|Topic:||28. Pleural Disease / Adult / Case Report / Clinical Problems (CP)|
|Authors:||M.M. Howsare, U. Gauhar; Louisville, KY/US|
Introduction: Thoracic splenosis is a rare condition in which splenic tissue is auto-transplanted to the thoracic cavity after simultaneous trauma to the spleen and left hemi-diaphragm. It is usually noted incidentally with an average duration of 20-25 years after inciting trauma.
Case: A 57 year old male with a history of COPD and cigarette smoking was referred to interventional pulmonary service at Robley Rex VAMC (Louisville, KY) after a screening low-dose CT of the chest revealed multiple left lung pulmonary nodules, the largest of which measured 1.5 x 2.6 cm. The patient’s past medical history included a gunshot wound to the left chest 27 years ago. The patient underwent CT guided biopsy of the nodule which showed benign hemato-lymphoid tissue. The patient’s case was presented to the Lung Nodule Evaluation Team which consists of a radiologist, interventional pulmonologist, oncologist and thoracic surgeon. The decision was made to perform a technetium-99Tc sulfur colloid scintigraphy which showed uptake in the left pleural based pulmonary nodules consistent with splenic tissue.
Discussion: Ranging up to 3cm in diameter, splenic nodules may be mistaken for nonspecific pleural masses.1 Thoracic splenosis, which is estimated to occur in 18% of patients with a history of thoraco-abdominal trauma should be considered in the differential diagnosis of patients presenting with pleural based pulmonary nodules. Splenosis occurs after seeding of splenic tissue onto the pleura at the time of the inciting incident, most cases are found incidentally with a small amount of patients presenting with cough or pleuritic chest pain. 2 This tissue can then grow and mature into splenic tissue, and is may provide some protection from encapsulated organisms. Management is expectant and surgery is only indicated if the diagnosis is unclear and there is still concern for malignancy.
In the initial National Lung Screening Trial the rate of positive screenings was 24.2%. With the increased number of pulmonary nodules diagnosed on CT imaging a multi-disciplinary team can be helpful in evaluation and follow up pulmonary nodules, and can in certain cases help avoid un-necessary invasive procedures. In the Tc99m sulfur colloid scan the sulfur colloid is isolated in the reticulo-endothelial system identifying all splenic tissue.
1. Mancano, D. Zanetti, G. et al. Thoracic Splenosis After Thoracoabdominal Trauma Presenting as Pleural Nodules Lung (2012) 190:699-701
2. Khan, A.M., Manzoor, K., Malik, Z. et al. Gen Thorac Cardiovasc Surg (2011) 59: 245. doi:10.1007/s11748-010-0706-8