Correspondence

Thoracic Splenosis

N Engl J Med 1995; 333:882September 28, 1995

Article

To the Editor:

We report a case of thoracic splenosis presenting as a pleural-based mass. Thoracic splenosis is a rare condition and should be considered in any patient with a left-sided thoracic mass and a distant history of severe thoracoabdominal injury.1

A 61-year-old man was admitted to the hospital with pleuritic pain over the left flank. He denied having cough, fever, or weight loss. His medical history included non-insulin-dependent diabetes, peptic ulcer disease, and splenectomy following a gunshot injury sustained during the Korean War in 1950. The physical examination was unremarkable, and chest radiography showed a healed fracture of the ninth rib on the left side, with an adjacent pleural-based mass. Computed tomography revealed a lobulated density of the pleura posteriorly (Figure 1Figure 1Computed Tomogram Showing a Left-Sided Pleural-Based Mass.). A fine-needle–aspiration biopsy was nondiagnostic. The patient underwent open biopsy, and the frozen section was consistent with splenic tissue (Figure 2Figure 2Photomicrograph Showing Splenic Tissue (Hematoxylin and Eosin, ×900).).

The patient had post-traumatic intrathoracic splenosis that presented as a pleural-based mass. Frequently, thoracic splenosis is pleural-based and found in the left hemithorax.2 The average reported interval between injury and diagnosis is 18.8 years, with a range of 9 to 32 years. Usually, the condition is asymptomatic and is discovered incidentally. Fewer than 20 cases have been reported in the English literature, despite the relatively frequent occurrence of trauma that can cause the condition.3 Radionuclide imaging is the only specific noninvasive method that is diagnostic; however, transthoracic fine-needle–aspiration biopsy may be helpful in diagnosing this benign condition. Abdominal pain and small-bowel obstruction resulting from abdominal splenosis have been reported, but no mortality or morbidity has been noted in relation to thoracic splenosis.4 Surgical treatment seems unnecessary when the condition is diagnosed preoperatively.

Thoracic splenosis should be considered in the differential diagnosis of left-sided chest masses in patients with a remote history of injury to the spleen and diaphragm.

Paramjit Singh, M.D.
Nancy J. Munn, M.D.
Hitendra K. Patel, M.D.
Marshall University School of Medicine, Huntington, WV 25701

4 References

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   Normand JP, Rioux M, Dumont M, Bouchard G, Letourneau L. Thoracic splenosis after blunt trauma: frequency and imaging findings. AJR Am J Roentgenol 1993;161:739-741
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   Durand DV, Joliot AY, Beaumont X, Levrat R. La splénose: revue de 117 observations. Gastroenterol Clin Biol 1981;5:758-764
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Citing Articles (8)

Citing Articles

1. 1

   Amir Maqbul Khan, Kamran Manzoor, Zeeshan Malik, Avsar Yasim, Chang Shim. (2011) Thoracic splenosis: know it—avoid unnecessary investigations, interventions, and thoracotomy. General Thoracic and Cardiovascular Surgery 59:4, 245-253
   CrossRef

2. 2

   Janusz Wójcik, Tomasz Grodzki. (2009) Thoracic Splenosis. Polish Journal of Surgery 81:11, 576-586
   CrossRef

3. 3

   Antwan Atia, Avinash Khiani, Vamsi Kanneganti, Charles Bower, Kamran Mahmood. (2008) Thoracic Splenosis. Clinical Pulmonary Medicine 15:6, 363-366
   CrossRef

4. 4

   Richard D. Fremont, Todd W. Rice. (2007) Splenosis: A Review. Southern Medical Journal 100:6, 589-593
   CrossRef

5. 5

   Salahuddin Syed, Paul Zaharopoulos. (2001) Thoracic splenosis diagnosed by fine-needle aspiration cytology: A case report. Diagnostic Cytopathology 25:5, 321-324
   CrossRef

6. 6

   Jeffrey S. Miller, Alberto Nunez, Rafael Espada. (2001) Thoracic Splenosis 25 Years after Gunshot Wound to the Abdomen. The Journal of Trauma: Injury, Infection, and Critical Care 50:1, 149-150
   CrossRef

7. 7

   William M. Sikov, Fred J. Schiffman, Michael Weaver, Jacob Dyckman, Richard Shulman, Philip Torgan. (2000) Splenosis presenting as occult gastrointestinal bleeding. American Journal of Hematology 65:1, 56-61
   CrossRef

8. 8

   JOHN A. VENTO, FANGYU PENG, RICHARD P. SPENCER, WILLIAM H. RAMSEY. (1999) Massive and Widely Distributed Splenosis. Clinical Nuclear Medicine 24:11, 845
   CrossRef