Parenchymal Thoracic Splenosis: History and Nuclear Imaging Without Invasive Procedures May Provide Diagnosis

Abstract

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 99mTc heat-damaged erythrocyte study rather than computed tomography-guided biopsy or invasive surgery.KeywordsThoracic splenosis; Computed tomography; Ppancreatectomy; Splenectomy; Gastrorrhaphy

Pitfalls in oncology: a unique case of thoracic splenosis mimicking malignancy in a patient with resected breast cancer

“…Therefore, the diagnosis can be very difficult or misleading, particularly in presence of a patient with a personal history of cancer, and it can be reached after unnecessary invasive approaches. In fact, more than half of all cases have been diagnosed after invasive procedures, such as fine-needle aspiration (FNA) or fine-needle aspiration biopsy (FNAB), and video-assisted thoracoscopic surgery (VATS) or thoracotomy (8). Notably, these invasive approaches are not free of complications, such as bleeding.…”

“…The mainstay in the diagnosis of TS remains scintigraphy by using specific radionuclides, such as 99mTc sulfur colloid, indium 111-labeled platelet, 99mTc heatdamaged erythrocyte, or the 99mTc white blood cell (8).…”

Esplenose Torácica: um achado acidental mais de 20 anos após traumatismo toraco-abdominal

“…1,7 Os achados analíticos são inespecíficos, no entanto a presença de tecido esplénico autotransplantado pode ser sugerido por achados laboratoriais como anisocitose, poiquilocitose e a presença de corpos de Howell-Jolly (remanescentes nucleares) no esfregaço de sangue periférico. 1,7,8 O diagnóstico de esplenose requer um elevado índice de suspeição, sendo de fulcral importância a descoberta na anamnese de um histórico de rutura traumática do baço e/ou esplenectomia. 1,7 Esta entidade nosológica deve ser considerada no diagnóstico diferencial de patologia maligna secundária da pleura.…”

“…1,2,3 A Esplenose é uma condição benigna, extremamente rara, definida como a autotransplantação heterotópica de fragmentos de tecido esplénico, que ocorre habitualmente após laceração do baço com rotura da sua cápsula, devido a trauma ou após manipulação cirúrgica do órgão, tal como acontece na esplenectomia eletiva. 1,4,5,6,7,8,9 Os implantes de tecido esplénico, em forma de nódulos encapsulados, surgem mais frequentemente nas cavidades abdominal e pélvica, mas também podem ser extra-peritoneais. Existem relatos de casos de baços ectópicos localizados na cavidade pleural, parênquima pulmonar, pericárdio, tecido subcutâneo e cérebro.…”

“…Existem relatos de casos de baços ectópicos localizados na cavidade pleural, parênquima pulmonar, pericárdio, tecido subcutâneo e cérebro. 4,6,7,8 A Esplenose torácica é geralmente assintomática, sendo frequentemente um achado acidental, diagnosticada na sequência de exames imagiológicos de rotina. No entanto, a sua presença pode originar sintomas como dor e hemorragia mimetizando diversas patologias tais como neoplasias, incluindo o carcinoma broncogénico, linfoma, mesotelioma e timoma, metástases pleurais e asbestose.…”