Intrathoracic splenosis - lesson learned: a case report

Our plain-English summary of Intrathoracic splenosis - lesson learned: a case report, by L. Tulinský, P. Ihnát, M. Mitták, et al (Journal of Cardiothoracic Surgery, 2016).

The study

• Authors: L. Tulinský, P. Ihnát, M. Mitták, P. Guňková, P. Zonča
• Journal: Journal of Cardiothoracic Surgery
• Published: 2016;11(1):72
• Type of article: Case report
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Intrathoracic splenosis presents an extremely rare thoracic lesion occurring after a simultaneous rupture of the spleen and diaphragm as a consequence of heterotopic autotransplantation and implantation of splenic tissue. Intrathoracic splenosis is usually an asymptomatic, incidental finding, which should be ideally managed without surgical intervention.

Case Presentation: We present a case of 68-year old woman with intrathoracic splenosis. Patient presented with a 2-month history of a dry cough unresponsive to administered antibiotics and antimycotics. Computed tomography (CT) of the chest revealed two homogeneous pleural nodules (diameters of 2 and 4 cm) in the left upper lung field. Two consequent CT-assisted transthoracic core-cut biopsies were performed. Histopathology examination of both biopsy specimens was inconclusive (haemorrhagic and non-specific tissue). After that, patient was referred to the department of thoracic surgery with a suspicion of malignant mesothelioma or metastatic lesions. Thoracoscopic revision of the left pleural cavity was performed and the presence of pleural nodules was confirmed. Bloody looking nodules were resected (standard thoracoscopic resection). Postoperative recovery was uneventful. The histopathology examination of the specimen showed normal splenic tissue. Only with the histopathology report in hand, a detailed medical history was taken. It revealed a gunshot injury requiring splenectomy (without known diaphragm or lung injury) 44 years ago (one of the longest time periods in the literature).

Conclusions: We would like to point out that following the recommendations regarding splenosis may be very difficult in daily routine practice. The simple question regarding abdominal trauma in a patient's history can lead the clinician to the diagnosis of splenosis, which can be unequivocally established via scintigraphy. The importance of thorough medical history taking, therefore, cannot be underestimated.

In plain English

This case report described a 68-year-old woman whose chest nodules were first suspected to be malignant mesothelioma or metastatic cancer but proved to be splenic tissue (intrathoracic splenosis). She had a 2-month dry cough that did not respond to antibiotics and antimycotic (antifungal) drugs. A CT scan showed two pleural nodules, with diameters of 2 and 4 cm, in the left upper lung field. Two CT-guided needle biopsies were inconclusive. Surgeons removed the nodules by thoracoscopy, and examination of the removed tissue showed normal splenic tissue. Only afterwards did a detailed medical history reveal a gunshot injury requiring removal of the spleen 44 years earlier. The cough subsided after several weeks, and there were no overwhelming infections or sepsis in the 3 years after surgery. The authors stated that the true cause of the cough was questionable, because sputum had also shown Burkholderia cepacia complex, which was treated with antibiotics. The authors concluded that asking about past abdominal trauma can lead to the diagnosis, which scintigraphy can confirm, and that unnecessary surgery could then be avoided. The report does not discuss asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 68-year-old woman with a 2-month dry cough that did not respond to antibiotics and antimycotics, referred to the authors' department of thoracic surgery
• Exposure: No asbestos exposure is reported. The relevant history was a gunshot injury requiring removal of the spleen (splenectomy), with no known injury to the diaphragm or lung, 44 years earlier.
• Main results:
  • CT of the chest showed two homogeneous pleural nodules, with diameters of 2 and 4 cm, in the left upper lung field.
  • Both CT-assisted core-cut biopsies were inconclusive, showing haemorrhagic and non-specific tissue. The patient was then referred to thoracic surgery with suspected malignant mesothelioma or metastatic lesions.
  • After thoracoscopic resection of the nodules, histopathology showed normal splenic tissue.
  • After the histopathology result, a more detailed physical examination found a small gunshot scar in the left upper quadrant of the abdomen.
  • Sputum examination before surgery showed Burkholderia cepacia complex.
  • At follow-up the dry cough subsided after several weeks. There were no overwhelming infections or sepsis in the 3 years after surgery.
• The authors' conclusion: The authors concluded that asking about past abdominal trauma can lead the clinician to a diagnosis of splenosis, which can be established by scintigraphy. In their view, had splenosis been suspected in this patient, scintigraphy would have confirmed it and unnecessary surgery would have been avoided.
• Limitations the authors state:
  • The authors stated that the real cause of the patient's dry cough is questionable. It may have been mechanical irritation from the splenosis, or it may have resolved because of antibiotic treatment aimed at Burkholderia cepacia. Sputum was not re-examined after surgery.

Topics

Medical terms in this study, explained in our Lexicon: Intrathoracic, Diaphragm, Histopathology, Biopsy, Thoracic Surgery, Mesothelioma, Pleural Cavity.

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