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

Malik UF, Martin MR, Patel R, Mahmoud A - J Clin Med Res (2010)

Bottom Line: Splenosis is a rare finding of ectopic splenic tissue found within the thoracic cavity, abdomen or peritoneal cavity.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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of General Internal Medicine, Stanford University Medical Center, Stanford, California, USA.

ABSTRACT

Unlabelled: 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.

No MeSH data available.


Related in: MedlinePlus

CT-guided biopsy of the mass which subsequently ruled out malignancy.
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Figure 2: CT-guided biopsy of the mass which subsequently ruled out malignancy.

Mentions: A 45-year-old Caucasian male who was hospitalized for pneumonia two months prior had a follow-up chest x-ray that revealed a stellate-shaped opacity in the right lower lobe. The patient subsequently had a computed tomography (CT) scan of the chest two months after the chest x-ray that revealed no abnormalities in the right lung. However, there was a nodule in the left lower lobe that measured 3.4 cm and was located directly above and possibly contiguous with the left diaphragm. The patient denied cough, hemoptysis or weight loss. The past medical history of this patient included hypertension and hepatitis C. Surgical history included a distal pancreatectomy, splenectomy, gastrorrhaphy, and chest tube placement status post gunshot wound to the thoracoabdominal region 13 years prior (1994). The patient denied smoking, alcohol or substance abuse but was a former methamphetamine user many years ago. He has been unemployed for many years. He had no known allergies and his only medications were thiazide diuretic and an angiotensin converting enzyme inhibitor for hypertension. After incidentally discovering the 3.4 cm mass adjacent to the left hemidiaphragm (Fig. 1), the next step was a CT-guided biopsy (Fig. 2) to rule out possible malignancy. The biopsy was essentially non-diagnostic and negative for fungi or tuberculosis. The next procedure was a left video assisted thoracoscopic surgery (VATS), which was further converted to a thoracotomy with excision of left pleural mass (Fig. 3). The gross specimen appeared as brown-tan homogenous tissue fragment. Microscopically, wedge excision of the left lower lobe nodule showed lymphoid follicles with areas reminiscent of normal splenic architecture: red pulp and white pulp with surrounding areas of fibrosis. Based on the pathology of the excision and on the patient’s past history of thoracoabodominal trauma resulting in a splenectomy, the diagnosis of thoracic splenosis was made. Overall, the patient tolerated procedure well.


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

Malik UF, Martin MR, Patel R, Mahmoud A - J Clin Med Res (2010)

CT-guided biopsy of the mass which subsequently ruled out malignancy.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104650&req=5

Figure 2: CT-guided biopsy of the mass which subsequently ruled out malignancy.
Mentions: A 45-year-old Caucasian male who was hospitalized for pneumonia two months prior had a follow-up chest x-ray that revealed a stellate-shaped opacity in the right lower lobe. The patient subsequently had a computed tomography (CT) scan of the chest two months after the chest x-ray that revealed no abnormalities in the right lung. However, there was a nodule in the left lower lobe that measured 3.4 cm and was located directly above and possibly contiguous with the left diaphragm. The patient denied cough, hemoptysis or weight loss. The past medical history of this patient included hypertension and hepatitis C. Surgical history included a distal pancreatectomy, splenectomy, gastrorrhaphy, and chest tube placement status post gunshot wound to the thoracoabdominal region 13 years prior (1994). The patient denied smoking, alcohol or substance abuse but was a former methamphetamine user many years ago. He has been unemployed for many years. He had no known allergies and his only medications were thiazide diuretic and an angiotensin converting enzyme inhibitor for hypertension. After incidentally discovering the 3.4 cm mass adjacent to the left hemidiaphragm (Fig. 1), the next step was a CT-guided biopsy (Fig. 2) to rule out possible malignancy. The biopsy was essentially non-diagnostic and negative for fungi or tuberculosis. The next procedure was a left video assisted thoracoscopic surgery (VATS), which was further converted to a thoracotomy with excision of left pleural mass (Fig. 3). The gross specimen appeared as brown-tan homogenous tissue fragment. Microscopically, wedge excision of the left lower lobe nodule showed lymphoid follicles with areas reminiscent of normal splenic architecture: red pulp and white pulp with surrounding areas of fibrosis. Based on the pathology of the excision and on the patient’s past history of thoracoabodominal trauma resulting in a splenectomy, the diagnosis of thoracic splenosis was made. Overall, the patient tolerated procedure well.

Bottom Line: Splenosis is a rare finding of ectopic splenic tissue found within the thoracic cavity, abdomen or peritoneal cavity.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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of General Internal Medicine, Stanford University Medical Center, Stanford, California, USA.

ABSTRACT

Unlabelled: 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.

No MeSH data available.


Related in: MedlinePlus