Thoracic splenosis: History is the key

Abstract

Splenosis is an acquired ectopic autotransplantation of splenic tissue; that occurs after traumatic splenic rupture and splenectomy [1]. Splenosis is a rare but benign disease, and the diagnosis can be challenging as the multiple incidentally found nodules could mimic malignancy [2].Abdominopelvic Splenosis is thought to occur in as many as 65% of cases of splenic rupture [1]. However, Thoracic Splenosis is rare and usually involve the left parietal and visceral pleura [1,2]. Intraparenchymal lesions are less common but have been reported in cases of parenchymal and diaphragm laceration [1,2].Taking a thorough history is of utmost importance, as these patients usually present more than two decades after the splenic traumatic rupture. The use of commonly available nuclear studies will further confirm the diagnosis [3]. This will help to avoid unnecessary procedures, like biopsies; and prevent the potential complications. We present a case of Thoracic Splenosis that highlights the importance of taking a detailed history; and the importance of using nuclear studies for the diagnosis. Further adding to its uniqueness, this case showed with multiple intraparenchymal nodules which is a less common presentation of Splenosis.

Spleen in the thorax: A case report on traumatic diaphragmatic rupture

“…Spleen in the thorax has been reported in a case with Poland Syndrome involving left hemithorax [ 18 ]. A rare benign entity, thoracic splenosis occurs with a prior history of traumatic spleen rupture or with the history of splenectomy, this was not present in our case but can present as such in the future for this patient [ 19 ].…”

Symptomatic Intrathoracic Splenosis More than Forty Years After a Gunshot Injury

“…The most common explanation for splenosis is the spillage of splenic pulp into adjacent body cavities during traumatic rupture; along with a diaphragmatic rupture in cases of intrathoracic splenosis. Other explanations include hematogenous seeding, hypoxic induction of tissue growth, and congenital ectopic cell rests, ​​​​​​all of which are supported by the incidence of splenosis without concomitant diaphragmatic rupture [5,13,14].…”

Utilización de hematíes marcados con ^99mTc y desnaturalizados por calor en el diagnóstico gammagráfico de un caso infrecuente de esplenosis intratorácica

“…También se han utilizado leucocitos marcados con 99m Tc o plaquetas marcadas con 111 In. Pero los hematíes marcados con 99m Tc y desnaturalizados por calor ( 99m Tc-HDC) constituyen la técnica de referencia al presentar una mayor sensibilidad y especificidad (2)(3)(4)(5) . Su uso requiere la extracción de una muestra de sangre del paciente, el marcaje de las células rojas con 99m Tc y su desnaturalización por calor antes de su reinyección.…”