Combined Intrathoracic and Intraperitoneal Splenosis after Splenic Injury: Case Report and Review of the Literature
A 54-year-old male was referred to Severance Hospital for evaluation of incidental left diaphragmatic mass and right upper lobe consolidation on chest X-ray (). Pleural core needle biopsy done at the previous hospital showed acute and chronic inflammation with mixed inflammatory cell infiltration. He had no unusual medical conditions and worked as a miner for 10 years in his twenties. He had smoked half a pack of cigarettes per day for 40 years, and quit 3 months before.\nOn admission, he did not have any symptoms, physical examination was unremarkable, and laboratory tests were normal. Chest computed tomography (CT) revealed multiple lobulated masses and nodules along diaphragm, lower mediastinum, and costal pleura of left side. Moreover, multiple calcified granulomas with fibrosis were seen in the right upper lobe (). Considering the previous history of smoking and mining, malignant tumors such as mesothelioma or pleural metastasis had to be differentiated and we proceeded 18F-fluoro-2-deoxygluocose (18F-FDG) positron emission tomography-CT (PET-CT). FDG PET-CT showed previously detected multiple masses and nodules along left diaphragm and multiple small nodular lesions in the left perigastric area and omentum with faint FDG uptake. Acute and chronic inflammation with fibrosis and calcified granulomas were observed in right upper lobe with intense FDG uptake (). However, his spleen was not visualized on PET-CT and review of chest CT. From further medical history obtained, he had undergone splenectomy following splenic trauma from a dynamite explosion while working in the mine 30 years ago.\nWith this history, splenosis was suspected, and a technetium (Tc)-99m-labeled heat-damaged red blood cell (RBC) scan was performed. The RBC scan showed multiple foci of increased uptake in the left thorax and left upper quadrant of the abdomen, consistent with thoracic and abdominal splenosis (). This patient has been followed up at our outpatient clinic without further invasive evaluation or treatment for the splenosis. He was diagnosed with pulmonary tuberculosis based on positive sputum culture and is on anti-tuberculous medications.