Thoracic splenosis is a rare heterotopic autotransplantation of the spleen into the thorax that occurs after trauma or surgery involving the spleen. It is most commonly found incidentally on imaging in the left hemithorax. To the best of our knowledge, only six symptomatic cases of thoracic splenosis have been described in the literature so far. We present a case of thoracic splenosis in a male with a remote history of a gunshot injury during childhood, who presented with chest pain and shortness of breath.
Ectopic spleen or splenosis is a condition that arises from the heterotopic autotransplantation of the spleen. The spleen will implant itself in another location, usually the serosal surface, deriving blood supply locally and progressing into differentiated nodules of splenic tissue . This occurs most commonly after splenic rupture following trauma or surgeries. The incidence of splenosis ranges from 26% to 65% following trauma and up to 20% following elective splenectomy [2,3]. The most common sites of splenosis are within the abdominal and pelvic cavity, where it involves both the layers of the peritoneum. It is usually asymptomatic but can rarely mimic a peritoneal malignancy .
The thoracic cavity is a relatively rare location of splenosis most commonly found incidentally on imaging in the left pleural cavity . It makes up about 18% of the total cases and is usually accompanied by a history of simultaneous rupture of the spleen and the diaphragm [6,7]. It commonly presents as variable-sized nodular lesions in the left thoracic cavity in an asymptomatic patient. Intrathoracic splenosis is usually managed expectantly unless the patient is symptomatic. However, in asymptomatic cases, a definitive diagnosis is most often not reached due to the rarity of this condition, and unnecessary surgical resection is done . We present a case of symptomatic intrathoracic splenosis occurring in a 51-year-old male who presented with chest pain and shortness of breath, 41 years after a gunshot injury wound. We stress the ability of symptomatic intrathoracic splenosis to mimic other medical conditions and to be a diagnostic dilemma for clinicians.
A 51-year-old man presented to the emergency department with complaints of chest pain and shortness of breath for two weeks. Chest pain was intermittent, on the left side of the chest with no radiation, and aggravated by deep breathing. Shortness of breath was exertional
Blood workup showed leukocytosis with white blood cell (WBC) count of 11700 cells per cubic millimeter, hemoglobin 14.3 gm/
His chest X-ray showed a peripheral opacity in the left upper
The cases of splenosis reported in the literature have shown a steady rise
Most cases of intrathoracic splenosis occur concurrently with intraabdominal splenosis and rarely occur alone .
The most common explanation for splenosis is the spillage of splenic pulp into adjacent body cavities during traumatic rupture; along with a diaphragmatic rupture in cases of intrathoracic splenosis. Other explanations include hematogenous seeding, hypoxic induction of tissue growth, and congenital ectopic cell rests, all of which
The most common means of diagnosing splenosis remains to be a percutaneous biopsy under CT guidance. However, a significant risk of bleeding exists, especially when biopsying splenic tissue. In addition, it can frequently be inconclusive as in our patient, or inaccessible or inaccurate, often being misdiagnosed as lymphoma [5,12,15]. Surgical resection through a thoracotomy or video-assisted thoracic surgery (VATS) has
Asymptomatic intrathoracic splenosis
The mean duration between the occurrence of trauma and detection of thoracic splenosis is about 20 years. A gap of 44 years is the longest gap reported in the literature followed by 41 years in our patient . This makes the diagnosis of intrathoracic splenosis very challenging. The index of suspicion should be high when either a relevant
Thoracic splenosis is a rare anomaly that is commonly discovered incidentally on imaging. Physicians should have a high index of suspicion when there is a history of trauma or splenic surgery along with suggestive findings on imaging, in which case scintigraphy may be done for confirmation, instead of invasive biopsy or surgery. A thorough history and physical exam remains the key, especially since the detection of the nodule might occur decades after the injury has occurred. Surgical options should be considered in cases of symptomatic intrathoracic splenosis or when malignancy cannot be ruled out completely.
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Symptomatic Intrathoracic Splenosis More than Forty Years After a Gunshot Injury
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Cite this article as:
Khan A, Khan S, Pillai S (October 24, 2019) Symptomatic Intrathoracic Splenosis More than Forty Years After a Gunshot Injury. Cureus 11(10): e5985. doi:10.7759/cureus.5985
Received by Cureus: October 19, 2019
Peer review began: October 20, 2019
Peer review concluded: October 21, 2019
Published: October 24, 2019
© Copyright 2019
Khan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.