대한흉부영상의학회 Weekly Chest Cases

Case No : 539 Date 2008-02-25

Courtesy of Seong Hoon Park, MD, Ki Nam Kim, MD, Ki-Nam Lee, MD. / Dong-A University Hospital, Korea.
Age/Sex 57 / M
Chief ComplaintCoughing for 1 month

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Diagnosis With Brief Discussion

Diagnosis: Thoracic splenosis
Radiologic Findings: Chest radiograph showed multiple healed rib fractures in left 6,7,8,9th level and left lower pleural thickening.
Chest CT demonstrated multiple homogeneously enhancing subpleural nodules, measuring up to 3 cm in
diameter, at the posterolateral base of the left hemithorax and the left major fissure.
Scintigraphy with Tc-99m Phytate showed focal increased uptake in left subpleural area.
Wedge reseection of LUL subpleural nodule was performed.
Specimen consists of lymphoid aggregations and a network of venous sinuses, consistent with splenic tissue.
Brief Review: Splenosis is the autotransplantation of splenic tissue to ectopic sites, as the result of penetrating or blunt
traumatic injury to the spleen. It most frequently involves the peritoneal cavity. In rare cases, presence of splenic
tissue within the pulmonary parenchyma has been reported when injury to the lung had occurred along with injury
to the spleen. In most instances, the diagnosis was made only after surgery.

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 an attenuation similar to that of the normal spleen. Differential considerations include pleural
metastases (most commonly arising from the lungs, breast, or melanoma), lymphoma, localized fibrous tumor of
the pleura, malignant mesothelioma, and invasive thymoma. Scintigraphy with indium In 111-labeled platelets,
99mTc SC, and 99mTc heat-damaged RBCs all are capable of demonstrating splenosis because they are
sequestered by splenic tissue. Howell-Jolly bodies represent nuclear material within the RBC, and are normally
retained by the spleen. 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.
Please refer to
References: 1. Thoracic Splenosis. Radiology 2006;239:293-296
2. Intrathoracic Splenosis. Ann Thorac Surg 2005;80:1934-6
3. Intrathoracic Splenosis : Superiority of Techinetium Tc 99m Heat-Damaged RBC Imaging Chest 2001;120;2097-2098
Keywords: Pleura, Lung, Trauma,

No. of Applicants : 56

▶ Correct Answer : 16/56, 28.6%

- ACCA, Poitiers, France Jerome Hannequin
- Hospital Sao Paulo, Brazil Israel Missrie
- Trakya University Edirne, Turkey Armagan Sarac
- China Medical University , Taiwan Jun jun Yeh
- CHU de Poitiers , France Paul ARDILOUZE
- Trakya Univercity School of Medicine , Turkey armagan sarac
- Gimpo Woori Hospital , Korea (South) Son Youl Lee
- Soonchunghyang university Bucheon hospital , Korea (South) Minhee Lee
- JungAng Radiology Clinic , Korea (South) CHANG LEE
- All India Institute of medical sciences , India Justin Moses
- UCLA , United States Fereidoun Abtin
- Polyclinique de SAVOIE , France, Metropolitan GAY-DEPASSIER Philippe
- MEDINOVA DIAGNOSTICS , India Harsha NS
- Depatment of Radiology, Yongsan Hospital, College of Medicine, Chgung-Ang University , Korea (South) Jae Seung Seo
- CHR ANNECY , France Olivier SEGALL
- Hanyang University Hospital , Korea (South) Yo Won Choi

▶ Correct Answer as Differential Diagnosis : 2/56, 3.6%

- IRSA , France jean BIGOT
- Homs National Hospital , Syria Rami Abou zalaf

▶ Semi-Correct Answer : 38/56, 67.9%

- KAUMS, Kashan, Iran Ebrahim Razi
- Shiga University of Medical, Japan Norihisa Nitta
- Osaka University, Japan Osamu Honda
- Regional Imaging Riverina, Australia Rashid Hashmi
- Seoul National University Hospital, Korea Sang Min Lee
- National Taiwan University Hospital, Taipei, Taiwan Chin Chung Shu
- Pims Loni, Maharashtra, India Sushant Bhadane
- Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
- Apollo Hospitals, Bangalore, India Sridhar. A.S
- Seoul national university hospital, Korea I Jin Joo
- Almana General Hospital, Saudi Arabia Jamal Hussein Abazid
- E-Da Hospital, Taiwan Yu-Feng Wei
- Dept. of radiology, Assam medicalcollege, Assam, India Karunakaran M
- Az Osp. Santa Maria, Terni, Italy Angelo Carloni
- CHU Grenoble France Fabrice Bing
- All India Institute of Medical Sciences , India Ashish Gupta
- Ondokuz Mayis University , Turkey Cetin Celenk
- Mackay Memorial Hospital, Taipei, Taiwan , Taiwan Chia-Fu Tsai
- Dongguk University International Hospital , Korea (South) Hee Seok Choi
- vital imaging centre , India ganesh agrawal
- Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
- Vitalife Clinics , Pune , India. , India rahul deshmukh
- radiology department , France gilles GENIN
- Mokpo HanKook Hospital , Korea (South) Sang Uk Park
- PITTWATER RADIOLOGY , Australia Julie Arora
- oswal cancer hospital,ludhiana , India lovkesh mittal
- Department of Radiology , Korea (South) Pyeong Guk Kang
- Jackson Memorial Hospital , United States Naganathan Mani
- Soonchunhyang University Cheonan Hospital , Korea (South) Park Hyun
- CHRU lille , France manuel toledano
- UVA , United States Rachita Khot
- Saga University , Japan Ryoko Egashira
- PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
- EKH-Berlin , Germany Michael Weber
- Hospital Sotiria , Greece Vasilios Tzilas
- Yonsei University college of medicine Severance hospital, Seoul, Korea , Korea (South) Hua Sun Kim
- MAX HEALTH CARE , India vickrant malhotra
- Toronto General Hospital, University of Toronto , Canada Yon Mi Sung

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 539 Date 2008-02-25

Discussion

No. of Applicants : 56