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Thoracic splenosis: know it—avoid unnecessary investigations, interventions, and thoracotomy

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An Erratum to this article was published on 18 August 2011

Abstract

Thoracic splenosis (TS) is autoimplantation of ectopic splenic tissue in the thoracic cavity that occurs following splenic injury. Most cases of TS are asymptomatic and are diagnosed during the course of an evaluation of incidentally discovered pulmonary lesions. Some cases may be difficult to diagnose, especially if features suggesting TS are not recognized. This may lead to an extensive workup and unnecessary invasive diagnostic procedures including thoracotomy. Multiple, asymptomatic, left-sided pleura-based lesions associated with a history of thoracoabdominal injury and splenectomy are the key points that should alert one to suspect TS, which can then simply be confirmed with a 99mTcsulfa colloid radionuclide scan. If TS is suspected and radionuclide imaging studies are performed, further extensive investigations, such as bronchoscopy, biopsy, thoracoscopy, and thoracotomy, are not required as the radionuclide scan is definitive for diagnosis. Most cases are asymptomatic, so further treatment is rarely required; all cases are managed conservatively. We emphasize that all physicians, radiologists, pathologists, and interventionalists should recognize key features that suggest the diagnosis of TS, order appropriate imaging when it is suspected, and avoid unnecessary invasive diagnostic procedures including thoracotomy.

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References

  1. Buschbinder JH, Liphoff GJ. Splenosis: multiple peritoneal splenic implants following abdominal injury—a report of a case and review of the literature. Surgery 1939;6:927–934.

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  3. Sahin E, Karadayi S, Nadir A, Kaptanoglu M. Thoracic splenosis accompanied by diaphragmatic hernia. Can J Surg 2009;52:E293–E294.

    PubMed  Google Scholar 

  4. Jayasekera P, Kumar P, Gill S, Hamdan K. Thoracic splenosis masquerading as bronchial cancer. BMJ Case Rep 2009 doi:10.1136/bcr.05.2009.1844.

  5. Wojcik J, Grodzki T, Kozlowska I, Urbanski S, Kubisa B. Usefulness of the scintigraphic assessment of the thoracic splenosis: a case report. Pneumonol Alergol Pol 2008;76:456–459.

    PubMed  Google Scholar 

  6. Limonard G, Joosten J, Berk Y, De Kievit I, Zomer S, Keemers M. A 37-year-old woman with an incidentally found mediastinal nodule. Chest 2008;133:1508–1511.

    Article  PubMed  Google Scholar 

  7. Khan AM, Manzoor K, Gordon D, Berman A. Thoracic splenosis: a diagnosis by history and imaging. Respirology 2008;13:481–483.

    Article  PubMed  Google Scholar 

  8. McKeen S, Dharsono F. Thoracic splenosis: diagnosis of a case based on history and computerized tomography findings. Australas Radiol 2007;51(suppl):B246–B249.

    Article  PubMed  Google Scholar 

  9. Puyalto P, Sánchez JJ, Olazábal A. Intrathoracic splenosis: a case report. Radiologia 2007;49:436–439.

    Article  PubMed  CAS  Google Scholar 

  10. Backhus LM, Bremner RM. Images in clinical medicine: intrathoracic splenosis after remote trauma. N Engl J Med 2006;355:1811.

    Article  PubMed  CAS  Google Scholar 

  11. Gezer S, Gülhan SS, Altinok T, Agaçkiran Y, Tastepe AI. Rare cause of pleural nodularity: splenosis. J Natl Med Assoc 2006;98:1342–1344.

    PubMed  Google Scholar 

  12. Prosch H, Oschatz E, Pertusini E, Mostbeck G. Diagnosis of thoracic splenosis by ferumoxides-enhanced magnetic resonance imaging. J Thorac Imaging 2006;21:235–237.

    Article  PubMed  Google Scholar 

  13. Itinteang T, McGiven JR, Koleda CB, McCrystal GD. Thoracic splenosis: a treatment approach. Med J Aust 2006;184:416.

    PubMed  Google Scholar 

  14. Aktekin A, Gurleyik G, Arman A, Pekcan H, Saglam A. Intrathoracic splenosis secondary to previous penetrating thoracoabdominal trauma diagnosed during delayed diaphragmatic hernia repair. Ulus Travma Acil Cerrahi Derg 2006;12:68–70.

    PubMed  Google Scholar 

  15. Thourani VH, Sharma J, Duarte IG, Miller JI Jr. Intrathoracic splenosis. Ann Thorac Surg 2005;80:1934–1936.

    Article  PubMed  Google Scholar 

  16. Papakonstantinou C, Christoforidis E, Vasiliadis K, Kanellos I, Zarogoulidis K. Thoracic splenosis twenty-nine years after traumatic splenectomy mimicking intrathoracic neoplasm. Eur Surg Res 2005;37:76–78.

    Article  PubMed  CAS  Google Scholar 

  17. Rubio Garay M, Belda Sanchis J, Iglesias Sentis M, Gimferrer Garolera JM, Catalan Biel M, Callejas Perez MA. [Noninvasive diagnosis of posttraumatic thoracic splenosis.] Arch Bronconeumol 2004;40:139–140.

    PubMed  CAS  Google Scholar 

  18. Khosravi MR, Margulies DR, Alsabeh R, Nissen N, Phillips EH, Morgenstern L. Consider the diagnosis of splenosis for soft tissue masses long after any splenic injury. Am Surg 2004;70:967–970.

    PubMed  CAS  Google Scholar 

  19. Gopal K, Jones MT, Greaves SM. An unusual cause of chest pain. Chest 2004;125:1536–1538.

    Article  PubMed  Google Scholar 

  20. Bodrov IuD, Builov VM, Borisanov AV. [Intrathoracic and intraabdominal splenosis following 40 years after splenectomy.] Vestn Rentgenol Radiol 2003;(6):56–58.

    PubMed  Google Scholar 

  21. Yammine JN, Yatim A, Barbari A. Radionuclide imaging in thoracic splenosis and a review of the literature. Clin Nucl Med 2003;28:121–123.

    PubMed  Google Scholar 

  22. Wold PB, Farrell MA. Pleural nodularity in a patient with pyrexia of unknown origin. Chest 2002;122:718–720.

    Article  PubMed  Google Scholar 

  23. Miller JS, Nunez A, Espada R. Thoracic splenosis 25 years after gunshot wound to the abdomen. J Trauma 2001;50:149–150.

    Article  PubMed  CAS  Google Scholar 

  24. Hagman TF, Winer-Muram HT, Meyer CA, Jennings SG. Intrathoracic splenosis: superiority of technetium Tc 99m heat-damaged RBC imaging. Chest 2001;120:2097–2098.

    Article  PubMed  CAS  Google Scholar 

  25. Syed S, Zaharopoulos P. Thoracic splenosis diagnosed by fine-needle aspiration cytology: a case report. Diagn Cytopathol 2001;25:321–324.

    Article  PubMed  CAS  Google Scholar 

  26. Sarda R, Sproat I, Kurtycz DF, Hafez R. Pulmonary parenchymal splenosis. Diagn Cytopathol 2001;24:352–355.

    Article  PubMed  CAS  Google Scholar 

  27. Velitchkov NG, Kjossev KT, Losanoff JE, Kavardjikova VA. Subcutaneous splenosis: a clue to diagnosis of thoracic splenosis. J R Coll Surg Edinb 2000;45:66.

    PubMed  CAS  Google Scholar 

  28. Gayed IW, Elshazly SM. Intrathoracic splenosis: status after a motor vehicle accident. Clin Nucl Med 2000;25:1045–1046.

    Article  PubMed  CAS  Google Scholar 

  29. Renne G, Coci A, Biraghi T, Schmid C. Fine needle aspiration of thoracic splenosis: a case report. Acta Cytol 1999;43:492–494.

    Article  PubMed  CAS  Google Scholar 

  30. Fidvi SA, Kroop SA, Klein SA. Posttraumatic thoracic splenosis and chronic aortic pseudoaneurysm. J Thorac Imaging 1999;14:300–302.

    Article  PubMed  CAS  Google Scholar 

  31. Gaedcke G, Storz K, Braun S, Horny HP. [Thoracic splenosis with symptoms of coronary heart disease.] Dtsch Med Wochenschr 1999;124:958–961.

    Article  PubMed  CAS  Google Scholar 

  32. Naylor MF, Karstaedt N, Finck SJ, Burnett OL. Noninvasive methods of diagnosing thoracic splenosis. Ann Thorac Surg 1999;68:243–244.

    Article  PubMed  CAS  Google Scholar 

  33. Buchino JJ, Buchino JJ. Thoracic splenosis. South Med J 1998;91:1054–1056.

    Article  PubMed  CAS  Google Scholar 

  34. Katranci N, Parildar M, Goksel T, Savas R, Alper H. Quiz case of the month: posttraumatic intrathoracic splenosis. Eur Radiol 1998;8:151–152.

    Article  PubMed  CAS  Google Scholar 

  35. O’Connor JV, Brown CC, Thomas JK, Williams J, Wallsh E. Thoracic splenosis. Ann Thorac Surg 1998;66:552–553.

    Article  PubMed  Google Scholar 

  36. Tsunezuka Y, Sato H. Thoracic splenosis; from a thoracoscopic viewpoint. Eur J Cardiothorac Surg 1998;13:104–106.

    Article  PubMed  CAS  Google Scholar 

  37. Singh P, Munn NJ, Patel HK. Thoracic splenosis. N Engl J Med 1995;333:882.

    Article  PubMed  CAS  Google Scholar 

  38. Nucken HJ, Lorey M. Intrathoracic splenosis: a rare differential diagnosis of pleural space-occupying growth. Rofo 1995;163:538–539.

    PubMed  CAS  Google Scholar 

  39. Madjar S, Weissberg D. Thoracic splenosis. Thorax 1994;49:1020–1022.

    Article  PubMed  CAS  Google Scholar 

  40. Kwan AJ, Drum DE, Ahn CS, Tow DE. Intrathoracic splenosis mimicking metastatic lung cancer. Clin Nucl Med 1994;19:93–95.

    Article  PubMed  CAS  Google Scholar 

  41. Artinian MA, Gilliam JI. CT of intrathoracic splenosis in the presence of bronchogenic carcinoma. J Comput Assist Tomogr 1993;17:827–828.

    Article  PubMed  CAS  Google Scholar 

  42. Hietala EM, Hermunen H, Kostiainen S. Intrathoracic splenosis: report of a case simulating esophageal leiomyoma. Scand J Thorac Cardiovasc Surg 1993;27:61–63.

    PubMed  CAS  Google Scholar 

  43. Cordier JF, Gamondes JP, Marx P, Heinen I, Loire R. Thoracic splenosis presenting with hemoptysis. Chest 1992;102:626–627.

    Article  PubMed  CAS  Google Scholar 

  44. Hart CM, Clore FC, Hood CI. Intrathoracic splenosis. Chest 1990;97:1024.

    Article  PubMed  CAS  Google Scholar 

  45. Roucos S, Tabet G, Jebara VA, Ghossain MA, Biagini J, Saade B. Thoracic splenosis: case report and literature review. J Thorac Cardiovasc Surg 1990;99:361–363.

    PubMed  CAS  Google Scholar 

  46. Farres MT, Grabenwoger F, Dock W, Klepetko W. [Intrathoracic splenosis.] Radiologe 1989;29:527–530.

    PubMed  CAS  Google Scholar 

  47. Jebara VA, Madi S, Ghossain M, Roucos S, Tabet G, Yammine J, et al. [Thoracic splenosis: review of the literature apropos of a case.] Ann Chir 1989;43:178–180.

    PubMed  CAS  Google Scholar 

  48. Carlson BR, McQueen S, Kimbrell F, Humphreys S, Gentry HL, Esbenshade A. Thoracic splenosis: diagnosis of a case by fine needle aspiration cytology. Acta Cytol 1988;32:91–93.

    PubMed  CAS  Google Scholar 

  49. Schiff RG, Leonidas J, Shende A, Lanzkowski P. The noninvasive diagnosis of intrathoracic splenosis using technetium-99m heat-damaged red blood cells. Clin Nucl Med 1987;12:785–787.

    Article  PubMed  CAS  Google Scholar 

  50. Yousem SA. Thoracic splenosis. Ann Thorac Surg 1987;44:411–412.

    Article  PubMed  CAS  Google Scholar 

  51. Gaines JJ, Crosby JH, Vinayak Kamath M. Diagnosis of thoracic splenosis by tru-cut needle biopsy. Am Rev Respir Dis 1986;133:1199–1201.

    PubMed  CAS  Google Scholar 

  52. Moncada R, Williams V, Fareed J, Messmore H. Thoracic splenosis. AJR Am J Roentgenol 1985;144:705–706.

    PubMed  CAS  Google Scholar 

  53. Ashour M, Butchart EG, Breckenridge IM. Simultaneous intrathoracic and peritoneal splenosis with spontaneous regression of intrathoracic splenosis. J R Coll Surg Edinb 1985;30:261–263.

    PubMed  CAS  Google Scholar 

  54. Scales FE, Lee ME. Nonoperative diagnosis of intrathoracic splenosis. AJR Am J Roentgenol 1983;141:1273–1274.

    PubMed  CAS  Google Scholar 

  55. Brune J, Termet H, Maton JP, Loire R, Seauve JP. [Intrathoracic splenosis: apropos of a case.] Rev Fr Mal Respir 1980;8:195–200.

    PubMed  CAS  Google Scholar 

  56. Dillon ML Jr, Koster JK, Coy J, Utley JR, Vasquez M, Canlas M. Intrathoracic splenosis. South Med J 1977;70:112–114.

    Article  PubMed  Google Scholar 

  57. Trahan TJ. Intrathoracic splenosis: report of a case. J Am Osteopath Assoc 1975;74:835–838.

    PubMed  CAS  Google Scholar 

  58. Dalton ML Jr, Strange WH, Downs EA. Intrathoracic splenosis: case report and review of the literature. Am Rev Respir Dis 1971;103:827–830.

    PubMed  Google Scholar 

  59. Freise G, Atay Z. [Intrathoracic splenosis.] Med Klin 1970;65:406–409.

    PubMed  CAS  Google Scholar 

  60. Ahmadi A, Faber LP, Milloy F, Jensik RJ. Intrathoracic splenosis. J Thorac Cardiovasc Surg 1968;55:677–681.

    PubMed  CAS  Google Scholar 

  61. Ovnatanyan KT. Splenosis of the pericardium. Vestin Khir Grekov 1966;97:59–62.

    Google Scholar 

  62. Skinner EF, Hurteau VM. Autotransplantation of spleen into thorax. J Thorac Surg 1957;33:807–813.

    PubMed  CAS  Google Scholar 

  63. Shaw AF, Shafi IA. Traumatic autoplastic transplantation of the splenic tissue in man with observation on the late results of splenctomy in six cases. Pathol Bacteriol 1937;45:215–235

    Article  Google Scholar 

  64. Normand JP, Rioux M, Dumont M, Bouchard G, Letourneau L. Thoracic splenosis after blunt trauma: frequency and imaging finding. AJR Am J Roentgenol 1993;161:739–741

    PubMed  CAS  Google Scholar 

  65. Jariwalla AG, Al Masiri NK. Splenosis pleurae. Thorax 1979;34:123–124.

    Article  PubMed  CAS  Google Scholar 

  66. Albrecht H. Ein fall von sehr zahlreichen, uber das ganze peritoneum versprengten Nebenmilzen. Beitr Pathol Anat 1896;20:513–527.

    Google Scholar 

  67. Armas RR. Clinical studies with spleen specific radiolabeled agents. Semin Nucl Med 1985;15:260–262.

    Article  PubMed  CAS  Google Scholar 

  68. Bordlee RP, Eshaghi N, Oz O. Thoracic splenosis: MR demonstration. J Thorac Imaging 1995;10:146–149.

    Article  PubMed  CAS  Google Scholar 

  69. Pearson HA, Johnston D, Smith KA, Touloukian RJ. The born-again spleen: return of splenic function after splenectomy for trauma. N Engl J Med 1978;298:1389–1392.

    Article  PubMed  CAS  Google Scholar 

  70. Zoli G, Corazza GR, Wood S, Bartoli R, Gasbarrini G, Farthing MJ. Impaired splenic function and tuftsin deficiency in patients with intestinal failure on long term intravenous nutrition. Gut 1998;43:759–762.

    Article  PubMed  CAS  Google Scholar 

  71. Zoli G, Corazza GR, D’Amato G, Bartoli R, Baldoni F, Gasbarrini G. Splenic autotransplantation after splenectomy: tuftsin activity correlates with residual splenic function. Br J Surg 1994;81:716–718.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Amir Maqbul Khan.

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An erratum to this article can be found at http://dx.doi.org/10.1007/s11748-011-0845-6

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Khan, A.M., Manzoor, K., Malik, Z. et al. Thoracic splenosis: know it—avoid unnecessary investigations, interventions, and thoracotomy. Gen Thorac Cardiovasc Surg 59, 245–253 (2011). https://doi.org/10.1007/s11748-010-0706-8

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