Skip to main content

A case of intrahepatic splenosis: usefulness of splenic scintigraphy

Abstract

We report a 39-year-old male with intrahepatic and peritoneal splenosis, focusing on scintigraphic findings. Dynamic computed tomography (CT) showed a 3 cm lesion in the posterior right lobe of the liver with strong early phase enhancement that was homogenous to the liver enhancement in the late phase. A few enhancing nodules were also found in the peritoneum. On gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced dynamic magnetic resonance imaging (MRI), the hepatic lesion had abnormal signal on diffusion-weighted imaging, high signal intensity on T2-weighted imaging, and early enhancement with accumulation decline in the hepatocyte phase. CT and MRI findings of the hepatic lesion were similar to normal spleen. To rule out hepatic neuroendocrine tumor and peritoneal metastases, somatostatin receptor scintigraphy was performed and showed tracer accumulation in the hepatic lesion, which we considered a false positive. Splenic scintigraphy using Tc-99 m-phytate showed accumulation in the hepatic lesion and peritoneal nodules. Given the patient’s history of splenic injury and splenectomy 15 years prior and the current imaging findings, we highly suspected splenosis. After surgical treatment, the patient was pathologically diagnosed with intrahepatic and peritoneal splenosis. Splenosis should be suspected when a patient has a history of trauma or abdominal surgery. Since intrahepatic splenosis presents as a nonspecific hypervascular lesion on CT and MRI, splenic scintigraphy should be considered in these patients. In addition Tc-99 m-phytate scintigraphy is easy to use and cost-effective.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Buchbinder JH, Lipkoff CJ (1939) Splenosis: Multiple peritoneal splenic implants following abdominal injury: A report of a case and review of the literature. Surgery 6:927-934

    Google Scholar 

  2. De Vuysere S, Van Steenbergen W, Aerts R et al (2000) Intrahepatic splenosis: imaging features. Abdom Imaging 25:187-189

    Article  Google Scholar 

  3. Wu C1, Zhang B, Chen L et al (2015) Solitary perihepatic splenosis mimicking liver lesion: A case report and literature review. Medicine 94:e586.

    Article  Google Scholar 

  4. Lake ST, Johnson PT, Kawamoto S et al (2012) CT of splenosis: patterns and pitfalls. Am J Roentgenol 199:686-693

    Article  Google Scholar 

  5. Xuan Z, Chen J, Song P et al (2018) Management of intrahepatic splenosis:a case report and review of the literature. World J Surg Oncol 16:119.

    Article  Google Scholar 

  6. Fleming CR, Dickson ER, Harrison EG Jr. (1976) Splenosis: autotransplantation of splenic tissue. Am J Med 61:414-419

    CAS  Article  Google Scholar 

  7. Van Hecke S, Van Den Wyngaert T, De Beeck BO et al (2018) Usefulness of splenic scintigraphy in differentiating splenosis and malignancy on gallium 68 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid-NaI3-octreotide. World J Nucl Med 17:56–58.

    Article  Google Scholar 

  8. Luo X, Zeng J, Wang Y (2019) Hepatic splenosis: Rare yet important - A case report and literature review. J Int Med 47:1793-1801

    Google Scholar 

  9. Gruen DR, Gollub MJ. (1997) Intrahepatic splenosis mimicking hepatic adenoma. Am J Roentgenol 168:725-726

    CAS  Article  Google Scholar 

  10. Kang KC, Cho GS, Chung GA et al (2011) Intrahepatic splenosis mimicking liver metastasis in a patient with gastric cancer. J Gastric Cancer 11:64-68

    CAS  Article  Google Scholar 

  11. Leong CW, Menon T, Rao S (2013) Post-traumatic intrahepatic splenosis mimicking a neuroendocrine tumor. BMJ Case Rep 6

  12. Suriano S, Ceriani L, Gertsch P et al (2011) Accessory spleen mimicking a pancreatic neuroendocrine tumor. Tumori 97:39e-41e.

    Article  Google Scholar 

  13. Li T, Yang XY, Tang ZY (2015) Intrahepatic and intraperitoneal splenosis mimicking hepatocellular carcinoma with abdominal wall metastasis in a patient with hepatitis C cirrhotic liver. Surgery 157:954-956

    Article  Google Scholar 

  14. Nakajima T, Fujiwara A, Yamaguchi M et al (2008) Intrahepatic splenosis with severe iron deposition presenting with atypical magnetic resonance images. Intern Med. 47:743-6.

    Article  Google Scholar 

  15. Kurtaran A, Pangerl T, Scheuba C et al (1998) Visualization of intestinal splenosis by somatostatin receptor scintigraphy. Am J Gastroenterol 93:1375-1376

    CAS  Article  Google Scholar 

Download references

Acknowledgements

We appreciate Dr. Jun Hashimoto and Dr. Jun Koizumi for their valuable advice. We would like to thank Enago for English editing a draft of this manuscript.

Funding

This study received no specific Grant from any funding agency.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shuichi Kawada.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the patient included in this case report.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kawada, S., Ichikawa, T., Ueda, H. et al. A case of intrahepatic splenosis: usefulness of splenic scintigraphy. Abdom Radiol 45, 2274–2278 (2020). https://doi.org/10.1007/s00261-020-02451-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-020-02451-4

Keywords

  • Splenosis
  • Liver
  • Tomography
  • X-ray computed
  • Magnetic resonance imaging