Case Author(s): Gregg D. Schubach, MD and Jerold W. Wallis, MD , 10/13/95 . Rating: #D2, #Q5
48-year old Vietnam veteran
who suffered a shrapnel injury in 1969 requiring
thoracoabdominal incision; now with nodules on chest
Anterior and posterior whole body images 30 minutes following the administration of Tc-99m heat-damaged red blood cells i.v.
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PA chest radiograph
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Lateral chest radiograph
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Non-contrast CT scan of the chest and upper abdomen.
Full history/Diagnosis is available below
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
Tc-99m labeled heat-
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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