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Introduction:
Thoracic splenosis is a rare condition resulting from simultaneous rupture of the spleen and left hemidiaphragm, with autotransplantation of splenic tissue into the left hemithorax. We report a case of thoracic splenosis and present it in an historical context.
Case Report:
A 61-year-old woman was admitted to the hospital with back pain and referred evaluation of pulmonary nodules suspicious for malignancy. Her medical history was significant for a gunshot wound to the left upper quadrant of the abdomen and left thoraks. 48 years previously, requiring removal of spleen, repair of diaphragmatic rupture and left hemithorax hemostasis. Apical and basal pleural based nodules were identified in CXR and further clarified by computed tomography (CT) scan of the chest. Video assisted thoracoscopic surgery (VATS) biopsy of the lesions was performed and histological examination confirmed the lesion as splenic tissue .
Discussion:
The crucial issue with asymptomatic splenosis is to establish a diagnosis of splenosis while excluding malignant lesions in an efficient and minimally invasive fashion . Shaw and Shafi in 1937, reported the first case of TS in a 20-year old Egyptian man . Since then there have been numerous cases of abdominal splenosis but only a total of 62 reports (66 patients) of thoraicic splenosis reported in the English language literature. Thoracic splenosis can be suspected if the following factors are present: a history of trauma, splenic injury, and diaphragmatic injury. Patients are usually presented asymptomatic. Diagnosis is made by chest X-rays, CT scans, radionuclide studies, but frequently during the operation. If the diagnosis can be confirmed surgical intervention must be avoided. If surgery is indicated eventually, a minimally invasive surgical procedure should be preferred.
Conclusion
Thoracic splenosis remains a rare diagnosis but can be expected based on a history of splenic trauma with diaphragmatic injury and single or multiple left sided pleural nodules.