Disorders of the Pleura |

Thoracic Splenosis Presenting as Acute Onset of Chest Pain FREE TO VIEW

Ashraf Elsawaf, MD; Jonathan Banibensu, MD; Heather Boakye, MD
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Jersey Shore University Medical Center, Neptune, NJ

Chest. 2014;145(3_MeetingAbstracts):258A. doi:10.1378/chest.1835722
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SESSION TITLE: Pleural Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Thoracic splenosis should be suspected in a patient with pulmonary nodules and history of splenic trauma.

CASE PRESENTATION: A 58 year old male with history significant for a motor vehicle accident at the age of 22 that resulted in a splenectomy, and bilateral pneumothoraces with chest tube placement presented to the ED with chest pain. Blood work demonstrated no significant laboratory abnormalities and troponins and EKG were negative. Computed tomography(CT) of the chest showed multiple pulmonary nodules scattered throughout the left lower lobe with an irregularity on the left adrenal gland. A PET scan was done given the multiple lesions, which was negative for malignancy. A CT guided biopsy was preformed, yielding tissue that was described as fibrovascular with lymphocytes and histocytes, along with a rich vascular network consistent with splenic tissue.

DISCUSSION: Splenosis is a rare and benign condition involving autotransplantation of splenic tissue to another compartment of the body. The most common site of transplantation is within the abdominal cavity.[1] The most common cause of thoracic splenosis is splenic trauma and left diaphragmatic laceration resulting in splenic tissue seeding into the thoracic cavity and developing into active splenic tissue. [1] There have been less than 40 reported cases, and in majority of cases these lesions were usually incidental findings with asymptomatic patients. [2,3] Because of its rarity, the diagnosis of thoracic splenosis usually involves extensive and invasive diagnostic procedures. [2] New non-invasive imaging utilizing T-99M heat damaged erythrocytes has been used to identify this ectopic tissue. [1] With regards to this case, the findings on the initial CT chest were suspicious of malignancy, therefore the more invasive approach was utilized. Because thoracic splenosis is a relatively benign process, the tissue does not need to be removed. It has been theorized that this ectopic tissue may be able to provide protection from encapsulated microorganisms despite being asplenic. [1]

CONCLUSIONS: In conclusion, thoracic splenosis is considered a benign process, and should be suspected in a patient with any CT or MRI demonstrating left pulmonary nodules with history of splenic trauma. Though new non invasive studies are available and are preferred to the invasive studies, the CT guided biopsy was done to rule out malignancy found on the initial chest CT.

Reference #1: Malik U (2010). Parenchymal Thoracic Splenosis: history and nuclear imaging without invasive procedures may provide diagnosis. J Clin Med Res. 2(4),180-184.

Reference #2: Mancano A (2012). Thoracic splenosis after thoracoabdominal trauma presenting as pleural nodules. Lung. 190(6), 699-701.

Reference #3: Sahin E. (2009). Thoracic splenosis accompanied by diaphragmatic hernia. Can J Surg. 52, E293-294

DISCLOSURE: The following authors have nothing to disclose: Ashraf Elsawaf, Jonathan Banibensu, Heather Boakye

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