CASE 13067 Published on 25.10.2015
0

Abdominal splenosis mimicking ascending colon tumour

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Márcio Rodrigues, Ricardo Correia, André Carvalho, Teresa Fernandes, Bárbara Viamonte.

Centro Hospitalar de S. João
Hospital de S.João, Radiologia
Alameda Prof. Hernâni Monteiro
4200–319 Porto;
Email:marciorodri@sapo.pt
Connected authors
Patient

60 years, female

Categories
Area of Interest Abdomen ; Imaging Technique Ultrasound, Nuclear medicine conventional, CT, MR
Download as PDF Print Show related cases Notify admin
Clinical History
The patient had a 30 pack-year smoking history and splenectomy in trauma context. She presented to the attending physician for long-term fatigue and discomfort in the right hypochondrium. At physical examination there weren’t any significant changes. The analytical study only showed a microcytic hypochromic anaemia.
Imaging Findings
During the diagnostic approach an abdominal ultrasound was requested, which showed a polylobulated mass, stretching along the right parietocolic gutter (Fig. 1). CT was performed for aetiologic investigation and corroborated the ultrasonography findings, demonstrating a lesion contiguous with the ascending colon and projecting into the hepatorenal space (Fig. 2). There were also signs of splenectomy and nodes in the left subphrenic space, consisting with splenosis implants (Fig. 3). These findings were complemented by MRI, showing that the right mass was constituted by a set of confluent nodes (Fig. 4a and 4c), which had the same signal intensity and enhancement as the nodes located in the left subphrenic space (Fig. 4b and 4d). A scintigraphy using heat-damaged erythrocytes tagged with Technetium-99 was done for diagnosis confirmation, revealing uptake by the referred lesions (Fig. 5).
Discussion
Splenosis is defined as the presence of ectopic splenic tissue, resulting from the dissemination and implantation of spleen cells after splenic rupture. It is typically detected in the abdominal and pelvic cavity, involving the parietal and visceral peritoneum [1].
It rarely causes symptoms, so splenosis in most situations is an incidental finding in a survey carried out for another reason [2]. However, clinically this entity is relevant, because it can mimic a primary malignancy or metastatic disease, as in this case [3].
The diagnostic approach relies on the clinical background (trauma history and/or splenectomy) and proving the splenic origin of these lesions. Ultrasound has very limited utility in aetiology determination. The attenuation and enhancing pattern of splenosis nodules on CT are similar to the ones expected of the normal splenic tissue, therefore it can suggest the diagnosis [1]. The possibility of better tissue characterization on MRI compared with CT allows a higher specificity, but does not allow a decisive exclusion of other diagnoses [4]. Despite the increasing reports describing MRI with IV superparamagnetic iron oxide use for diagnosing abdominal splenosis [5, 6], the most established modality is scintigraphy using heat-damaged erythrocytes tagged with Technetium-99 [7].
Commonly, after splenosis is confirmed, no further workup is required, since surgical removal is not recommend in asymptomatic cases [8].
Splenosis should be included in the differential diagnosis in the approach of abdominopelvic nodules in all splenectomized patients. Once suspected, scintigraphy using heat-damaged erythrocytes tagged with Technetium-99 allows splenosis diagnosis, avoiding unnecessary invasive procedures.
Differential Diagnosis List
Abdominal splenosis mimicking ascending colon tumour.
Peritoneal carcinomatosis
Lymphoma
Adenopathy
Final Diagnosis
Abdominal splenosis mimicking ascending colon tumour.
Case information
URL: https://www.eurorad.org/case/13067
DOI: 10.1594/EURORAD/CASE.13067
ISSN: 1563-4086
License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Figure 1

Ultrasound

Ultrasound
Coronal sonogram of right parietocolic gutter demonstrating a polylobulated mass.
Figure 2

CT

CT
Axial (A), coronal (B) and sagittal (C) contrast-enhanced CT images (soft tissue window) showing a lesion (*) contiguous with the ascending colon and projecting into the hepatorenal space.
CT
Axial (A), coronal (B) and sagittal (C) contrast-enhanced CT images (soft tissue window) showing a lesion (*) contiguous with the ascending colon and projecting into the hepatorenal space.
CT
Axial (A), coronal (B) and sagittal (C) contrast-enhanced CT images (soft tissue window) showing a lesion (*) contiguous with the ascending colon and projecting into the hepatorenal space.
Figure 3

CT

CT
Axial contrast-enhanced CT image (soft tissue window) showing signs of splenectomy and nodes in the left subphrenic space (arrow), consisting with splenosis implants.
Figure 4

MR

MR
Sagittal T1-weighted image after contrast administration demonstrating a lobulated mass(*) on the right parietocolic gutter, constituted by a set of confluent nodes, with the same enhancement as the nodes in left subphrenic space (arrow).
MR
Axial T1-weighted image after contrast administration showing small subphrenic nodes (arrow), with similar enhancement as the lobulated mass(*) on the right parietocolic gutter.
MR
Sagittal T2-weighted image demonstrating a lobulated mass(*) on the right parietocolic gutter, constituted by a set of confluent nodes, with the same signal as the nodes located in left subphrenic space.
MR
Axial T2-weighted image showing subphrenic nodes (arrow), with similar signal intensity as the lobulated mass(*) on the right parietocolic gutter.
Figure 5

Scintigraphy

Scintigraphy
Scintigraphy using heat-damaged erythrocytes tagged with Technetium-99 reveals uptake by the mass (*) located on the right parietocolic gutter and by left upper quadrant nodules (arrow).