29 Jul 2016Case Report
Thoracic splenosis Report of a case and review of the diagnostic workup
Walter Bugiantella 1Federico Crusco 2Nicola Avenia 3Rondelli Fabio 4
Affiliations
Article Info
1 General Surgery, “San Giovanni Battista Hospital”, AUSL Umbria 2, Foligno (Perugia), Italy; University of Perugia, PhD School in Biotechnologies, Perugia, Italy
2 Radiology, “San Giovanni Battista Hospital”, AUSL Umbria 2, Foligno (Perugia), Italy
3 General and Specialized Surgery, “Santa Maria” Hospital, Terni, Italy; University of Perugia, Department of Surgical and Biomedical Sciences, Perugia, Italy
4 General Surgery, “San Giovanni Battista Hospital”, AUSL Umbria 2, Foligno (Perugia), Italy; University of Perugia, Department of Surgical and Biomedical Sciences, Perugia, Italy
Ann. Ital. Chir., 2016, 5(July), 1-4;
Published: 29 Jul 2016
Copyright (c) 2016 Annali Italiani di Chirurgia
Abstract
Splenosis is the autoimplantation of splenic tissue to ectopic sites after spleen injury. Although splenosis most commonly occurs in the abdomen, it may occur in the thorax in case of diaphragm rupture. Thoracic splenosis (TS) is often asymptomatic and is diagnosed incidentally in the course of chest examination. We describe the case of a man, with a history of thoracoabdominal trauma, undergoing routine chest radiography with the evidence of radio-opaque images close to the inferior left curvature of the cardiac shadow, which resulted to be nodules of TS at the contrast enhanced CT scan. CT scan or MRI and an accurate anamnesis are usually sufficient to diagnose TS, otherwise scintigraphy with 99mTc is needed. Imaging-guided biopsy and thoracoscopy should be performed if scintigraphy is unavailable or results are inconclusive. It is not usually necessary to remove the TS because the splenic tissue is slow growing, non-invasive and benign. Rarely surgery may be required for symptomatic TS (hemoptysis, cough or pleuritic chest pain). TS may be difficult to diagnose, especially if features suggesting TS are not recognized and the anamnesis in not known. This may lead to an extensive work-up and unnecessary invasive diagnostic procedures (including biopsy, thoracoscopy, up to thoracotomy). In the workup of thoracic nodules TS should be considered in patients with a history of trauma and spleen injury.
Keywords
- Mediastinal nodules
- Spleen
- Thoracic splenosis
- Thoracoabdominal trauma