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A Journal on Surgery

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Chirurgia 2006 August;19(4):289-91

language: Italian

Rare case of intrathoracic splenosis. occasional finding after 23 years from a thoracoabdominal trauma

Benvenuti M., Benetti D., Botticini G. B., Pariscenti G. L., Viotti F., Bovolato P.

Divisione di Chirurgia Toracica, Policlinico Satellite Spedali Civili - Brescia


Thoracic splenosis is an uncommon side effect resulting from seeding of splenic tissue in the pleural cavity following a simultaneous splenic and diaphragmatic injury (thoracoabdominal trauma or gunshot wound). 29 cases of thoracic splenosis have so far been reported and patients generally have an asymptomatic thoracic lesion discovered on a chest X-Ray. Few cases present multiple lesions, mild recurrent hemopthys or hemothorax. We describe and discuss a case of a 40 y.o man with a history of blunt thoracoabdominal trauma (22 years before), with hepatic and spleen rupture and with a left sided diaphragmatic lesion not referred by the patient. A paracardiac mass of 4 x 6 cm was discovered on routine chest radiography and a CT scan confirmed the incidental finding. At the videoassisted exploration of the left pleural cavity the tumor looked strictly connected with the lung and the phrenic nerve and artery (from where it received the rich vascularization). No diaphragmmatic lesions or herniae were found. A frozen section could exclude milignancy and the phrenic nerve was saved. A second lesion with same aspect was found at the level of the parietal pleura (even if it was not seen at splenic scintigraphy performed after surgery) and was spared. Even if there is no documented benefit to removal of the splenic nodules in asymptomatic patients, the escissional biopsy is generally necessary when FNA is not possible to be performed. This will consent a certain diagnosis.

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