Case Author(s): Jeff Chesnut, D.O. and Keith Fischer, M.D. , 5/22/99 . Rating: #D1, #Q5

Diagnosis: Thoracic splenosis

Brief history:

53 year old male who sustained a gunshot wound to the abdomen many years earlier. Recent chest CT showed multiple pulmonary nodules.


A single transaxial slice from a CT scan through the lung bases is shown.

View main image(ct) in a separate image viewer

View second image(si). Images from heat-damaged red blood cell scintigram.

Full history/Diagnosis is available below

Diagnosis: Thoracic splenosis

Full history:

56 year old man who sustained a gunshot wound to his abdomen and underwent subsequent splenectomy many years ago. A CT scan of his chest demonstrated multiple soft tissue masses of various sizes in the left hemithorax.


Tc-99m labeled heat-damaged red blood cells


Multiple foci of tracer activity are seen in the left hemithorax on the heat-damaged red blood cell scintigram


One of the spleen's functions is to remove damaged red blood cells from the circulation. Advantage may be taken of this function when searching for ectopic splenic tissue by radiolabeling damaged red blood cells. The red blood cells are damaged by heating them to 50 degrees Centigrade for 30 minutes on a heat block.

Splenosis is a common sequela of splenic rupture. Splenic tissue can implant in the chest through a rent in the diaphragm or through an anatomic hiatus. Splenosis should enter the differential diagnosis when a soft tissue mass is found in the chest of a patient who has experienced severe abdominal trauma where there was a high liklihood of diaphragmatic trauma such as as in a motor vehical accident or gunshot wound.

Major teaching point(s):

1. Heat damaged red blood cells are highly effective in the detection of ectopic splenic tissue.

2. Splenosis should be considered when a soft-tissue mass is detected in the chest of a patient who has undergone remote severe abdominal trauma.

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: si004

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