대한흉부영상의학회 Weekly Chest Cases

Case No : 783 Date 2012-10-29

Courtesy of Kyoung Won Doo, Hwan-Seok Yong, Eun-Young Kang. / Korea University Guro Hospital.
Age/Sex 42 / M
Chief Complaintabnormal findings on chest radiograph

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Figure 1.

Diagnosis With Brief Discussion

Diagnosis: Thoracic splenosis
Radiologic Findings: Chest CT demonstrated multiple variable sized well-defined ovoid shaped homogeneously enhancing masses along the pleura and diaphragm at left hemithorax. Thoracoscopic guided biopsy of left pleural nodule was performed. Specimen consists of lymphoid aggregation, consistent with splenic tissue.
Brief Review: Splenosis involves the autotransplantation of splenic tissue to abnormal locations after splenic injury. Splenic tissue implants are found most commonly in the mesentery, peritoneum, and omentum. Thoracic splenosis occurs less frequently than abdominal splenosis and may be found in 18% of patients after splenic rupture.
Intrathoracic splenosis is usually asymptomatic. Thoracic splenosis typically presents as single or multiple subpleural masses at computed tomographic scan. Pleural-based implants may occur on the parietal or visceral pleura, and they have attenuation similar to that of the normal spleen. Differential diagnosis includes pleural metastases (most commonly arising from the lung, breast, or melanoma), lymphoma, localized fibrous tumor of the pleura, malignant mesothelioma, invasive thymoma and sclerosing hemangioma.
When necessary, the preoperative diagnosis of splenosis may be established with technetium 99m (99mTc) sulfur colloid scintigraphy of the liver and spleen. Use of 99mTc sulfur colloid, 111 In-labeled platelets, or 99mTc heat-damaged erythrocytes results in specific uptake of the radioactive isotope in splenic tissue.
Intrathoracic splenosis should be considered in any patient with pleural-based nodules in the left hemithorax with a history of thoracoabdominal trauma and splenectomy or splenic injury. A preoperative diagnosis of thoracic splenosis can prevent unnecessary biopsy or thoracotomy.
References: 1. Huang AH, Shaffer K. Case 93: thoracic splenosis. Radiology. 2006;239:293-6.
2. Kim K, Choi HJ, Kim YM, Kwon WJ, Lee WC, Suh JH. Thoracic splenosis: a case report and the importance of clinical history. J Korean Med Sci. 2010;25:299-303.
Keywords: pleura, trauma,

No. of Applicants : 98

▶ Correct Answer : 64/98, 65.3%

- Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Dong-A University Hospital , Korea (South) Ji-yeon Han
- chp st martin , France Mariotte benoit
- HUEC , Brazil Diogo Pinheiro
- Sunchun university hospital, Bucheon , Korea (South) So Young Bae
- Emory University Department of Radiology , United States Travis Henry
- McGill university , Canada Badriya Al-qassabi
- University of British Columbia , Canada Amr Ajlan
- Asan medical center , Korea (South) Sang Young Oh
- 遺 , Korea (South) Jiye Sim
- GATA Haydarpasa Training Hospital , Turkey Kemal Kara
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Goa Medical College , India Paresh Desai
- Scans world , India Philson Mukkada
- Dong-A university hospital , Korea (South) Woo-jeong Kim
- All India Institute of medical sciences , India Justin Moses
- James Paget Hospital , U.K , United Kingdom nabil mahmood
- Asan medical center , Korea (South) Cherry Kim
- Ewha Womans University Mokdong Hospital , Korea (South) So Won Lee
- SRMC , India prabhu radhan
- Centre Hospitalier Lyon Sud , France matthieu ROUSSET
- SCGH , Australia Yuranga Weerakkody
- Kizawa Memorial Hospital , Japan Yo Kaneko
- Kohka Public Hospital , Japan Akitoshi Inoue
- University of Pennsylvania , United States Lisa Jones
- Myongji hospital , Korea (South) Ji Ye Lee
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- CNUH , Korea (South) Kim Soo Hyun
- Chonnam national univ. hospital , Korea (South) Choi Seul-Gi
- Saint Malo , France jean-baptiste Noel
- SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
- Hopital du Sacre Coeur , Canada Andrea Ojanguren
- McGill University Health Center , Canada Alexandre Semionov
- Radnet Teleradiology Istanbul , Turkey Armagan Sarac
- Afyon Kocatepe University Department of Radiology Medical Imaging , Turkey huseyin ucar
- Myongi , Korea (South) soon Moon
- CMC , Korea (South) Kyongmin Beck
- Asan Medical Center , Korea (South) Ji Eun Kim
- Asan medical center , Korea (South) Hyun Joo Lee
- Asan Medical Center , Korea (South) Hye Jeon Hwang
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Homs National Hospital , Syria Rami Abou Zalaf
- Hanyang University Hospital , Korea (South) Jina Park
- China Medical University , Chia-Yi Christian Hospital ,Taiwan, R.O.C. , Taiwan Jun Jun Yeh
- Assam Medical college , India samudra borah
- SMC , Korea (South) Yi Kyung Kim
- IRSA La Rochelle France , France Denis Chabassiere
- Ishikawa Matto Central Hospital , Japan Manabu Akimoto
- Hanyang University Hospital , Korea (South) Yo Won Choi
- Montreal , Canada Drago Le King
- Asan Medical Center , Korea (South) Sang Min Lee
- Radnet Teleradiology , Turkey Murat Ulusoy
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- CAC Rennes , France nicolas gautier
- blue hosptial , Turkey sukru sahin
- CHRU Lille , France Paul Lebert
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- Fortis hospital , Mohali , India Shaleen Rana
- Chonnam National University Hospital , Korea (South) Jung hyun Kim
- Health sinces university of mongolia , Mongolia bakhytnur khuanysh
- Medicheck health care , Korea (South) Chae Lim

▶ Correct Answer as Differential Diagnosis : 2/98, 2.0%

- UWO , Canada S Lee
- Onomichi Municipal Hospital , Japan Yoshihisa Masaoka

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 783 Date 2012-10-29

Discussion

No. of Applicants : 98