Case Author(s): Gregg D. Schubach, MD and Jerold W. Wallis, MD , 10/13/95 . Rating: #D2, #Q5

Diagnosis: Splenosis

Brief history:

48-year old Vietnam veteran who suffered a shrapnel injury in 1969 requiring thoracoabdominal incision; now with nodules on chest radiograph.


Anterior and posterior whole body images 30 minutes following the administration of Tc-99m heat-damaged red blood cells i.v.

View main image(si) in a separate image viewer

View second image(xr). PA chest radiograph

View third image(xr). Lateral chest radiograph

View fourth image(ct). Non-contrast CT scan of the chest and upper abdomen.

Full history/Diagnosis is available below

Diagnosis: Splenosis

Full history:

48-year old Vietnam veteran who suffered a shrapnel injury in 1969 requiring a thoracoabdominal incision and splenectomy. Chest radiographs demonstrate left-sided thoracic nodules. Thoracic CT scan demonstrates four soft tissue density masses within the left pleural space. A small soft tissue mass was identified lateral to the left kidney. Intrathoracic splenosis is the suspected clinical diagnosis.


Tc-99m labeled heat- damaged erythrocytes


Five areas of radiopharmaceutical uptake are identified. There is a single focus of activity just lateral to the left kidney. Additionally, there are foci of uptake in the region of the left hemidiaphragm, the left cardiac border, posterior mediastinum, and along the left lateral chest wall. These correspond to the lesions identified on the CT scan. These scintigraphic findings confirm the diagnosis of thoracic splenosis.


Thoracic splenosis is a rare condition that occurs when there is simultaneous splenic and diaphragmatic rupture. Splenic implants proliferate within the thorax, more commonly on the left. The resulting pleural nodules are often multiple and typically measure 3 cm in diameter or less; however, 7 cm lesions have been reported. This splenic tissue, which may also implant on the pericardium and peritoneum, is functional and need not be removed in the absence of symptoms. The nodules may implant on the parietal or visceral pleura and are usually discovered incidentally on chest radiographs months to years after the inciting trauma. Should the spleen have been removed at the time of trauma (as in this patient), the absence of Howell-Jolly bodies in a peripheral smear would suggest persisting ectopic splenic activity. The diagnosis may be confirmed with scintigraphy using Tc-99m sulfur colloid, Tc-99m labeled heat-damaged erythrocytes, or In-111 platelets, all of which will be sequestered by ectopic splenic tissue.

References: 1) Armstrong et al. Imaging of Diseases of the chest. 2) Juhl et al. Essentials of Radiologic Imaging, 5th edition.

Major teaching point(s):

Intrathoracic splenic tissue may be misinterpreted as a neoplastic disorder, e.g., bronchogenic carcinoma or pulmonary metastases. The combination of left-sided pleural nodules in a patient with a history of splenic and diaphragmatic injury should raise the suspicion of thoracic splenosis.

ACR Codes and Keywords:

References and General Discussion of Spleen Imaging (Anatomic field:Gasterointestinal System, Category:Effect of Trauma)

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Case number: si001

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