, Wuhan, Hubei Province, 430200, People's Republic of China
| | - Yuxiang Cai
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Weidong Tian
- Center for Disease Control and Prevention, Jiangxia District of Wuhan, Hubei Province, 430200, People's Republic of China.
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3
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"Multimodality imaging of the extrapleural space lesions". Clin Imaging 2021; 79:64-84. [PMID: 33892397 DOI: 10.1016/j.clinimag.2021.03.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/20/2021] [Accepted: 03/29/2021] [Indexed: 11/23/2022]
Abstract
Extrapleural space (EPS) is a potential space between the outer layer of the parietal pleura and the inner layer of the chest wall and the diaphragm. Many different pathologies including chronic inflammatory conditions, infections, trauma, neoplastic disease (both benign and malignant) as well as many infiltrative disorders can involve the EPS. It is one of the frequently overlooked entity on imaging due to relative lack of understanding of the anatomy and the imaging appearances of the diseases localized to this space. The knowledge of the EPS is essential for the radiologists as the pathologies which involve the EPS may require different treatment approach compared to pleural or parenchymal lung disease. Additionally, the EPS involvement may influence the staging and treatment planning for chest malignancies. In this review, we give an overview of the anatomy and various pathologies involving EPS, utility of different imaging modalities in the evaluation of EPS lesions with emphasis on cross sectional imaging and emerging technologies like spectral CT and its role in recognizing the imaging features which enable specific diagnosis of various pathologies.
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4
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Alfahad A, Hussain R, Devaraj M, Svec A. Ectopic spleen presenting as a slowly enlarging lung nodule in the right lower lobe following gastric pull up operation. BMJ Case Rep 2021; 14:14/2/e237912. [PMID: 33622743 PMCID: PMC7907855 DOI: 10.1136/bcr-2020-237912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This is a case report of an elderly man who was investigated at our respiratory clinic for slowly enlarging right lower lobe lung nodule on the background of oesophageal cancer diagnosed more than 11 years ago with gastric pull up. CT guided biopsy confirms the diagnosis of intrathoracic ectopic spleen.
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Affiliation(s)
- Anas Alfahad
- Respiratory, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Rima Hussain
- Division of Pathology, Royal Victoria Hospital, Newcastle upon Tyne, UK
| | - Mamatha Devaraj
- Division of Pathology, James Cook University Hospital, Middlesbrough, UK
| | - Alexandr Svec
- Division of Pathology, James Cook University Hospital, Middlesbrough, UK
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5
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Kosydar SR, Sanchirico PJ, Pfeiffer DC. A case of thoracoabdominal splenosis. Radiol Case Rep 2019; 15:7-10. [PMID: 31737138 PMCID: PMC6849435 DOI: 10.1016/j.radcr.2019.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 01/10/2023] Open
Abstract
We describe a case of a 38-year-old male with a remote history of motor vehicle trauma who presented to the emergency department with 1-week history of progressively worsening abdominal pain localized to the epigastric region. Patient history included splenectomy. Computerized tomography demonstrated multiple masses in the left pleural space as well as masses continuous with the diaphragm and abdominal wall in the left upper quadrant. In addition, a lobulated mass was identified in the right upper quadrant along the anterior right hepatic lobe. A diaphragmatic defect was noted containing splenic tissue. A diagnosis of splenosis was made. Disseminated splenosis presenting in both the thorax and abdomen is rare and poorly documented. This case serves to further illuminate this condition.
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Affiliation(s)
- Samuel R Kosydar
- WWAMI Medical Education Program (MD), University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Paul J Sanchirico
- St Joseph Regional Medical Center, 415 6th St, Lewiston, ID 83501, USA
| | - David C Pfeiffer
- WWAMI Medical Education Program and Department of Biological Sciences, University of Idaho, 875 Perimeter Drive, Moscow, ID 83844-3051, USA
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6
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Khan A, Khan S, Pillai S. Symptomatic Intrathoracic Splenosis More than Forty Years After a Gunshot Injury. Cureus 2019; 11:e5985. [PMID: 31807373 PMCID: PMC6876915 DOI: 10.7759/cureus.5985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Thoracic splenosis is a rare heterotopic autotransplantation of the spleen into the thorax that occurs after trauma or surgery involving the spleen. It is most commonly found incidentally on imaging in the left hemithorax. To the best of our knowledge, only six symptomatic cases of thoracic splenosis have been described in the literature so far. We present a case of thoracic splenosis in a male with a remote history of a gunshot injury during childhood, who presented with chest pain and shortness of breath.
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Affiliation(s)
- Adnan Khan
- Critical Care, Freeman Health System, Joplin, USA
| | - Sana Khan
- Internal Medicine, Sindh Medical College, Karachi, PAK
| | - Saran Pillai
- Emergency Medicine, Kerala Institute of Medical Sciences Hospital, Trivandrum, IND
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7
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Porzionato A, Macchi V, De Caro R. Forensic clinical anatomy of the spleen in medical malpractice. Forensic Sci Int 2019; 304:109772. [PMID: 31601437 DOI: 10.1016/j.forsciint.2019.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/15/2019] [Accepted: 04/24/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Andrea Porzionato
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Veronica Macchi
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Raffaele De Caro
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy.
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8
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Niu Y, Liu W, Xian L, Liu T, Huang C, Yang S. Thoracic splenosis presenting as pulmonary space-occupying lesion. BMC Surg 2018; 18:119. [PMID: 30572857 PMCID: PMC6302502 DOI: 10.1186/s12893-018-0461-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/13/2018] [Indexed: 11/10/2022] Open
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9
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Varghese J, Bergson J, Yaipen O. Intrahepatic Splenosis: Incidental Liver Lesion after Splenectomy. J Comput Assist Tomogr 2018; 42:730-731. [PMID: 29958200 DOI: 10.1097/rct.0000000000000762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe the case of a 50-year-old man with history of remote splenectomy who underwent routine lung cancer screening chest computed tomography and was incidentally found to have a liver lesion. Dedicated liver protocol computed tomography demonstrated "archiform" enhancement pattern in the arterial phase and homogenous filling-in enhancement on portal venous and delayed phases. Multiple other smaller enhancing intraperitoneal lesions were also found. These findings along with history of splenectomy confirmed a diagnosis of intrahepatic and intraperitoneal splenosis and helped avoid biopsy. Intrahepatic splenules can be challenging to diagnose owing to its unusual location and similarity in appearance to a liver neoplasm or metastasis. However, careful evaluation of enhancement pattern and review of medical history can lead to an accurate diagnosis and avoidance of invasive biopsy.
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Affiliation(s)
| | - Jill Bergson
- Department of Radiology, Northport VA Medical Center, Northport
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10
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Ferrer Marrero TM, Prieto-Centurion V, Jaffe HA. Thoracic splenosis: History is the key. Respir Med Case Rep 2017; 22:251-253. [PMID: 28971001 PMCID: PMC5612806 DOI: 10.1016/j.rmcr.2017.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 10/25/2022] Open
Abstract
Splenosis is an acquired ectopic autotransplantation of splenic tissue; that occurs after traumatic splenic rupture and splenectomy [1]. Splenosis is a rare but benign disease, and the diagnosis can be challenging as the multiple incidentally found nodules could mimic malignancy [2]. Abdominopelvic Splenosis is thought to occur in as many as 65% of cases of splenic rupture [1]. However, Thoracic Splenosis is rare and usually involve the left parietal and visceral pleura [1,2]. Intraparenchymal lesions are less common but have been reported in cases of parenchymal and diaphragm laceration [1,2]. Taking a thorough history is of utmost importance, as these patients usually present more than two decades after the splenic traumatic rupture. The use of commonly available nuclear studies will further confirm the diagnosis [3]. This will help to avoid unnecessary procedures, like biopsies; and prevent the potential complications. We present a case of Thoracic Splenosis that highlights the importance of taking a detailed history; and the importance of using nuclear studies for the diagnosis. Further adding to its uniqueness, this case showed with multiple intraparenchymal nodules which is a less common presentation of Splenosis.
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Affiliation(s)
| | - Valentin Prieto-Centurion
- University of Illinois at Chicago, Chicago, IL, United States
- Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Howard A. Jaffe
- University of Illinois at Chicago, Chicago, IL, United States
- Jesse Brown VA Medical Center, Chicago, IL, United States
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11
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Xiao SM, Xu R, Tang XL, Ding Z, Li JM, Zhou X. Splenosis with lower gastrointestinal bleeding mimicking colonical gastrointestinal stromal tumour. World J Surg Oncol 2017; 15:78. [PMID: 28399879 PMCID: PMC5387232 DOI: 10.1186/s12957-017-1153-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 04/02/2017] [Indexed: 12/19/2022] Open
Abstract
Background Splenosis refers to the heterotopic transplantation of splenic tissue following splenic trauma or splenectomy. Splenosis is typically asymptomatic and is often identified incidentally. Case presentation We report a case of splenosis with colon and stomach invasion presenting as lower gastrointestinal bleeding and mimicking colonic gastrointestinal stromal tumour (GIST). The importance of suspicion for splenosis in patients with a history of splenic injury should be highlighted. Computed tomography (CT)-guided biopsy, nuclear scintigraphy and ferumoxide-enhanced magnetic resonance imaging (MRI) can support an accurate diagnosis. Conclusions An accurate diagnosis of splenosis is important to avoid unnecessary operations, especially in patients with previous histories of splenic trauma or splenectomy.
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Affiliation(s)
- Shuo-Meng Xiao
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Rui Xu
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Xiao-Li Tang
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Zhi Ding
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Ji-Man Li
- Department of Pathology, Sichuan Cancer Hospital, Chengdu, China
| | - Xiang Zhou
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China.
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12
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Tulinský L, Ihnát P, Mitták M, Guňková P, Zonča P. Intrathoracic splenosis - lesson learned: a case report. J Cardiothorac Surg 2016; 11:72. [PMID: 27118208 PMCID: PMC4845488 DOI: 10.1186/s13019-016-0474-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intrathoracic splenosis presents an extremely rare thoracic lesion occurring after a simultaneous rupture of the spleen and diaphragm as a consequence of heterotopic autotransplantation and implantation of splenic tissue. Intrathoracic splenosis is usually an asymptomatic, incidental finding, which should be ideally managed without surgical intervention. CASE PRESENTATION We present a case of 68-year old woman with intrathoracic splenosis. Patient presented with a 2-month history of a dry cough unresponsive to administered antibiotics and antimycotics. Computed tomography (CT) of the chest revealed two homogeneous pleural nodules (diameters of 2 and 4 cm) in the left upper lung field. Two consequent CT-assisted transthoracic core-cut biopsies were performed. Histopathology examination of both biopsy specimens was inconclusive (haemorrhagic and non-specific tissue). After that, patient was referred to the department of thoracic surgery with a suspicion of malignant mesothelioma or metastatic lesions. Thoracoscopic revision of the left pleural cavity was performed and the presence of pleural nodules was confirmed. Bloody looking nodules were resected (standard thoracoscopic resection). Postoperative recovery was uneventful. The histopathology examination of the specimen showed normal splenic tissue. Only with the histopathology report in hand, a detailed medical history was taken. It revealed a gunshot injury requiring splenectomy (without known diaphragm or lung injury) 44 years ago (one of the longest time periods in the literature). CONCLUSIONS We would like to point out that following the recommendations regarding splenosis may be very difficult in daily routine practice. The simple question regarding abdominal trauma in a patient's history can lead the clinician to the diagnosis of splenosis, which can be unequivocally established via scintigraphy. The importance of thorough medical history taking, therefore, cannot be underestimated.
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Affiliation(s)
- Lubomír Tulinský
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 70852, Czech Republic. .,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic.
| | - Peter Ihnát
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 70852, Czech Republic.,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic
| | - Marcel Mitták
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 70852, Czech Republic.,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic
| | - Petra Guňková
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 70852, Czech Republic.,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic
| | - Pavel Zonča
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 70852, Czech Republic.,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic
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13
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Combined Intrathoracic and Subcutaneous Splenosis Discovered 51 Years after Abdominal Trauma. Case Rep Pulmonol 2015; 2015:969067. [PMID: 26236530 PMCID: PMC4510120 DOI: 10.1155/2015/969067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/29/2015] [Indexed: 11/17/2022] Open
Abstract
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.
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14
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Klair JS, Duvoor C, Meena N. A rare benign intrathoracic mass in a patient with history of rocket explosion. Respir Med Case Rep 2014; 14:4-6. [PMID: 26029565 PMCID: PMC4356165 DOI: 10.1016/j.rmcr.2014.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Thoracic splenosis is rare benign condition that follows trauma leading to diaphragmatic injury. Most of the patients including ours present with a clear traumatic event leading to autotransplantation of spleen in thoracic cavity. Mostly diagnosed incidentally and we need to avoid unnecessary workup including radiological and invasive. It is a very important case which signifies importance of good history taking and initial imaging for making diagnosis and making our pulmonogist and internist aware of this diagnosis.
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Affiliation(s)
- Jagpal Singh Klair
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Chitharanjan Duvoor
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Nikhil Meena
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Pulmonary and Critical Care, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Corresponding author. Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences (UAMS), 4301 W. Markham Street, Little Rock 72205, USA.
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15
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O-Yurvati AH, Thompson JB, Woods TN. Thoracic Splenosis More Than 40 Years After Thoracoabdominal Trauma. J Osteopath Med 2013; 113:853-6. [DOI: 10.7556/jaoa.2013.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Splenosis is a rare occurrence that is defined as autotransplantation of splenic tissue usually after splenic rupture due to trauma and subsequent splenectomy. Although splenosis most commonly occurs in the abdomen, the authors report a rare case of thoracic splenosis after remote thoracoabdominal trauma. A 62-year-old woman was found to have lower-lobe, pleural-based nodular lesions in juxtaposition to the posteromedial segment of the lung during workup for an abdominal hernia. Surgical excision of the mass confirmed the diagnosis of ectopic splenic tissue, and splenosis was diagnosed. This woman was among the rare 18% of people who are found to have splenosis in the intrathoracic space. In the workup of pulmonary nodules in patients with a history of trauma, splenosis should be a consideration.
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16
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Lopes B, Almeida LR, Vicente AA, Marcellos DC, Corassa M, Romano RF, Freire F. Thoracic splenosis as a differential diagnosis of juxtapleural nodules. Respir Med Case Rep 2013; 11:1-3. [PMID: 26029518 PMCID: PMC3969606 DOI: 10.1016/j.rmcr.2013.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/24/2013] [Accepted: 10/04/2013] [Indexed: 01/04/2023] Open
Abstract
Thoracic splenosis is rare and consists of ectopic implantation of splenic tissue into the chest after concomitant thoracic and abdominal trauma with diaphragm injury. It occurs in about 18% of cases of splenic ruptures. In almost all cases, diagnosis is given incidentally once patients are usually asymptomatic. Thoracic splenosis should be considered as a differential diagnosis in all patients with history of trauma presenting with juxtapleural nodules in chest computed tomography. However, malignant conditions should be ruled out firstly. Biopsy is not essential for the diagnosis once nuclear medicine can confirm splenosis in patients with pertinent history of trauma and suggestive tomographic image. We present a typical case of thoracic splenosis whose diagnosis was made by nuclear medicine and no invasive procedures were required.
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Affiliation(s)
- B Lopes
- Department of Internal Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - L R Almeida
- Department of Internal Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - A A Vicente
- Department of Internal Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - D C Marcellos
- Department of Internal Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - M Corassa
- Department of Internal Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - R F Romano
- Department of Radiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - F Freire
- Department of Internal Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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17
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Splenic anomalies of shape, size, and location: pictorial essay. ScientificWorldJournal 2013; 2013:321810. [PMID: 23710135 PMCID: PMC3654276 DOI: 10.1155/2013/321810] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 04/01/2013] [Indexed: 12/19/2022] Open
Abstract
Spleen can have a wide range of anomalies including its shape, location, number, and size. Although most of these anomalies are congenital, there are also acquired types. Congenital anomalies affecting the shape of spleen are lobulations, notches, and clefts; the fusion and location anomalies of spleen are accessory spleen, splenopancreatic fusion, and wandering spleen; polysplenia can be associated with a syndrome. Splenosis and small spleen are acquired anomalies which are caused by trauma and sickle cell disease, respectively. These anomalies can be detected easily by using different imaging modalities including ultrasonography, computed tomography, magnetic resonance imaging, and also Tc-99m scintigraphy. In this pictorial essay, we review the imaging findings of these anomalies which can cause diagnostic pitfalls and be interpreted as pathologic processes.
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18
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Moon C, Choi YJ, Kim EY, Lee IS, Kim SB, Jung SM, Kim SK, Chang J, Jung JY. Combined intrathoracic and intraperitoneal splenosis after splenic injury: case report and review of the literature. Tuberc Respir Dis (Seoul) 2013; 74:134-9. [PMID: 23579787 PMCID: PMC3617134 DOI: 10.4046/trd.2013.74.3.134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 05/23/2012] [Accepted: 07/25/2012] [Indexed: 01/05/2023] Open
Abstract
Splenosis is defined as an autotransplantation of the splenic tissue after splenic rupture or splenectomy, and occurs most frequently in the peritoneal cavity. Splenosis is usually asymptomatic and is found incidentally. We report a case of combined intrathoracic and intraperitoneal splenosis in a 54-year-old male who worked as a miner for 10 years in his twenties, and was a current smoker. He was referred to our hospital for further evaluation of an incidental left diaphragmatic mass. Positron emission tomography-computed tomography and bronchoscopy were performed to evaluate the possibility of malignancy. There was no evidence of malignancy, but the spleen was not visualized. Reviewing his medical history revealed previous splenectomy, following a dynamite explosion injury. Therefore, splenosis was suspected and technetium-99m-labeled heat-damaged red blood cell scan confirmed the diagnosis. Radionuclide imaging is a useful diagnostic tool for splenosis, which could avoid unnecessary invasive procedures.
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Affiliation(s)
- Chansoo Moon
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Seoul, Korea
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19
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Khan AM, Manzoor K, Malik Z, Avsar Y, Yasim A, Shim C. Thoracic splenosis: know it--avoid unnecessary investigations, interventions, and thoracotomy. Gen Thorac Cardiovasc Surg 2011; 59:245-53. [PMID: 21484550 DOI: 10.1007/s11748-010-0706-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Accepted: 09/01/2010] [Indexed: 11/28/2022]
Abstract
Thoracic splenosis (TS) is autoimplantation of ectopic splenic tissue in the thoracic cavity that occurs following splenic injury. Most cases of TS are asymptomatic and are diagnosed during the course of an evaluation of incidentally discovered pulmonary lesions. Some cases may be difficult to diagnose, especially if features suggesting TS are not recognized. This may lead to an extensive workup and unnecessary invasive diagnostic procedures including thoracotomy. Multiple, asymptomatic, left-sided pleura-based lesions associated with a history of thoracoabdominal injury and splenectomy are the key points that should alert one to suspect TS, which can then simply be confirmed with a (99m)Tcsulfa colloid radionuclide scan. If TS is suspected and radionuclide imaging studies are performed, further extensive investigations, such as bronchoscopy, biopsy, thoracoscopy, and thoracotomy, are not required as the radionuclide scan is definitive for diagnosis. Most cases are asymptomatic, so further treatment is rarely required; all cases are managed conservatively. We emphasize that all physicians, radiologists, pathologists, and interventionalists should recognize key features that suggest the diagnosis of TS, order appropriate imaging when it is suspected, and avoid unnecessary invasive diagnostic procedures including thoracotomy.
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Affiliation(s)
- Amir Maqbul Khan
- Department of Pulmonary Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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