Abstract Introduction Splenosis is a rare, benign condition characterized by heterotopic autotransplantation of splenic tissue into unexpected sites such as the pelvis or abdomen (65%), thorax (18%) or subcutaneous tissue (less than 20 reported cases), most commonly following traumatic splenic rupture with diaphragmatic injury or splenectomy. Because these nodules can mimic malignant pulmonary lesions on imaging, patients are often subjected to unnecessary invasive diagnostic procedures. We report a case of left-sided intrathoracic and intra-abdominal splenosis discovered incidentally decades after splenectomy, highlighting the importance of clinical suspicion and non-invasive nuclear imaging for diagnosis. Case Presentation A 36-year-old male with a history of asthma presented for follow-up of chronic cough and shortness of breath for the past year. At this visit his cough and wheezing had improved, but he reported intermittent bilateral chest pain, more pronounced on the right. He denied hemoptysis, weight loss, or constitutional symptoms. Physical examination was unremarkable. Review of prior medical records revealed multiple pleural masses within the inferior aspect of the left hemithorax on CT imaging from 14 years earlier, highly suggestive of intrathoracic splenosis. Upon further questioning, the patient recalled a motor-vehicle collision 18 years earlier resulting in splenectomy. Repeat contrast-enhanced CT Chest was obtained, again demonstrating left pleural nodules isodense to splenic tissue in the splenectomy bed, most consistent with splenosis. The largest lesion measured approximately 10cm.After discussion with radiology, a technetium-99m sulfur colloid (Tc-99m SC) scan confirmed regenerative splenules in the left lower chest and left upper abdominal quadrant. No biopsy or surgical intervention was pursued. The patient remained asymptomatic and was managed conservatively with surveillance. No biopsy or surgery was performed. Discussion Intrathoracic splenosis is a rare, often incidental radiographic finding that can resemble neoplastic disease. Diagnosis may be confidently established noninvasively using radionuclide scintigraphy or magnetic resonance imaging (MRI), avoiding unnecessary surgical risk in patients without concerning features. Ferumoxide-enhanced MRI is an alternative non-invasive diagnostic technique. Although ectopic splenic tissue may confer partial immunologic benefit, surgical excision is not recommended unless symptoms or diagnostic uncertainty exist. This case underscores the importance of maintaining a high index of suspicion in patients with a history of splenic trauma or splenectomy who present with unexplained intrathoracic nodules, to ensure accurate diagnosis, appropriate management, and avoidance of unnecessary surgical risk. This abstract is funded by: None
Qasim et al. (Fri,) studied this question.