Case Author(s): Edward Pinkus,M.D., Keith Fischer,M.D.,Farrokh Dehdashti,M.D., and Jerold Wallis, M.D. , . Rating: #D2, #Q4
Diagnosis: Splenosis.
Brief history:
Status post spleenectomy eight years ago (gunshot), now presents with newly diagnosed esophageal cancer and pleural based soft tissue masses.
Images:
whole body coronal fdg-pet images
View main image(pt) in a separate image viewer
View second image(pt).
selected views of fdg-pet whole body scan
View third image(ct).
CT with contrast of the chest
View fourth image(ct).
CT of the chest
Full history/Diagnosis is available below
Diagnosis: Splenosis.
Full history:
29 year old man,status post gunshot wound in the past, at which time he had a splenectomy . The patient presents with newly dagnosed low esophageal neoplasm and soft tissue lesions along the pleura in the left hemithorax suspicious for splenosis. Patient is paraplegic and has a port-a-catheter in place.
Radiopharmaceutical:
15.0 mCi F-18 FDG, and
2.2 mCi heat damaged in-vitro labeled autologous red blood cells.
Findings:
PET findings: Intense uptake in the mid to lower esophagus, consistent with malignancy.
Right paratracheal intense uptake is consistent with FDG in the tip of the clot of the port-a-cath.
CT of the chest: Clot in the IVC, at the tip of port-a-cath. Also seen are pleural based soft tissue lesions in left chest; note that these did not demonstrate significant FDG uptake.
Discussion:
The finding of pleural based lesions on CT without corresponding FDG uptake was suspicious for splenosis, in this patient with history of gun-shot wound. Heat-damaged red cells labeled with Tc-99m can be used to localize splenic tissue.
Followup:
To confirm the nature of the pleural based lesions, the patient underwent imaging with heat damaged red cells.
These images demonstrate splenosis of the left pleural space. The large region of faint uptake represents the liver, with intense uptake in the splenic tissue within the thorax.
View followup image(si).
Images of the abdomen 30 min after administratiom of the Tc-99m heat damaged red blood cells.
ACR Codes and Keywords:
References and General Discussion of Red Cell Survival (Anatomic field:Gasterointestinal System, Category:Effect of Trauma)
Search for similar cases.
Edit this case
Add comments about this case
Return to the Teaching File home page.
Case number: rb001
Copyright by Wash U MO
