CTICasesPleural Splenosis Post-Traumatic Splenectomy
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Imaging findings
Portable chest x-ray reveals vague opacity in the left hemithorax and abnormal findings at the base. CT demonstrates innumerable pleural nodules of varying sizes, widely distributed along the entire left pleural space, including mediastinal, paraspinal, and diaphragmatic surfaces, with a particularly large nodule above the diaphragm. A scout view and history reveal prior splenectomy due to remote trauma. Splenic tissue deposits are also seen along the undersurface of the diaphragm. The diaphragm appears intact.
Key takeaways
Pleural splenosis is a rare but important diagnosis in patients with a history of splenic trauma and splenectomy. It results from auto-implantation of splenic tissue onto pleural surfaces, often following diaphragmatic injury, and can mimic pleural metastases. Imaging features include multiple, often discrete, nodules coating the pleura. While a biopsy or Tc-99m sulfur colloid scan can confirm the diagnosis, the classic history and imaging appearance are highly suggestive.
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